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Senators Introduce GME Accountability Legislation
May 18, 2012—Sens. Jack Reed (D-R.I.) and Jon Kyl (R-Ariz.) May 17 introduced the Graduate Medical Education Reform Act of 2012 (S.3201), bipartisan legislation to strengthen accountability and transparency in Medicare’s support of graduate medical education (GME). AAMC President and CEO Darrell G. Kirch, M.D., thanked the senators for their efforts and agreed that “achieving transparency and accountability within Medicare’s support for GME is a positive first step, and one that directly aligns with our members’ ongoing commitment to advancing medical education in accordance with the country’s anticipated workforce needs.” The AAMC supports this legislation as a component of a larger GME reform package that must include an increase in the number of Medicare-supported residency slots, such as the Resident Physician Shortage Act of 2011 (S. 1627) [see Washington Highlights, Sept. 30, 2011].
In a May 18 press statement, Dr. Kirch added, “Teaching hospitals are working to achieve the goals of better coordinated, team-based, and system-focused care identified in this bill to meet the needs of our patients. We hope Congress lifts the cap on physician training enacted 15 years ago so that we have enough well-trained doctors to care for an aging, growing population.”
The legislation directs the Secretary of Health and Human Services (HHS) to develop measures of patient care priorities that are in line with what has been suggested by the Medicare Payment Advisory Commission (MedPAC) and the Accreditation Council for Graduate Medical Education (ACGME), including the extent of training provided in evaluation and management or cognitive services, training across a variety of settings and systems, coordination of patient care across various settings, the relevant cost and value of various diagnostic and treatment options, inter-professional and multidisciplinary care teams, methods for identifying system errors and implementing system solutions, and the use of health information technology. The bill also establishes a budget neutral Indirect Medical Education (IME) performance program which would put 3 percent of a teaching hospital’s IME funding at risk, as opposed to the 50 percent recommended by MedPAC in its June 2010 report to Congress.
In his introductory floor statement, Sen. Reed said, “MedPAC suggested Congress should make teaching hospitals more accountable for the GME funding they currently receive. In MedPAC’s proposal, all GME funding would stay in the system to help support and improve medical education and training.” He continued, saying “the legislation we are introducing today aligns closely with MedPAC’s proposal for greater accountability by teaching hospitals and enhanced effectiveness in the use of GME funding, but with some key changes. One such change would enable hospitals to compete for additional GME funding in order to provide a greater incentive for teaching hospitals to improve their programs.”
Both Sens. Reed and Kyl discouraged the efforts of some in Washington, including Congress and the administration, to reduce funding to teaching hospitals for GME. Sen. Reed said, “It is critical that GME funding remain intact, but that doesn’t mean we shouldn’t use this opportunity to encourage these programs to do more to better train residents in: primary care delivery, a variety of settings and systems, care coordination, and how to work in inter-professional and multi-disciplinary teams. In addition, the legislation would enhance GME payment transparency, which we hope will help prove to the skeptics that this funding serves a critical purpose.”
Sen. Kyl added, “[T]he government has a strong interest in doing more to encourage the training of physicians who can deliver quality care to our nation’s seniors. Even if we continue funding medical education at current levels, we will soon face a severe crisis in access to medical care. Cutting this medical education funding would be counterintuitive at best; dangerous at worst. In recent years, however, there have been several proposals to do just that.”
Director, Government Relations
Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.
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Senior Director, Government Relations