This document represents AACOM’s Public Policy Agenda for the 115th Congress. It reflects AACOM’s legislative and regulatory priorities to ensure that osteopathic medical education (OME) is an active force in the formulation of national health and higher education policies as osteopathic medical schools continue to grow in number, size, and importance to the U.S. health care and medical education systems. AACOM will aggressively pursue these goals, notwithstanding the challenging political and fiscal environment.
Graduate Medical Education
AACOM strongly supports programs that promote medical education, particularly innovative programs designed to better prepare physicians for quality care of patients and to improve the health of communities in the 21st century. Federal graduate medical education (GME) funding is critical to ensure the stability and continuity of both the nation’s medical residency training programs that produce future physicians and the health care system that provides care to our nation’s citizens. AACOM supports the following:
- GME programs that expand the participation of community-based institutions; this is particularly important at a time when physician workforce shortages exist and/or are projected to continue over the next decade or longer.
- Preservation of federal GME funding. AACOM believes that cuts to GME will ultimately increase, not decrease, health care costs.
- GME funding that is directly associated with health care workforce needs. Meeting the health care needs of a growing, aging, and diverse population will require an expanded physician workforce.
- Lifting the statutory cap on Medicare-funded GME slots and exploring additional methods of financing GME outside of CMS, in particular, in underserved rural and urban areas.
- Federal programs that expand training in community-based settings to produce and retain primary care physicians in high-need communities.
- Protection of and permanency for the Health Resources and Services Administration’s (HRSA) Teaching Health Center (THC) GME Program, which aims to address the nation’s primary care workforce shortage and expand opportunities for future physicians training in primary care.
- Collaboration with policymakers and policy experts as they pursue concepts conveyed in The National Academies of Sciences, Engineering, and Medicine Health and Medicine Division’s Committee on the Governance and Financing of GME’s 2014 report, Graduate Medical Education That Meets the Nation's Health Needs, and partnering with Members of Congress and other stakeholders to address the challenges of reassessing the GME system to better address the nation's physician workforce needs, while simultaneously recognizing the need for accountability of GME funding.
- Expansion and sustainability of GME positions at the Department of Veterans Affairs (VA) medical facilities created by the Veterans Access, Choice, and Accountability Act of 2014.
- Work with the Council on Graduate Medical Education (COGME) and other federal committees to support a physician workforce that meets the needs of diverse patient populations in an evolving health care system.
AACOM strongly supports federal health care workforce policies intended to ensure an adequately-trained physician workforce to meet the heath care needs in the 21st century. AACOM supports the following:
- Reauthorization of and sustainable funding for HRSA’s Title VII health professions education and workforce training programs, specifically the Primary Care Training and Enhancement Program, Area Health Education Centers, and the Faculty Loan Repayment Program. These programs have been vital to the growth of OME and primary care training; the programs benefit the health care system far beyond their modest costs.
- Federal investment in the National Health Service Corps (NHSC) and continued funding for other scholarship and loan repayment programs to help recruit and retain primary care physicians and other health care professionals in geographical areas in need.
- The work of federal committees such as COGME, the Advisory Committee on Training in Primary Care Medicine and Dentistry, the VA’s National Academic Affiliations Council, and other federal bodies that work to align the physician health care workforce and broader health professional workforce with high-quality care for the nation’s patient populations.
- Innovative expansion of inter-professional practice and team-based programs that provide resources for the implementation and evaluation of inter-professional training models to deliver efficient, high-quality patient care.
- Health care workforce data production, analysis, and oversight to ensure that investments in the future of health care appropriately address the areas of greatest need. This includes support for funding the National Health Care Workforce Commission, which was previously authorized by Congress.
Medical Students and Federal Student Financial Aid
AACOM recognizes the significant student loan debt burden osteopathic medical students and graduates shoulder, as well as the overall impact this has on students pursuing primary care and other needed specialties. In the 2015-16 academic year, osteopathic medical schools educated nearly 26,000 U.S. medical students – more than 23 percent of all U.S. medical students. As osteopathic medical student debt rises, addressing accruing interest on federal loans over which considerably inflates the overall cost of medical student debt must be addressed. A majority of these students are also entering medical school with high debt from their undergraduate education, further exacerbating their loan debt after graduation. AACOM supports the following:
- Reauthorization of the Higher Education Act and Congress exploring fiscally-responsible solutions to lower medical student debt.
- Investment in programs that include a service component in loan repayment options, such as the NHSC and the Indian Health Service, to assist students who graduate with accumulated debt loads, as the nation faces a critical physician workforce shortage.
- Creation of new programs and support for current programs that directly fund students pursuing primary care and other needed specialties.
- Lowering interest rates on all federal student loans, including lowering the interest rate caps for graduate and professional students put in place by the Bipartisan Student Loan Certainty Act of 2013.
- Reinstating the in-school interest subsidy for graduate students on Federal Stafford Loans which was eliminated in the Budget Control Act of 2011.
- Addressing statutes and regulations that increase the administrative and financial burden that interfere with the educational mission of member institutions, such as the state authorization and gainful employment regulations in the USDE’s 2010 Program Integrity rule.
- Working to ensure that U.S. medical students and schools are well-served by the Title IV federal financial aid programs as well as supporting requirements that all foreign medical schools be held to the same standards and accountability as U.S. medical schools in order to qualify to receive Title IV federal financial aid.
As OME continues to grow across the country, AACOM believes that more research must be devoted to analyzing this practice modality, and supports fully integrating osteopathic medicine into the nation’s research infrastructure. AACOM supports the following:
- Investment in and increased funding for the National Institutes of Health (NIH).
- Investment in NIH’s National Center for Complementary and Integrative Health (NCCIH) to expand a full spectrum of research on osteopathic manipulative medicine, from basic to applied research to investigate and assess its efficiency.
- Maintaining funding for the Agency for Healthcare Research and Quality (AHRQ) and expanding programs at AHRQ that evaluate quality of care, promote knowledge transfer, and fund patient-centered outcomes research (PCOR).
- Continuing funding for PCOR implemented by the Patient-Centered Outcomes Research Institute (PCORI) and prioritization by PCORI of resources to train osteopathic researchers.
- Funding research by the Center for Medicare & Medicaid Innovation, AHRQ, and other agencies to explore innovation in methods of physician training and health care delivery.
AACOM continues to advocate for osteopathic physicians and osteopathic medical educators to serve on federal committees and advisory boards. AACOM supports the following:
- Nominating osteopathic medical educators and osteopathic physician experts for standing and newly-established federal committees, commissions, councils, advisory panels, and task forces. AACOM will collaborate with the American Osteopathic Association and other national associations to work to increase osteopathic representation on these federal bodies.
- Elevating visibility of OME and informing Congress and federal agencies about the importance of representation from this community.
- Working in collaboration with and provide recommendations to federal agencies, including the USDE, Health and Human Services, and the VA to ensure OME is an active force in report recommendations to agencies and Congress.