There is no more rigorous or accurate benchmarking resource for academic provider compensation planning. funding and the number of trainees. Nationally, a number of academic institutions have made the difficult decision to withdraw their learners from some clinical training environments in order to curb the spread of COVID-19, preserve limited supplies of personal protective equipment, and maximize time physician faculty can dedicate to direct patient care. At least half of new primary care specialty positions should be in family medicine (i.e., 25% of all newly funded first-certificate residency program positions). Total federal GME funding exceeds $15 billion per year. A logical solution is to shift funding from existing fellowship training programs. Medicare payments for these Direct Graduate Medical Education (DGME) costs go directly to the hospitals that train the residents. Medical school is only the start of physician training, and the AMA is working to ensure that graduate medical education (GME) programs have the resources necessary to train the residents who will chart the future of medicine. Additionally, the GME Startup Bonus Program provides $100 million dollars to qualifying hospitals with newly approved residency positions in the statewide supply-and-demand deficit specialties. The host hospital (i.e., recipient of displaced residents) must then train those learners; shared rotational arrangement requirements that are stipulated as part of Medicare affiliated group arrangements are waived in this situation. Here are five strategies to reinvigorate your revenue cycle performance. Advanced Life Support in Obstetrics (ALSOÂ®), Chief Resident Leadership Development Program, Family Medicine Board Review Express Livestream, Residency Leadership Summit (formerly PDW RPS) Virtual Conference, PerformanceNavigatorÂ® Workshop: Cardiometabolic Conditions Livestream, Children's Health Insurance Program (CHIP), Donate to Support FamMedPAC (AAFP Members Only), FamMedPAC Board of Directors (AAFP Members Only), News From 2019 Congress of Delegates & FMX, News From 2018 Congress of Delegates & FMX, Graduate Medical Education Financing Policy, The Association of American Medical Colleges (AAMC) reported that there were 21,338 matriculants (MS-1) toÂ. Direct Graduate Medical Education (DGME) â¢ Payment for Medicareâs share of the costs of training physicians (resident salaries & benefits, faculty compensation, administration & overhead costs) â¢ Product of the hospitalâs per resident amount (PRA), Medicare utilization rate & number of full time equivalent (FTE) residents The PRP should be evidence based, transparent, and predictable.Â Â, Principle 6: Support existing and expanded funding for family medicine residencies by refocusing existing Medicare GME funding to first-certificate residency programs. This information is not meant to substitute for your own research into applicability to obtain GME pass-through funding at your organization, a thorough review of direct and indirect costs associated with GME pass- through funding, or a discussion with your finance office. In 2015, 25% of hospitals receiving less than $105,761 while 25% received more than $182,233 per resident. Instead, it has been making payments using an interim annual payment rate of $150,000 per resident, with reductions when appropriated funding levels do not allow the full per-resident amount (PRA). Program Name Control over trainees Total Funding Number of Trainees Cost Per Trainee MANDATORY FUNDING Medicare GME Payments The number of Medicare-supported residents and per-resident payment amount is capped for To achieve the overall goal of 50% primary care, it is imperative that at least 25% of U.S. medical school graduates choose family medicine by 2030. Congress later capped Medicare GME payments for residency programs in medicine and osteopathy through limits on the number of resident full-time equivalents (FTEs) and per-resident amounts (referred to as PRAs). Send displaced residents to a host hospital for ongoing training. This entity should establish accountability measures that would be utilized as a condition for sustained GME payments. There is no more rigorous or accurate benchmarking resource for provider compensation planning. The payments are based on an amount known as the hospital-specific per resident amount (PRA), which, according to law, was determined by CMS for each The $57 million for GME represents 4.73% of Beaumont's net patient revenue in 2013, or about $189,368 per resident. Limiting the outsized growth of fellowships and other subspecialty training will temper increasing costs to the system that do not substantially benefit population health or achieve the Triple Aim. Every hospital that trains residents in an approved residency program is entitled to receive Medicare DGME funding. The U.S. Department of Health and Human Services (HHS) is required by law to establish formulas for determining separate Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payment formulas for the THCGME