MedPAC Votes Not To Recommend
IME Cut
January 17, 2003 - After a lengthy discussion, in
a narrow 9-6 vote (with two abstentions), the Medicare Payment
Advisory Commission (MedPAC)
voted at its Jan. 15 meeting not to make a recommendation
to Congress to reduce the Medicare indirect medical education
(IME) adjustment from the current level of 5.5 percent. A
number of other recommendations, however, were approved by
the Commissioners and will be included in MedPAC's March 2003
Report to the Congress on Medicare payment issues (see
related article).
The recommendation voted on would have reduced the adjustment
to 5.0 percent in fiscal year 2004 and by 0.5 percentage points
each year thereafter until the empirical IME level - currently
estimated by MedPAC staff as 2.7 percent - was reached. Voting
in favor of the recommendation were the MedPAC Commission
Chair and Vice-Chair, Glenn Hackbarth and Robert Reischaurer.
Joining them were Commissioners DeBusk, Durenberger, Newhouse,
and Rosenblatt. Voting against the recommendation were Commissioners
Burke, Feezor, Min-DeParle, Muller, Nelson, Raphael, Rowe,
Smith, and Stowers. Commissioners Wakefield and Wolter abstained.
The IME recommendation discussion centered on the portion
of IME payments provided to teaching hospitals that are above
the so-called "empirical" IME level. The empirical
level is derived from a complex statistical analysis. Since
the beginning of the Medicare program Congress has set the
IME adjustment above this amount. While recognizing the overall
value of teaching hospitals, a vast majority of Commissioners
voiced opinions that IME payments above the empirical level
were not clearly targeted to specific goals and responsibilities
of teaching hospitals.
During the discussion, Commissioner Jack Rowe, M.D., CEO
of Aetna and former head of New York's Mount Sinai hospital,
offered an alternative recommendation that would have cut
IME payments over time but would have returned the money to
teaching hospitals in a manner that would require teaching
hospitals to pursue improved and innovative educational activities.
While this alternative was ultimately not voted upon, there
was consensus in favor of better targeting IME payments. The
Commission agreed to return to the IME issue "promptly"
and further discuss Commissioner Rowe's idea and other possible
targeting mechanisms at a future meeting.
The AAMC sent a
letter Jan. 14 to MedPAC opposing the IME cut recommendation.
Information:
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
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