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AAMC Offers Strong Support for GME Expansion Legislation
March 15, 2013—AAMC President and CEO Darrell G. Kirch, M.D., commended Reps. Aaron Schock (R-Ill.) and Allyson Schwartz (D-Pa.) and Sens. Bill Nelson (D-Fla.), Charles Schumer (D-N.Y.), and Majority Leader Harry Reid (D-Nev.) for reintroducing March 14 legislation that would increase the number of Medicare-supported residency positions.
“On the eve of Match Day — when fourth-year medical students learn where they will begin their residency training required to care for patients — a number of our member medical schools are reporting highly qualified U.S. seniors not matching to residency programs,” said Dr. Kirch. “Because it takes seven to 10 years to train a doctor, Congress must act now to increase Medicare’s support for graduate medical education. We commend the leadership and long-term vision these lawmakers have shown in reintroducing this measure.”
Both the “Training Tomorrow’s Doctors Today Act” (H.R. 1201 ) and “The Resident Physician Shortage Reduction Act of 2013” (S. 577 ) would phase in 15,000 Medicare-supported residency positions over five years, with the House bill reserving one-third of the new residency slots for teaching hospitals that are training over their Medicare cap. At least 50 percent of the available new slots each year must be used for shortage specialty residency programs as identified by a Government Accountability Office report (GAO) in the House bill or the National Healthcare Workforce Commission report in the Senate bill.
Both versions of the legislation would distribute the new residency positions based on priorities such as:
- emphasis on training in community or outpatient settings;
- location in states with new medical schools or new branch campuses; and
- eligibility for electronic health record (EHR) incentive payments.
“The primary way our country can address the physician shortage is by ensuring we increase the number of Graduate Medical Education slots,” said Rep. Schock. “By doing so, we are increasing the number of medical school graduates who will receive hands-on training in a patient setting to gain the experience needed to become a practicing physician.”
“The United States is on the cusp of a crisis in access to both specialty and primary care physicians. We have an urgent need to take action to ensure Americans have access to quality, well trained doctors,” added Rep. Schwartz. “While there will be more than 74 million American seniors in need of health care services within 20 years, experts estimate that 130,000 new physicians will be necessary to eliminate the workforce shortage by 2025. This bipartisan legislation is critical.”
The House legislation also instructs the Secretary of Health and Human Services (HHS) to establish quality measures of “patient care priorities” to strengthen accountability and transparency within the Medicare GME system. The measures would be required to be endorsed by accrediting organizations, to be developed through a consensus-based process, and to demonstrate the extent of training in a number of specified priority areas, like care coordination and/or delivery of evaluation and management services.
Beginning in FY 2018, each hospital that does not report patient care measures would have its Medicare indirect medical education (IME) payments reduced by 0.5 percent, and beginning in FY 2019, hospitals that fail to achieve the new performance standards would have their IME payments reduced by 2.0 percent. The House measure also directs the secretary to issue an annual report on GME payments to teaching hospitals and the additional costs teaching hospitals incur as a result of their teaching mission.
The House and Senate sponsors both introduced similar versions of their respective bills in the 112th Congress.
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