Hospital leaders today briefed congressional staff on the important role that Medicare’s support for graduate medical education (GME) plays in helping teaching hospitals train the next generation of health care providers and urged Congress to provide adequate funding to support these efforts.
The AHA-sponsored briefing included remarks by Rep. Joseph Crowley, D-N.Y., co-sponsor along with Rep. Charles Boustany, R-La., of the AHA-backed Resident Physician Shortage Reduction Act, H.R. 2124, which would increase by 15,000 over five years the number of available physician resident slots at teaching hospitals. Sens. Bill Nelson, D-Fla., Charles Schumer, D-N.Y., and Harry Reid, D-Nev., have introduced a similar measure, S. 1148.
Crowley called his bill a “modest start towards addressing the issue of a doctor shortage in our country.”
The 1997 Balanced Budget Act froze residency positions at the 1996 level, effectively limiting the supply of physicians. Panelists noted that the U.S. could face a shortage of as many as 130,000 physicians by 2025 – the result of the cap in the GME and Indirect Medical Education (IME) -funded residency programs.
Direct GME payments help fund the teaching costs of residency programs, such as salaries and benefits for residents and faculty, and administrative overhead expenses. IME payments are made to compensate for the higher costs associated with teaching hospitals, such as residents learning by doing, greater use of emerging technology and greater patient severity.
The AHA brought its message of protecting teaching hospital payments to Capitol Hill because the federal budget environment continues to put certain hospital programs at risk for spending cuts to reduce overall federal spending or to help pay for other legislation.
Some lawmakers have eyed GME for as much as $10 billion in cuts in the past. The president’s fiscal year (FY) 2016 budget blueprint called for reducing the IME adjustment by 10%, which would cut Medicare’s medical education payments by approximately $16.3 billion over 10 years. An Institute of Medicine committee last year recommended sweeping changes to Medicare’s GME financing structure that, over five years, would reduce payments to teaching hospitals by more than 35%.
At last week’s briefing, Jeffrey Berns, M.D., professor of medicine at the Hospital of the University of Pennsylvania; Joshua Goldstein, M.D., Northwestern University School of Medicine’s associate dean for medical education; and Andrew Thomas, M.D., chief medical officer at Ohio State University Wexner Medical Center, described how adequate GME and IME funding helps offset the cost of training future physicians and providing uncompensated care in disadvantaged communities.
“Any reduction or reallocation of GME or IME payments put our educational and patient care services at risk,” Berns told a packed meeting room, which included Rep. Joyce Beatty, D-Ohio.
“Additional cuts would jeopardize the ability of these institutions to maintain their commitment to training physicians and to helping their communities,” said Goldstein. He also urged Congress to avoid prescribing a physician training mix. “Mandating that a certain number of residency slots be diverted to specific specialties such as primary care is arbitrary and will not address physician shortages,” he said. “Congress must take meaningful action to improve patients’ access to care.”
Thomas described the work of the Accreditation Council for Graduate Medical Education (ACGME), which accredits 9,500 residency programs and sets educational standards to ensure consistent resident training curricula at each institution. The AHA is one of the ACGME’s five members. He said the council’s Clinical Learning Environment Review project is making strides in promoting patient safety, appropriate supervision of care, managing fatigue of residents and increasing the professionalism of physicians.
The AHA also released a report describing how teaching hospitals reach millions of people with lifesaving treatments and shape the future of medicine through research on new procedures, technology, treatments and medicine.
“Policymakers must ensure that payment or policy changes to GME do not upend a world-class graduate medical education system and a financing mechanism that has achieved the longstanding goal of supporting hospitals in the mission of training physicians,” the report concludes.