COGME Discusses IME
April 25, 2003 - AAMC Senior Vice President Robert
Dickler defended maintaining the Medicare Indirect Medicare
Education (IME) adjustment at double the empirical level on
both technical and policy grounds at the Council on Graduate
Medical Education (COGME) meeting April 10 and 11. Responding
to a briefing on the IME by Medicare Payment Advisory Commission
(MedPAC) staff member Craig Lisk, Mr. Dickler pointed out
that questions often have been raised about the definitions
of cost and the regression model employed in estimating the
IME coefficient. Placing greater emphasis on the policy issues,
Mr. Dickler cautioned about the mission and sustainability
of teaching hospitals, noting that from its inception Medicare
has not been viewed narrowly as a pure insurance program and
that teaching hospital margins are the lowest among all hospitals
at 1.5 percent.
Health Resources and Services Administration chief Elizabeth
Duke, Ph.D., briefed the Council on a HRSA program - administered
through the states - to enhance hospital preparedness for
bioterrorism with appropriations of $125 million for FY 2002
and $514 million for FY 2003. She also mentioned the administration's
priorities of expanding both the Community Health Center and
National Health Service Corps programs.
A discussion of medical malpractice insurance issues focused
on approaches to alleviate the problems of rising premiums,
rising awards, and the exit of major carriers from the market.
Emily Cornell of the National Governor's Association described
the options states are exploring: interventions in the insurance
market, tort reforms, alternate dispute resolution programs,
and efforts to improve patient safety. COGME members expressed
concern about the potential for high premium costs to affect
new physicians' choices of where to practice.
Ed Salsberg, executive director of the Center for Health
Workforce Studies at SUNY Albany, gave preliminary findings
from his re-assessment of physician workforce policy guidelines
for the United States, a study being conducted under contract
to COGME. Center staff projected demand, extrapolating demographics,
economic growth, and health care utilization from base year
2000. They also projected need by assuming universal health
care coverage. Physician supply was projected by extrapolating
physician demographic characteristics, U.S. vs. non-U.S. medical
education, rates of retirement, and productivity. These projections
suggested a shortage of physicians in 2020. COGME members
raised a number of questions about the study's assumptions
and asked Mr. Salsberg to conduct sensitivity analysis and
report back at the next meeting.
Information:
Sunny Yoder, Director of Resident Affairs
AAMC Health Care Affairs
syoder@aamc.org
(202) 828-0497
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