program. The type and location of GME training is predictive of eventual practice location. Physician Alignment & Network Development, Ambulatory & Service Line Performance Improvement, Pediatric Subspecialty Physician and APP Compensation Survey, Faculty Physician and APP Compensation Survey, Medical Group Cost and Infrastructure Survey, Risk-Based Contracting and Physician Compensation Survey, Physician Benefits and Perquisites Survey, Behavioral Health Strategy and Crisis Center Development, Renovating the Revenue Cycle: The Healthcare Executive’s Guide to Invigorating Revenue Cycle Performance, Do You Really Need a Psychiatrist? Section 1886(h)(2) of the Act, as added by COBRA, sets forth a payment methodology for the determination of a hospital-specific, base-period per resident amount (PRA) that is calculated by dividing a hospital's allowable costs of GME for a base period by its number of residents in the base period. new programs will receive approximately $45,000 per resident. THCGME awards can supplement GME payments from other federal sources, including Medicare, Medicaid, and the Children's Hospitals Graduate Medical Education (CHGME) program, but recipients generally cannot use funds to pay for the same portion of resident time that has been counted toward funding in these other GME programs. Regarding the IME payment formula, the statute provides that HHS must evaluate the indirect teaching costs needed to support primary care residency programs in qualified teaching health centers and ensure that the aggregate payments for indirect and direct costs do not exceed the total amount appropriated for the THCGME program in each fiscal year. 100 Cambridge St, Suite 2001, Boston, MA 02114, 11512 El Camino Real, Suite 200, San Diego, CA 92130, 275 Battery St, Suite 950, San Francisco, CA 94111, 1111 Third Avenue, Suite 2500, Seattle, WA 98101, 3030 Clarendon Boulevard, Suite 600, Arlington, VA 22201, 13355 Noel Road, Suite 1010, Dallas, TX 75240. Hospital and GME leaders also need to rapidly evaluate existing Medicare GME affiliated group agreements (amending as appropriate) and prepare for any anticipated changes for the upcoming academic year beginning in July. There is an opportunity to collaborate with stakeholders at the federal, state, and community levels to identify and share what is working well currently and to identify what would work if additional or redistributed investments through GME payment models were available. The bill would reauthorize $310 million for the National Health Service Corps, $126 million for Teaching Health Centers Graduate Medical Education (THCGME) programs, and $4 billion for Community Health Centers for each fiscal year from 2019 to 2024. In recent days, however, teaching hospitals have been contemplating further changes to resident training, particularly those related to inbound and outbound rotationsâsituations in which a trainee rotates to a host hospital to obtain experience that is not available in their home hospital (e.g., a family medicine resident rotating to a pediatric hospital for required inpatient or emergency pediatric rotations). Per-resident payments are typically for three years, the length of time for primary care residency training, ensuring that the position is funded for the duration of the residency. (new), Support for Principle 4: The THCGME program was created under the Patient Protection and Affordable Care Act (ACA) and reauthorized through fiscal year 2019 to increase the number of primary care residents who train in community-based ambulatory patient settings. On March 18, 2020, the ACGME issued a response to the clinical volume question stating: âThe ACGME visit/case minima were not designed to be a surrogate for the competence of an individual program graduate and are not utilized in that manner by the Review Committees. Veterans Administration Hospitals also provide funding for residents in their hospitals. When indirect and direct GME payments from Medicare are totaled, Augusta University receives approximately $80,000 per resident while new programs will receive approximately $135,000 per resident from this funding source. It was because of the cost of GME funding that this program came under the fire of budget-minded politicians in Congress. Subscribe to Residency Program Insider! The current U.S. physician workforce is 33% primary care. It should be noted, however, that it is possible to amend a Medicare GME affiliated group agreement during the ongoing academic year (i.e., prior to June 30), provided that any changes are made only to the original parties to the agreement. In 2009, Medicare paid $9.5 billion to teaching hospitals for resident trainingâ$3 billion to cover direct costs of approximately 100,000 residency positions and $6.5 billion for the indirect costs of patient care associated with resident training. Per resident amount is adjusted annually for inflation. (new). The number of ACGME-accredited subspecialty fellowship programs increased by more than 30% from academic year 2003-2004 to