On Implementing a National Graduate Medical Education Trust Fund (1997) / Chapter Skim
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Principles
Principles
Pages 8-16
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From page 8... ...
If, as the record of statements and decisions from Medicare suggests (Appendix B) , GME and the teaching hospital subsidy are general, societal benefits, to a degree separate from providing medically necessary health care services, then Medicare could pay its share, but a decision could be taken not to do so.
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From page 9... ...
The GME mission enables the creation of, and its trainees help with the staffing levels needed by, these kinds of care, which are primarily found in teaching hospitals (Jones and Smith, 19971. Although a competitive health care environment is forcing needed reductions of redundancies in expensive services and overcapitalization through mergers and closures (Blumenthal et al., 1996; Gold, 1996)
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From page 10... ...
The Medicare GME payment system remains, however, a vital component that continues the government's historic obligation to provide for access to highquality care settings for Medicare beneficiaries, to contribute fairly to paying all of the costs of the hospital system and not just the marginal costs of the least expensive providers, and to help with the special costs of teaching hospitals (e.g., uncompensated care; sicker patients; special, complex, or technologically sophisticated care; unsponsored research; and inefficiencies of care delivered by trainees, namely extra tests and procedures)
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From page 11... ...
GME payment provides vital support for teaching hospitals and academic health centers; contributions to medical advances and quality of care from these institutions are the other products that GME funding buys. The relatively small price paid for these high-quality results in a $1 trillion health care system seems quite reasonable.
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From page 12... ...
In a rapidly changing health care market, precise plans for the ideal work force composition are uncertain. Observations on variation in the shape and size of the work force in different parts of the country with apparently equivalent health outcomes call into question the validity of descriptions of the appropriate work force size and composition (Goodman et al., 1996; Whitcomb, 19951.
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From page 13... ...
To complement changes in federal policy, the committee urges accrediting bodies to make accreditation available to new entities that are creative and provide the kinds of training settings that are responsive to system change and teach new and more cost-effective ways of providing care. Some managed care organizations appear to be providing such settings now (Ladder et al., 1996; Ludden, 1996, 1997)
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From page 14... ...
Diploma nurse programs, which train non-graduate-level nurses and are currently eligible for GME nursing funds, are generally operated by nonteaching hospitals that receive partial reimbursement for the submitted costs of operating these programs. Advanced practice nurses, on the other hand, can substitute for physicians in many cases (Green and Johnson, 1995~.
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From page 15... ...
The scope of the committee's charge does not include the issues raised by these Medicare capitation calculations, except insofar as the committee expects that the problems will be mitigated by a defined GME fund and other aspects of the committee's plan. In a limited trust fund, inclusion of capitated caseload in the IME formula, as suggested later, can distribute funds to recognize service to managed care plans but cannot increase total expenditures.
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From page 16... ...
Like all education, GME depends on consistent, stable support and having time to adapt to change. Changes made to rationalize the system, to eliminate incentives that distort public policy, and to level support variances should also recognize legitimate differences in local conditions and allow for transitions.
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