GME Issues Prominent in Recently
Released Medicare Inpatient Rule
May 14, 2004 - Proposals that would affect Medicare
direct graduate medical education (DGME) and indirect medical
education (IME) payments are a key focus in the FY 2005 Medicare
inpatient prospective payment system (IPPS) proposed rule
that was published on the Centers for Medicare and Medicaid
Services' (CMS) Web site on May 12 and will be published in
the Federal Register on May 18.
Most of the GME proposals reflect provisions in the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003
(MMA), including a closely-watched program that would reduce
Medicare resident caps for hospitals with below-cap resident
counts and "redistribute" them to hospitals seeking
to expand their caps. The proposed rule provides detailed
information on this program, including proposed criteria to
determine which hospitals should receive additional cap slots
in the event demand exceeds supply. The May 12 publication
also discusses, but does not propose specific regulations,
a change in how CMS would "weight" the DGME resident
count for residents that pursue specialties that require an
initial year of broad-based training (commonly known as the
"preliminary year" issue).
Other GME issues in the rule include:
- Implementing the MMA provision to freeze the DGME per
resident amounts for hospitals above 140 percent of the
national average, and
- Eliminating the written agreement requirement (but not
the underlying rules) between hospitals and nonhospital
sites where residency training occurs, in exchange for a
proposal that hospitals compensate the nonhospital site
for GME costs by the end of the month following a month
in which the training occurred.
The May 12 release proposes changes in a number of other
areas, including:
- Updating the base rates for hospitals that submit quality
data by the full increase in the hospital market basket,
currently estimated at 3.4 percent;
- Modifying the hospital wage index to reflect differences
in hospitals' "occupational mix";
- Establishing new "core based statistical areas"
based on 2000 census data; and
- Tightening rules regarding hospitals within hospitals.
Comments on the proposed rule are due July 12 with the final
rule expected to be published on August 1.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
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