The Government Accountability Office (GAO) March 29 released a report examining graduate medical education (GME) funding. The report, titled “Physician Workforce: HHS Needs Better Information to Comprehensively Evaluate Graduate Medical Education Funding” describes the “amount and distribution of federal government and state Medicaid agency spending on GME; describes what is known about GME costs; and examines the extent to which the federal government collects information to understand its investments in GME.” The report follows a 2017 report titled “Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs” that examined the changes in the number of residents in GME training by location and type of training from 2005 to 2015, as well as the federal efforts to increase GME training in rural areas, and in primary care [see Washington Highlights, June 30, 2017].
The report examines the various funding streams of GME, including Medicare, Medicaid, Children’s Hospital GME (CHGME), Teaching Health Center GME (THCGME), and funding through the Department of Veterans Affairs (VA). Among these programs, the report finds that the amount paid per full time equivalent (FTE) resident varied across programs and across regions.
Additionally, the report finds that GME training costs vary due to a number of factors, including the size of the program, the type of specialty, the type of training setting, the location of the program and the age of the program. For example, a rural residency site may have higher costs than an urban residency site because it may have to rotate residents through multiple settings in order to meet the necessary patient case mix for accreditation purposes.
The report finds that myriad challenges exist in measuring and comparing GME training costs, and that the information available to agencies is not sufficient in order to comprehensively evaluate the various funding streams. According to the report, because the information gathered is not complete or comprehensive enough to adequately evaluate the programs, the Department of Health and Human Services (HHS) “cannot identify problems and make or recommend changes to Congress in order to improve the efficient and effective use of federal funds.”
Ultimately, the report reiterates its recommendations from a report issued in 2015 that HHS develop a comprehensive planning approach to identify and address areas of health care workforce need. In order to provide the data necessary to move forward with that recommendation, the report concludes that the Secretary of HHS should coordinate with federal agencies that fund GME training to identify the information needed to evaluate program performance and identify opportunities to improve the quality and consistency of the information collected.