Congress Approves New GME Slots

The year-end federal COVID-19 relief bill brought changes to Medicare’s graduate medical education program.

Among those changes:

  • 200 new GME slots over the next five years
  • additional federal funding for residency training – the first new funding for the program in nearly a quarter of a century
  • new opportunities for some hospitals to establish new (and higher) resident caps
  • new flexibilities for rural hospitals to participate in physician training programs

Learn more in the National Law Review article “COVID-19: Reimbursement Corner: Graduate Medical Education Gets Major Boost From Congressional Appropriations Bill.”

Medicare Money for Nurse Practitioner and Physician Assistant Training?

Should Medicare offer graduate medical education money for nurse practitioner and physician assistant training?

That was the subject of a recent inquiry by the U.S. Government Accountability Office.

In a new report inspired by concern over the current physician shortage and the belief that making greater use of nurse practitioners might help relieve that shortage, the GAO examined whether expanding Medicare’s graduate medical education (GME) program to include resources for the training of nurse practitioners and physician assistants was practical or possible.  As part of its research, the GAO reviewed current literature, interviewed officials of professional associations, and explored the financial and academic implications of a greater federal role in the training of nurse practitioners and physician assistants.

The possibility of GME funding for nurse practitioner and physician assistant training would be of great interest to the many private safety-net hospitals that have medical education programs.

Read about what the GAO learned in its new report Views on Expanding Medicare Graduate Medical Education Funding to Nurse Practitioners and Physician Assistants

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.