AACOM monitors and advocates on federal issues that address or may impact osteopathic medical education. Select from the topic links below to learn about these issues, related AACOM activity and additional resources.
Resident Physician Shortage Reduction Act of 2009
Government Accountability Office
Capitol Hill Briefing
Department of Veterans Affairs, Office of Academic Affiliations
Medicare Payment Advisory Commission
Resident Physician Shortage Reduction Act of 2009
- RPSRA would expand the number of Medicare-supported physician residency training positions by 15 percent or roughly 15,000 slots. Preference would be given to hospitals that apply for primary care, general surgery, or slots that emphasize community-based training. Additional preference would be given to: (1) hospitals in states with fewer Medicare-supported residency slots than medical students; and (2) hospitals with low resident physician-to-population ratios.
The legislation would require that all time spent by a resident physician in nonhospital settings be counted towards the determination of full-time equivalency for the purposes of payments for direct graduate and indirect medical education costs, without regard to the setting in which the activities are performed, if the hospital continues to incur the costs of the resident's stipends and fringe benefits during the time spent in that setting.
The legislation would permit Medicare indirect graduate medical education (GME) reimbursement for educational activities that occur in the hospital as well as Medicare direct GME reimbursement for educational activities that occur in clinical nonhospital settings, such as community health centers and other community-based ambulatory care sites.
Finally, the legislation would allow residency slots in hospitals that close to be redistributed to nearby teaching hospitals so that these slots are not lost upon hospital closure. |
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| Updated: 8/5/2009 |
Government Accountability Office
- The Government Accountability Office issued a report in 05/04/09 focusing on:
- trends in postgraduate medical training;
- factors that influence medical students’ specialty choice; and
- trends in the amounts of student debt incurred by medical school graduates.
A summary of the report appears at: http://www.gao.gov/products/GAO-09-438R; for the full report, entitled, Graduate Medical Education: Trends in Training and Student Debt go to: http://www.gao.gov/new.items/d09438r.pdf. |
| Updated: 8/5/2009 |
Capitol Hill Briefing
- In 04/22/09, the Association of American Medical Colleges and the American Osteopathic Association partnered to present a congressional briefing on Medicare support for graduate medical education (GME). The groups’ presentation on the basics of GME is available at: http://www.aamc.org/newsroom/presskits/gme-thebasics.pdf.
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| Updated: 8/5/2009 |
Department of Veterans Affairs, Office of Academic Affiliations
- AACOM and Department of Veterans Affairs (VA) are working together to make all Colleges of Osteopathic Medicine, Osteopathic Postdoctoral Training Institutions, Osteopathic Graduate Medical Education Program Sponsors, and VA facilities aware of opportunities for collaboration on osteopathic medical education.
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| Posted: 7/1/2009 |
Medicare Payment Advisory Commission
- On 06/15/09, the Medicare Payment Advisory Commission (MedPAC), the panel that advises Congress on Medicare issues, released its June 2009 report to Congress, Improving Incentives in the Medicare Program.
Chapter one of the report examines medical education in the context of long-term health care delivery system reform. In a study of internal medicine residency programs, MedPAC found that formal curricula are not well aligned with objectives of delivery system reform. Although most programs provide at least some training in selected topics essential for delivery reform (e.g., care coordination across settings), overall, their curricula fall far short of the instruction recommended by the IOM and other experts.
Of particular concern is the relative lack of formal training and experience in multidisciplinary teamwork, cost awareness in clinical decision making, comprehensive health information technology, and patient care in ambulatory settings. Residency experience in nonhospital and community-based settings is important because most of the medical conditions that practicing physicians confront should be managed in nonhospital settings. Inherent financial incentives and Medicare regulations, however, strongly encourage teaching hospitals to confine their residents' learning experiences to within the hospital.
Future MedPAC work on medical education policy issues may include exploring ways to link delivery system reforms to medical education incentives and structuring medical education subsidies to produce the optimal balance of generalists and specialists.
Another issue to examine is enlisting all payers to contribute explicitly to medical education. To view the entire report, go to: http://medpac.gov/documents/Jun09_EntireReport.pdf. The table of contents, with links to individual chapters, is located at: http://medpac.gov/document_TOC.cfm?id=576. Additionally, a news release and a fact sheet regarding the report are available at: http://medpac.gov/documents/June09NewsReleaseFINAL.pdf and http://medpac.gov/documents/June09FactSheet_FINAL.pdf, respectively. |
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MedPAC voted on 01/08/09, to decrease the current 5.5 percent indirect medical education (IME) adjustment by one percentage point to 4.5 percent and redirect the funds to support the implementation of a value-based purchasing (VBP) system. VBP requires a portion of a hospital’s reimbursement be dependent on their performance in pre-defined quality measures.
The reduction of IME is based on the committee’s findings that there was only a 2.2 percent increase in costs for every 10 percent increase in teaching intensity in a hospital, whereas the current payments showed a 5.5 percent increase for every 10 percent increase in teaching intensity. |
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| Updated: 8/5/2009 |
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