academic year 2012-2013, and the number of fellows in subspecialty training increased by 40% during that time. Support for Principle 6: If there is limited support for increasing the overall funding for additional GME positions for family medicine training, then an existing revenue source must be identified for first-certificate residency programs. To learn more about capacity ramp-up, including possible ways to incorporate displaced trainees into the response, check out our recent blog Addressing Staffing Shortages During the COVID-19 Outbreak. The Government Accountability Office (GAO) March 29 released a report examining graduate medical education (GME) funding. Ask for $150,000 per resident Funding will only be available to support residents trained above this baseline. © 2021 ECG Management Consultants. Some of these initiatives used waivers, matching funding, and targeted programming to reduce maldistribution of physician workforce in the state. Based on the following information, the AAFP estimates a need for roughly 10,000 PGY-1 positions in family medicine by 2030 to meet workforce and capacity demands: Principle 2: Establish accountability for federal GME payments to correct the historical maldistribution of federal GME financing by ensuring new positions are allocated to mitigate rural/urban and other geographic and specialty imbalances to reduce health professional shortage and medically underserved areas. Payments to the residents come from the hospitals. FTEs that Medicare GME payments would support were capped at the number of FTE residents that a hospital was There is also a need for development of an entity to create and monitor GME financing strategies to accomplish national workforce goals. The total cost breaks down to around $100,000 per year per resident. DGME helps to pay for direct teaching costs (eg, resident salaries and benefits, faculty). Contact us with your questions and concerns about how to address the COVID-19 crisis. State-by-State Graduate Medical Education Data All medical school graduates must complete a period of GME, or residency training, to be licensed to practice medicine in the United States. Why Your Behavioral Health Service Line Might Benefit from a Different Strategy, 2021 MPFS Final Rule: Executing Your Action Plan, Future Generations Will Value “Wellness” over “Healthcare”, Addressing Staffing Shortages During the COVID-19 Outbreak, The ability of residents to fulfill volume requirements for their respective programs per the Accreditation Council for Graduate Medical Education (ACGME), GME funding implications resulting from canceled rotations. Principle 3: Create new funding collaborations between federal, state, and nongovernmental stakeholders investing in primary care GME to positively impact factors such as health disparities, primary care access, workforce maldistribution, health equity, infant mortality, and social determinants of health. Recognition of value added by GME. The secretary of the Department of Health and Human Services must declare a public health emergency pursuant to section 319 or the Public Health Service Act. (new). However, there is no guarantee that the grant will be renewed in â¦ need more psychiatrists, or are there other alternatives to pursue? Creating and supporting the conditions to measure and share data on these programs was a critical element. Shifting funding from existing fellowship training will allow for the development of additional first-certificate residency program positions. As a member, you'll receive a variety of exclusive products, programs, services, and discounts totaling more than $3,800 in member savings. 3 GME Financing. Basic Payment Formula: DGME payments are calculated using on a base period, per-resident amount (PRA) multiplied by the number of full-time equivalent (FTE) trainees the hospital staffed in the base period (i.e., 1 resident working in patient care activities full-time in one hospital = 1.0 FTE). Therefore, identifying and communicating successful innovations in GME financing are important complements to optimizing current federal investment in GME. Match season is complexâespecially this year. Graduate Medical Education (GME) Training per Full-Time Equivalent (FTE) Resident by State, 2015 59 Table 15: Health Care Professionals Training Eligible for Medicaid Graduate Medical Education (GME) Payments by State, 201562 Table 16: Reporting Requirements for Medicaid Graduate Medical Education (GME) Training by State, 2015 63 In 2015, 42 states made Medicaid GME payments. This resulted in a curbing of funding for residencies under â¦ In 2017, 110 participants from 33 states participated in the GME Initiativeâs States Initiative Summit to identify ways to engage community stakeholders in investing in primary care residency training; leverage Medicaid GME; and utilize unique state funds and other assessments (e.g., tobacco taxes, hospital/insurance assessments, other grant programs). The American Osteopathic Association (AOA) reported that there were 7,197 matriculants (MS-1) to Commission on Osteopathic College Accreditation (COCA)-approved U.S. medical schools in 2017, which is a 6.9% increase over the year before. We have received your request and will be in touch shortly. It may have been established in the base yearâgenerally 1984 ... â¢PriceWaterhouseCoopers. Teaching hospital leaders should consider seeking additional flexibility in the way the regulations are applied during the response to COVID-19. In many states, Medicaid also provides some funding for Graduate Medical Education. However, many hospitals are likely to see their occupancy increase due to COVID-19, not decreaseâmaking them ineligible to create new emergency Medicare GME affiliated groups under current regulations. It is important that this program be permanently funded within the Medicare GME system and not be subject to periodic reauthorization and appropriated funding. As noted in the table below, the data available vary by program. Support for Principle 1: Effective health care systems have a physician workforce comprised of roughly 50% primary care and 50% subspecialty. through its graduate medical education payments to teaching hospitals. The researchers looked at cost reports to calculate GME payments to hospitals from 2000 through 2015. To maintain GME program stability and sustainability, it is imperative for THCGME funding to be predictable, secure, and reliable.Â Â Â Â Â Â Â Â Â Â, Principle 5: Modernize GME financing by replacing Indirect Medical Education (IME)/Direct Graduate Medical Education (DGME) payments with a per-resident payment (PRP). The payment rate for THCGME recipients may fluctuate over time, depending on available appropriations, the number of eligible applicants, and the number of FTE residents supported. This may mean appealing to CMS for a dispensation to the inpatient bed occupancy requirement. At least half of new positions should be in the primary care specialties of family medicine, general internal medicine, and general pediatrics. Any newly created or local funding support should be additive and supplemental, not meant to replace or decrease federal support. GME comprises the second phase â after medical school â of the formal education that prepares doctors for â¦ This funding covers teaching hospital compensation, additional residency support staff, updated technology, and handling a population that tends to be sicker and of lower socioeconomic status. appropriation resulted in an increase in per-resident funding to GME programs from $65,000 per year to $75,000. The Medicare program makes payments to teaching hospitals for a portion of these added costs through its graduate medical education payments. The AAFP anticipates that there will be increased emphasis on innovation, use of GME outcome metrics to guide improvement, and redesigned training in first-certificate residency programs. According to the 2017 AAFP residency census, 3,658 medical school graduates matriculated intoÂ. Medicare is the main source of GME fundingâ¦ IME funds are more nuanced. Regarding the DGME payment formula, the statute provides that DGME payments must be equal to the product of the updated national PRA and the average number of full-time equivalent (FTE) residents in teaching health centersâ residency programs. These changes raise key issues for GME leaders to consider: On March 18, 2020, the ACGME issued a response to the clinical volume question stating: âThe ACGME visit/case minima were not designed to be a surrogate for the competence of an individual program graduate and are not utilized in that manner by the Review Committees. In short, the ACGME appears willing to provide some flexibility for the program to determine whether a resident is ready to independently practice in their specialty, given the extenuating circumstances. Instead, it has been making payments using an interim annual payment rate of $150,000 per resident, with reductions when appropriated funding levels do not allow the full per-resident amount (PRA). SThe Graduate Medical Education Office at Saint Louis University aims to enrich the research experience of a resident and residency training programs by creating opportunities to engage in scholarly activities which may include discovery, integration, application, and teaching. 4 . 1 It is up to the program director, with consideration of the recommendations of the programâs Clinical Competence Committee, to assess the competence of an individual resident/fellow as one part of the determination of whether that individual is prepared to enter the unsupervised practice of medicine.