On Implementing a National Graduate Medical Education Trust Fund (1997) / Chapter Skim
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Pages 37-44
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From page 37... ...
The current IME formula could be applied to new teaching hospitals using values for the variables from the most recent experience, then divided into halves in the same way as is done for existing teaching hospital IME funding. Merged or acquired institutions with DME training programs could be paid the uniform per-resident amount or, if available, the existing per-resident amount, whichever is less.
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From page 38... ...
Importantly, a controlled academic hospital GME payment system will have been devised for Medicare that will allow consideration of academic health center issues separate from overall hospital or health care services sector issues. THE BALANCED BUDGET ACT OF 1995 Although the committee did not analyze every past legislative initiative, there was a sense that some effort should be devoted to reviewing the GME provisions of the Balanced Budget Act of 1995.
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From page 39... ...
Today's DME distribution draws heavily on historical hospital expenses from as long ago as 1984, which may not be relevant in today's rapidly changing health care system; maintains marked variations in funding among teaching hospitals (ProPAC, 1996a) ; and, at a time when excess residency positions are a source of concern, encourages increases rather than decreases in the number of residents (Dunn and Miller, 1996; Shine, 1995~.
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From page 40... ...
While a voucher system might increase site options such as loosely affiliated or unaffiliated ambulatory care centers, it could pose challenges to the present quality control mechanisms for residency training sites. It could add an unknown number of new sites that would have to be examined and accredited.
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From page 41... ...
Determining new payment amounts for multiple, changing sites would be an additional challenge as would be determining how to continue IME teaching hospital support for residents based in non-hospital programs. There would also be a potential for program disruption if residents could shift locations without appropriate coordination.
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From page 42... ...
If consortia serve to promote coordination, resource sharing, and efficiency among GME institutions, and if they are formed voluntarily to serve members' needs, then the committee thinks it makes sense to include them as recipients of GME funds. If there is a desire to promote national GME and work force policies to encourage primary care, ambulatory training, reductions in resident positions, physician distribution, and minority recruitment goals, and if consortia could be structured to make progress toward these objectives, then it might be reasonable to provide active encouragement by some incentive add-on along the lines of a 1% or so extra DME payment.
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From page 43... ...
. Other components should include at least some of the following: managed care organizations, ambulatory centers, community health centers, group practices, universities, or other institutions involved in graduate training.
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