Transcript Graduate Medical Education Reimbursement and Residency Funding

Graduate Medical Education
Reimbursement and Residency Funding
Prepared by:
Erin E. Schneider, MD
Emergency Medicine Resident, PGY-2
Oregon Health and Science University
Objectives
• Funding sources
• Reimbursement sources
• Limitations on payments
GME Funding- who pays?
• Centers for Medicare and Medicaid
services
• Veterans Administration (9%)
• Private Insurers
• Costs are separated into direct and
indirect costs
Direct vs. Indirect costs
• Direct Costs:
– resident salaries
– Overhead
– faculty supervision
• Indirect Costs: costs to hospital of training
residents
- higher acuity patients
- state-of-the-art technology
- multiple learners creating inefficiency
- added staff
How are indirect costs reimbursed?
• Congress determines multiplier “X”
• Inpatient cost per case increases by “X” %
for every 10% increase in resident to bed
ratio
• “X” decreased 11.6% (1980s) to 5.5%
(2003).
– MedPac recommended elimination of X
• Potential loss of $340 million per year
Report to the Congress: Medicare Payment Policy. March 2003. MedPac. P 56
Medicaid Funding in Jeopardy
• 2007: CMS proposed to eliminate
“inappropriate” payments to hospitals
• Issue may continue to arise in current
healthcare reform debates
• Potential place for resident advocacy
Resident Position Allocations
• CMS pays 1.0 FTE (full time equivalent)
for every resident up to 5 years of
residency
• Balanced Budget Act of 1997 placed cap
on residency positions in the US
• Resulted in redistribution of residency
positions to rural/small urban areas
Outside EM rotations
• Hospital paid by CMS for residents
rotating at non-hospital settings
• Community outside rotations may get
reimbursed, but non-hospital settings (e.g
poison centers, some rural hospitals) do
not.
EMRA Position Statement
• "EMRA will support current research and studies aimed
toward revising current Graduate Medical Education funding
mechanisms and work to change current Direct Medical
Education regulations that limit research and extramural
educational opportunities.
EMRA will work with other healthcare organizations to better
define the problem of Graduate Medical Education funding
and propose alternatives and solutions that may involve both
the public and private sectors.
EMRA opposes reductions in Medicare funding for Graduate
Medical Education at the Federal and State level and
supports diversified sources of funding that help meet the
overall goals of residency training.”
• Original policy adopted by Resolution Council, 5/08 9
Conclusions
• Multiple pressures to reduce payments
• Limitations on physicians does not reflect
expanded need of growing population
• Funding improvements and redistribution
needed for adequate training
References
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Fishman LE. Medicare Payment With an Educational Label: Fundamentals and the Future.
Washington, DC: Association of American Medical Colleges; 1996
American College of Emergency Physicians Issue Paper: GME Funding. Updated 2007
www.acep.org/workarea/showcontent.aspx?id=30144
1 CRS Report for Congress. Medicaid and GME funding.
http://aging.senate.gov/crs/medicaid8.pdf. Accessed January 8, 2008.
2 Ramano, M. Modern Healthcare. 2003. Vol. 33 Issue 40, p10.
3Report to the Congress: Medicare Payment Policy. March 2003. MedPac. Pp 53-59
http://www.medpac.gov/documents/Mar03_Entire_report.pdf. accessed December 28, 2008
4 Indirect Medical Education (IME). Center for Medicare and Medicaid Services.
http://www.cms.hhs.gov/AcuteInpatientPPS/07_ime.asp#TopOfPage, accessed December 22,
2008.
5 Medicare Indirect Medical Education Payments (IME).
http://www.aamc.org/advocacy/library/gme/gme0002.htm. Accessed January 28, 2009
6Medicare payments for Graduate Medical Education: What Every Medical Student, Resident, and
Advisor Needs to Know. Association of American Medical Colleges 2006.
http://www.uth.tmc.edu/med/administration/gme/pdf_files/medicare_payments_gme.pdf
7 Securing Medicare GME funding for Outside Rotations. ACEP
http://www.acep.org/practres.aspx?id=22488, accessed December 22, 2008.
8 “Public Law 110-252: Making appropriations for military construction, the Department of Veterans
Affairs, and related agencies for the fiscal year ending September 30, 2008, and for other
purposes.” (6/30/08; enacted HR 2642). Text from: United States Public Laws. Available from:
The Library of Congress; Accessed: 12/22/08.
9 Section X: Education and Professional Development - Securing GME Funding for Resident
Education. EMRA.org. Accessed 12/22/08