January 5, 2001
COGME Issues Report on GME Financing
At its Dec. 13-14 meeting, the Council on Graduate Medical Education (COGME) issued its 15th report, "Financing Graduate Medical Education in a Changing Health Care Environment." The council emphasized that the report should be read as a set of ideas for discussion, not a finished policy proposal. To foster this discussion, the council will devote the first day of its April 11-12, 2001 meeting to presentations from and discussions among interested organizations, including the AAMC.
The report sets forth these policy objectives for GME funding:
- Provide a stable mechanism that is responsive to the community yet consistent with national workforce objectives.
- Enable health care institutions to compete on price and quality by subsidizing higher costs attributable to educational activities and uncompensated care.
- Create adequate support and appropriate incentives for developing community-based educational programs.
- Encourage effective and efficient educational models.
- Foster mechanisms to stabilize the total number of physicians while improving distribution.
- Hold recipients of federal and state funds accountable for producing needed public goods.
To attain these objectives COGME makes eight recommendations:
- Create a GME fund that combines all federal GME funding with all-payer funds.
- Establish indirect medical education (IME) accounts from the fund to pay hospitals and other clinical training sites for the indirect costs of educational activities.
- Establish direct GME accounts from the fund and make GME payments directly to institutional sponsors or their designees.
- Establish a national average per resident amount for direct GME costs.
- Continue the Balanced Budget Act of 1997 limits on the number of residents but apply the caps to institutional sponsors rather than hospitals. 8 Establish an account of at least 10 percent of the fund from which to support special projects and programs directed at building community-based training capacity or achieving specific workforce goals.
- Modify the Medicare rules related to teaching physicians to emphasize the teaching physician's overall responsibility for the management of a patient's care and to reduce the importance of documentation.
- Provide additional support for hospitals and community-based training sites that serve a disproportionate share of low income patients.
Carl Getto, M.D., dean and provost, Southern Illinois University School of Medicine and chair of the working group that oversaw preparation of the 15th report, suggested that it should be placed before Congress as an alternative to the MedPAC proposal to treat GME costs as costs of patient care.
The council also welcomed four new members:
- Allen I. Hyman, M.D., executive vice president and chief of staff, New York Presbyterian Hospital;
- Robert L. Johnson, M.D., professor and vice chair of pediatrics, University of Medicine and Dentistry of New Jersey;
- Jerry A. Royer, M.D., M.B.A., senior vice president and chief medical officer, Mercy Health Plans, St. Louis; and
- Humphrey Taylor, chair, The Harris Poll, Harris Interactive, Inc. Rochester, N.Y.
Departing from COGME are David Sundwall, M.D., who has chaired the council for several years; Macaran Baird, M.D. of Mayo Management Services, Kylann Green of INOVA Health Systems, and Ezra Davidson, M.D. of King/Drew.
The meeting agenda included a discussion of Hispanic physicians and the health needs of the Hispanic population. The nation's 40 million Hispanics represent 12 percent of the population and half the foreign born in the U.S., according to Elena Rios, M.D., president of the National Hispanic Medical Association (NHMA). To promote entry into health careers, especially medicine, by Hispanics, NHMA is sponsoring a leadership program at the Wagner Graduate School of Public Service, resident leadership programs at Stanford and Cornell medical schools, and a medical student mentorship program at the University of Texas, San Antonio.
Lois Colburn, assistant vice president, AAMC Division of Community and Minority Programs, reviewed data on Hispanic applicants and matriculants at U.S. medical schools. Mexican-Americans account for the large majority of Hispanics in the U.S. population. Two-thirds of Mexican-American medical school applicants come from Texas and California. In California, applications to medical school from this population have declined since Proposition 209 in 1996. In Texas, applications declined after the decision in the case of Hopwood v. Texas, but have rebounded.
Billy Ballard, M.D., D.D.S., chair of pathology at University of Texas Medical Branch (UTMB) told the council about steps taken subsequent to the Hopwood decision to encourage underrepresented minorities to enter medicine. As a result of these efforts, URM students have increased to 25 percent at UTMB, equal to the proportion at the time of the Hopwood decision.
The council asked staff to pursue discussions with the AMA about using the AMA Masterfile data to improve information on underrepresented minorities in medicine.
Information: Sunny Yoder, AAMC Division of Health Care Affairs, 202-828-0497.
