Grassley Questions Aspects of Graduate Medical Education

Graduate medical education is the subject of inquiry in a recent letter from Senate Finance Committee chairman Charles Grassley to Health and Human Services Secretary Alex Azar.

In his letter to Secretary Azar, Senator Grassley asks for information about how federal GME money is spent and how much is spent, how federal money factors into the broader financing of hospital residency programs, and how the federal government ensures that GME programs engage in best practices.

The letter also questions whether the indirect benefits of operating medical education programs are factored into how much the federal government spends on medical education, how the federal government allocates residency slots based on geographic considerations and physician shortages, and how the cost of educating medical residents is calculated, and how Medicare’s share of that cost is determined.

Many private safety-net hospitals host medical residents and have graduate medical education programs.

See a news release from Senator Grassley’s office that includes the letter to Secretary Azar.

HHS Needs to Do More on Physician Training

The federal government needs to do more to ensure an adequate supply of primary care physicians and their deployment in non-urban areas outside of the northeastern U.S.

Or so concludes a new study performed by the U.S. Governor Accountability Office.

According to the GAO report, efforts by the U.S. Department of Health and Human Services have resulted in progress toward meeting both of these goals – but not enough progress.  With the federal government spending $15 billion on graduate medical education, GAO believes, HHS can and should do more to ensure an adequate supply of primary care physicians throughout the country and not just in urban areas.

Many private safety-net hospitals are teaching hospitals.

Learn more about what the GAO found and what it recommended in its new report Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs, which can be found here.

NAUH Calls for More Medical Residency Slots

In December, the House Energy and Commerce Committee invited stakeholders to submit comments on Medicare’s graduate medical education (GME) program.

NAUH LogoThe National Association of Urban Hospitals has responded with a letter that addresses several of the issues the committee highlighted, most notably the adequacy of Medicare’s GME program in its current form.  NAUH urged the committee to increase the number of medical residency slots, frozen by law since 1997, to help address the country’s growing shortage of physicians.

Many private safety-net hospitals are teaching hospitals, giving them a major stake in this issue.

See NAUH’s comments on Medicare’s graduate medical education program here, on the NAUH web site.

IOM Releases Graduate Medical Education Report

‘’…there is an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME (graduate medical education).”

So says the Institute of Medicine (IOM) in its new report Graduate Medical Education That Meets the Nation’s Health Needs.

iom_logoThe IOM also calls for “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”

The report notes that government today, mostly through Medicare, plays the primary role in financing graduate medical education.  It observes that while there is a common perception that the nation faces a shortage of physicians, simply increasing the number of residency slots that Medicare supports – a limit set in 1997 – without addressing geographic and specialty distribution issues will not solve the problem.

In the report, the IOM proposes six goals for improving GME financing.

  1. Encourage production of a physician workforce better prepared to work in, help lead, and continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost.

  2. Encourage innovation in the structures, locations, and designs of GME programs to better achieve Goal 1.

  3. Provide transparency and accountability of GME programs, with respect to the stewardship of public funding and the achievement of GME goals.

  4. Clarify and strengthen public policy planning and oversight of GME with respect to the use of public funds and the achievement of goals for the investment of those funds.

  5. Ensure rational, efficient, and effective use of public funds for GME in order to maximize the value of this public investment.

  6. Mitigate unwanted and unintended negative effects of planned transitions in GME funding methods.

To fulfill these goals, the report offers three specific recommendations:

  1. Investing strategically: Maintain Medicare GME funding at its current level, but modernize payment methods to reward performance, ensure accountability, and incentivize innovation in the content and financing of GME. The current Medicare GME payment system should be phased out.

  2. Building an infrastructure to facilitate strategic investment: Establish a two-part governance infrastructure for federal GME financing. A GME Policy Council in the Office of the Secretary of the Department of Health and Human Services should oversee policy development and decision making. A GME Center within the Centers for Medicare & Medicaid Services should function as an operations center with the capacity to administer payment reforms and manage demonstrations of new payment models.

  3. Establishing a two-part Medicare GME fund: Allocate Medicare GME funds to two distinct subsidiary funds—a GME Operational Fund to finance ongoing residency training activities and a Transformation Fund to finance development of new programs, infrastructure, performance methods, payment demonstrations, and other priorities identified by the GME Policy Council.

Graduate medical education is an important issue for the many private safety-net hospitals that also are teaching hospitals.

To learn more about why the study was undertaken, what problems it sought to address, what the IOM learned, and what it proposed, follow this link to the IOM’s web site and the complete report as well as a report summary.