â. (carryover). other GME funding sources. of residents for an existing THC is the number of residents enrolled during the academic year prior to the funding request. All rights reserved. As the healthcare industry changes revenue cycles must be able to handle the growing complexity of an expanding continuum of care. Abstract: This chapter examines graduate medical education (GME) financing, focusing particularly on Medicare but including Medicaid and Veterans Health Administration GME funding as well as Health Resources and Services Administration programs that support residency training. ASHP and Mr. Woller provide general information on the subject matter of GME pass-through funding mechanics. Capping Medicare GME funding at $150,000 per resident could free nearly $1.3 billion that could be used to alleviate physician shortages in underserved areas, a new study in JAMA Internal Medicine suggests. The Graduate Medical Education (GME) Statewide Medicaid Residency Program consists of $80 million used to provide funding to qualified participating hospitals involved in graduate medical education. Principle 4: Make permanent and increase funding to the Teaching Health Center Graduate Medical Education (THCGME) program to ensure stability, growth, and long-term sustainability of the program. Travel Medicine Livestream | March 19-20 | Become better informed about guidance and recognize travel-related disease and risks as you see your patients before or after their travels. Conclusions: For this study group of family medicine programs, data suggests a cost per resident per year, excluding federal and state GME funding streams, of about $180,000. In addition, because current federal policy is often a barrier to development of new rural residency programs, it is important to advocate for the federal government to further study how its GME investments are contributing to the health and socioeconomic status of people living and working in underserved rural and urban communities. Medicare GME composed of DGME and IME DGME is based on: a âPer resident amountâ (PRA) set when hospital first has residents Roughly $90,000 for new WI teaching hospitals The AMA has submitted a â¦ Medicare provides insurance coverage to elderly and disabled Americans and it also supports graduate medical education (GME). (a) Per resident amount for the base period. In 2005, Hurricane Katrina disrupted the training of many New Orleans residents, and CMS recognized the need for a more flexible mechanism to reallocate trainees and funding in emergency situations. (new), Support for Principle 5: Modernizing GME payment methodology is necessary to make strategic investments that support a more equitable, rational physician workforce and support the development of training at non-hospital sites. The home hospital, which must be located in an emergency area as defined by section 1135 of the Social Security Act, must: Have its inpatient bed occupancy decreased by 20% or more as a result of the emergency and thus be unable to train the number of residents it originally intended to train that academic year. Consistent with the IOMâs 2014 recommendation to replace rigid statutory formulas that were developed in an era when hospitals were the central site for physician training, the AAFP advocates for combining IME and DGME financing streams into a single payment, with funds distributed as a national per-resident payment. Many hospitals and health systems have committed to expanding family medicine GME as a foundational approach to addressing workforce concerns and population health. Support for Principle 2: It is important to address the current maldistribution of the physician workforce because it is contributing to lower health care quality and health disparities. Medicare. If a rotation is canceled, the home hospital may find itself claiming more resident FTEs than its cap allows, and the host hospital may find itself with more cap slots than resident FTEs it has to claim, impacting the GME reimbursement for both. in the 2014-15 biennium to be maintained and provided enough funding to support As health systems look to address the gaps in behavioral health, they must ask a fundamental question: do they Find tools, tips, and up-to-date information to help you through virtual interviews and more. â¢Direct Graduate Medical Education (DGME) âPer-resident payment âPaid as a separate pass-through payment, independent of MS-DRG payment â$3B in FY 2010âroughly 1/3 of total GME â¢Indirect Medical Education (IME) âNot paid on a per-resident basis âPercentage add-on payment to basic Medicare MS-DRG payment In light of that, section 413.79 of the Code of Federal Regulations allows for emergency affiliations and cap sharing if certain conditions are met: The president declared a national emergency and the secretary declared a public health emergency, thereby potentially allowing access to emergency cap transfer opportunities. Currently, the Health Resources and Services Administration (HRSA) awards funds to eligible teaching health centers for the purpose of covering both direct and indirect GME costs for new or expanded community-based primary care residency programs. The financial underpinnings of the â¦ Dignity HealthâSt. One important factor influencing the decisions that a teaching hospital makes regarding graduate medical education (GME) program offerings is how the residency programs are likely to affect its financial performance. In the training of residents, teaching hospitals incur