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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

AAMC Commends Schock, Schwartz for Introduction of GME Bill

August 6, 2012—AAMC President and CEO Darrell G. Kirch, M.D., applauded Reps. Aaron Schock (R-Il.) and Allyson Schwartz (D-Pa.) for introducing The Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act, H.R. 6352. In a statement, Dr. Kirch said, “The new residency positions created by this legislation, along with the thoughtful approach to achieving transparency and accountability for graduate medical education, represent the beginning of a comprehensive strategy to make sure Americans have access to the care they need.”

This legislation essentially combines two Senate graduate medical education (GME) related bills, the Resident Physician Shortage Reduction Act of 2011 (S. 1627), which adds an additional 15,000 Medicare-support residency slots [see Washington Highlights, Sept. 30, 2011], and the Graduate Medical Education Reform Act of 2012 (S.3201), which incorporates accountability measures and transparency within the Medicare GME program [see Washington Highlights, May 18].

Similarly to S. 1627, H.R. 6352 would increase the number of Medicare-supported GME slots for physician residency training by 15 percent or 15,000 over five years. However, this version specifies that one-third of new residency slots are available as cap relief to teaching hospitals already training over their cap.  At least half of the available new slots each year must be used for a shortage specialty residency program as identified in the Government Accountability Office (GAO) physician shortage specialty report, or prior to the report, as defined by the December 2008 Health Resources and Services Administrations (HRSA) report on the physician workforce. The legislation would allow qualifying teaching hospitals to receive up to 75 slots between calendars years 2013 through 2017, with slots distributed based on these priorities:

  • Hospitals in states with new medical schools or new branch campuses;
  • Hospitals that emphasize training in community health center or community-based settings or in hospital outpatient departments;
  • Hospitals eligible for electronic health record (EHR) incentive payments, and;
  • All other hospitals.

With regard to accountability and transparency, the legislation instructs the Secretary of Health and Human Services to establish quality measures of “patient care priorities” in GME. Beginning in FY 2017, each hospital that does not report patient care measures would have its indirect medical education (IME) payments reduced by 0.5 percent, and beginning in 2018, hospitals that fail to achieve the new performance standards would have their IME payments reduced by up to 2 percent. The quality measures would demonstrate the extent of training provided in:

  • The delivery of evaluation and management (E/M) or other cognitive services;
  • A variety of settings and systems;
  • The 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 (HIT).

Lastly, the bill directs the secretary to issue an annual report on GME including direct graduate medical education (DGME) and IME payments to teaching hospitals; the full DGME cost to the hospital; the number of full-time-equivalent residents (FTEs) at each hospital that are counted for DGME and IME, and those that are not counted; and the factors that contribute to teaching hospital’s higher costs, such as standby services and research.

In his statement, Rep. Schock said, “The significant shortfall in trained doctors and medical professionals will only continue to grow if we don’t begin to address the problem now.” He continued,“The primary way our country can address the physician shortage is by ensuring we increase the number of graduate medical education slots. By doing so, we are increasing the number of medical school graduates who will receive hands-on training in a patient setting and gain the experience needed to become a practicing physician.”

Rep. Schwartz said, “Our nation’s graduate medical education system trains the world’s best physicians who serve patients in practice settings ranging from renowned teaching hospitals, to community hospitals, to small primary care practices across the country. This bipartisan effort reflects the pressing need for reforms to our nation’s graduate medical education system that will not only expand training capacity, but also improve the quality of physician training in this country.”

Contact:

Len Marquez
Director, Government Relations
Telephone: 202-862-6281
Email: lmarquez@aamc.org

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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org