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  • Washington Highlights

    HRSA Publishes Final Response to Comments on its Proposed Standards for the Children’s Hospitals Graduate Medical Education Payment Program’s Quality Bonus System

    Mary Mullaney, Director, Hospital Payment Policies
    Andrew Amari, Hospital Policy and Regulatory Specialist

    The Health Resources and Services Administration (HRSA) released its final response to comments for the establishment of standards for the Children’s Hospitals Graduate Medical Education (CHGME) Payment Program’s Quality Bonus System (QBS). HRSA requested feedback, and the AAMC commented in response to the proposed CHGME QBS’s goals, measures, metrics, structure, and implementation timeline, among other things [see Washington Highlights, Dec. 15, 2017]. In response to comments by AAMC and other stakeholders, HRSA implemented several changes to the proposed standards.

    The AAMC commented that the purpose of CHGME grants is to pay for graduate medical education (GME) and the quality bonus payment must be tied to the training program, not to other hospital activities.  Additionally, AAMC requested that HRSA allow for sufficient time to monitor the program before expanding criteria beyond fiscal year (FY) 2019. 

    In the final response, HRSA revised the goal of the QBS to recognize hospitals for quality improvement and GME transformation efforts in high priority areas and build standards to increase involvement of residents in broader initiatives.  Furthermore, HRSA will implement a baseline phase for QBS in FY 2019 and collect information during this baselines period to be used to establish QBS standards for implementation in FY 2021.

    HRSA also altered its plans for the QBS measures and metrics. Many commenters, including the AAMC, stressed the difficulty with tying patient outcomes to resident training. In response, HRSA plans to review all the identified measures, as well as measures recommended for use in the QBS’s next phase. Additionally, following the initial baseline phase of the QBS, HRSA plans to conduct an environmental scan of GME quality measures, develop quality measures for GME programs, and engage stakeholders on future measures.