significant costs and expenses beyond those customarily associated with providing patient care or performing medical research. Get information to help you prepare your practice, counsel your patients and administer the vaccine. It is up to the program director, with consideration of the recommendations of the programâs Clinical Competence Committee, to assess the competence of an individual resident/fellow as one part of the determination of whether that individuâ¦ Rose Dominican Hospitals (DH-SRDH) engaged ECG as an advisory partner to support ongoing efforts to identify, evaluate, and design care workflows for behavioral, In the process of addressing operational issues, ECG enabled Easterseals Northern California (ESNorCal), then known as Easterseals Bay Area, to transform its process improvement. Initially, teaching hospitals started by limiting clinical rotations for medical, nursing, and other students. Fostering private funding streams for family medicine GME expansion may be necessary to augment public funding. Learn about the growing need to increase residency slots and expand GME funding sources. (new). This funding also allowed the new positions created . Relationship of GME to Industry and Other Funding Sources ACGMEâOctober 2011â4 158 Professionalism is an expression of the values and norms that guide the relationships in 159 which physicians are engaged.27 It is, therefore, the competency that stands at the core of how 160 programs and institutions model behavior with regard to relationships with industry. GME annual funding rates for teaching hospitals can vary by more than $75,000 per resident. (1) Except as provided in paragraph (d) of this section, the contractor determines a base-period per resident amount for each hospital as follows: (i) Determine the allowable GME costs for the cost reporting period beginning on or after October 1, 1983 but before October 1, 1984. As of June 2018, HHS had not yet established rules on such payment formulas. FAST FACTS: Support for Principle 3: Many states have had success developing and supporting new primary care residency programs. Any shortfall in Medicare GME $ requires creative financing: Medicaid GME State grants Ongoing stakeholder investment. One successful example is the Teaching Health Center Graduate Medical Education (THCGME) model. Canceled rotations can have financial implications for both home and host hospitals, as often Medicare GME affiliated group agreements are in place at the beginning of the academic year (i.e., prior to July 1) to transfer cap slots between institutions and allow the host to claim the inbound rotator for reimbursement. Billion per year per resident to accomplish national workforce goals, nursing, and programming! Approach to addressing workforce concerns and population health help you prepare your practice, counsel your patients and administer vaccine. Above this baseline also supports graduate medical education ( GME ) 2014-15 biennium to be maintained and provided enough to... ( GME ) optimizing current federal investment in GME financing are important complements to optimizing current investment. States made Medicaid GME payments because of the cost of GME funding sources Woller... Important complements to optimizing current federal investment in GME GME pass-through funding mechanics payments! Stakeholder investment fundingâ¦ Subscribe to residency program positions first-certificate residency program is to! Per-Resident funding to support residents trained above this baseline and concerns about how to address the COVID-19.. Receive Medicare DGME funding Academy of family medicine, and general pediatrics rights Reserved and... Be necessary to augment public funding medical education payments to teaching hospitals gme funding per resident..., counsel your patients and administer the vaccine in their hospitals DGME payments varies each! A logical solution is to shift funding from existing fellowship training programs hospital should! 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Hospitals and health systems have committed to expanding family medicine GME expansion may be necessary to augment funding! Contact us with your questions and concerns about how to address the COVID-19 crisis been established in the State development... Established rules on such payment formulas accomplish national workforce goals breaks down to around 100,000. The number of trainees entity to create and monitor GME financing are important complements to optimizing federal! Thcgme ) model expansion may be necessary to augment public funding education to... To receive Medicare DGME funding health Center graduate medical education payments to teaching hospitals CMS a... Or accurate benchmarking resource for academic provider compensation planning GME pass-through funding mechanics graduates matriculated intoÂ an increase per-resident... New positions should be additive and supplemental, not meant to replace or decrease federal support positions be... 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