Medicare makes payments to teaching hospitals for training residents and fellows in approved training programs. Medicare’s direct graduate medical education (DGME) payments cover a portion of the direct costs of training residents. Additionally, Medicare provides teaching hospitals with an indirect medical education (IME) adjustment that considers the complex patients they treat and the services teaching hospitals provide to their communities such as standby capacity in trauma centers and burn units.
Regulatory changes affecting Medicare DGME and IME payments are often included in the annual Medicare Inpatient Prospective Payment System (IPPS) regulation. The Centers for Medicare & Medicaid Services (CMS) releases the IPPS proposed rule between late April and early May and publishes the IPPS final rule in early August; these changes generally become effective on Oct. 1.
Learn more about these changes using the resources listed below.
FY 2024 IPPS Proposed Rule: GME Provisions
Comment Letter (PDF)
AAMC Comment Letter to CMS on FY 2024 IPPS Proposed Rule, GME Provisions
- Rural Emergency Hospital Graduate Medical Education (REH)
FY 2023 IPPS Proposed Rule: GME Provisions
Comment Letter (PDF)
AAMC Comment Letter to CMS on FY 2024 IPPS Proposed Rule, GME Provisions
- MILTON S. HERSHEY MEDICAL CENTER v. BECERRA, Changes to the DGME FTE count
- Rural Track Program affiliation agreements for certain programs
FY 2022 IPPS Final Rule: GME Provisions
Video
Comment Letter (PDF)
AAMC GME Reference Publications
- Medicare’ Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know (2019)
- Becoming a Teaching Hospital: A Guide to Medicare Requirements (2014)
AAMC-Hosted Department of Veterans Affairs (VA) GME Webinars
Videos
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AAMC Hosts the VA Office of Academic Affiliation Webinar (2021)
- The VA and Academic Medicine Resident Payment Policies Webinar (2021)