MedPAC Recommends Not Increasing
Cap for Geriatric Residents
May 2, 2003 - At its April 24-25
meeting, the Medicare Payment Advisory Commission (MedPAC)
agreed not to recommend altering the Medicare resident cap
to allow for training of additional geriatric residents. Currently,
Medicare "caps" the number of residents used in
determining the levels of direct graduate medical education
(DGME) and indirect medical education (IME) payments. The
cap is determined by the number of residents a hospital reported
on its 1996 Medicare cost report, regardless of specialty.
The conference report to the FY 2001 omnibus appropriations
bill requested that MedPAC examine the effect of resident
caps on geriatrician training and whether Congress should
increase the caps to accommodate additional geriatrician residents.
MedPAC staff reported that the resident caps do not seem
to be a significant factor in limiting the supply of geriatricians.
Over recent years, the number of geriatric residency slots
filled was significantly less than the number offered. MedPAC
staff noted that there are a number of reasons affecting the
number of geriatric residents, most importantly being resident
interest. During the public comment period, AAMC staff urged
the Commission to study the impact of the resident caps generally
on academic medicine and training opportunities. MedPAC will
provide its views to Congress through a "letter report,"
which will be completed in the near future.
The Commission staff reported on a letter from the Centers
for Medicare and Medicaid Services (CMS) regarding the probable
2004 physician fee schedule update. MedPAC staff used CMS
data to estimate the sustainable growth rate (SGR) of 6.4
percent for 2004. The report noted that actual spending continued
to outpace target spending, largely driven by increases in
the volume of physician services. The report stated that several
factors may be contributing to the volume increase and that
the trend actually began in 2001. Overall, the report indicated
that there is a 49.5 percent probability that the 2004 update
will be between -6.0 percent and -4.1 percent.
In the quality arena, the commissioners approved a recommendation
that requests the use of demonstrations to evaluate provider
payment differentials and structures that reward and improve
quality. It was noted that any incentive program must have
a strong emphasis on integration and coordination of care
and not focus strictly on disease specific measures. The initial
focus would be Medicare+Choice plans and inpatient rehabilitation
facilities due to their established measures and standardized
data collection methods.
Other topics addressed at the meeting included:
- Growth and variation in the use of physician services,
- Variation in hospital financial performance under prospective
payment
- Private insure methods for paying for outpatient drugs,
and
- Variation in per beneficiary Medicare expenditures
Information:
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
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