On Implementing a National Graduate Medical Education Trust Fund (1997) / Chapter Skim
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Overview of Graduate Medical Education and the Distribution of a Trust Fund
Overview of Graduate Medical Education and the Distribution of a Trust Fund
Pages 1-7
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program is under the aegis of one of the approximately 1,000 teaching hospitals in this country; is accredited by a nongovernmental professional body; and produces practitioners who are recognized as, and are usually eligible to obtain board certification as, for example, generalists in family medicine or specialists in radiology. Graduate medical education, for the purposes of the report, also means, unless otherwise noted, the training of dental and podiatric professionals; undergraduate, preprofessional nurses; and a number of allied health professionals, such as x-ray technicians and respiratory therapists, among others.
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The direct GME component from Medicare comprises payments made directly to teaching hospitals based on 1984 historical costs to cover the stipends of residents, the supervisory personnel, and other associated hospital costs for supporting a residency program. These are payments for each individual, fulltime-equivalent resident.
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The committee was not charged with deciding the size or composition of the health care work force, or, in particular, the physician work force or with addressing the issues of international medical graduates. The committee was aware that much has been written and many recommendations made on these matters and yet the nature of the problems is such that no simple solutions have been found.
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The committee observed that institutions that currently serve the most Medicare beneficiaries are not necessarily those that will best train practitioners to care for the Medicare population in the future, and that some institutions that now serve few Medicare patients could be desirable training sites. The committee questioned whether
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It also provides opportunities for training in new settings such as ambulatory sites and managed care organizations, under the aegis of consortia and the like. In addition, taken together with the other recommendations, it also improves the financial standing of, for example, children's hospitals or institutions offering residencies in preventive medicine, by permitting them to become DME-eligible sponsoring institutions and providing a uniform DME payment.
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In conclusion, the committee's suggested plan provides for an annually defined fund targeted to the support of GME and teaching hospitals and separate from the payment considerations of the overall Medicare DRG payment system and from the calculations by Medicare involving plans paid on a prepaid, per capita basis. The plan does not attempt new work force restructuring, but suggests setting a uniform price per resident and creating a system open to new
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OVERVIEW OF GME AND DISTRIBUTION OF THE TRUST FUND 7 entrants, less restrictive, and more responsive to changing health care delivery. Relentless pressure to control expenditures has caused private-sector payers for health care services to deny training costs, putting teaching institutions and GME at risk, and increasingly shifting the burden towards responsible governmental public payers like Medicare.
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