What is the federal funding for graduate medical education?
Mar 21, 2022 · With the establishment of Medicare in 1965, Congress acknowledged the need to support medical education as well as patient care. Medicare Part A pays hospitals on a “cost of service” basis. GME costs are explicitly approved for inclusion in teaching hospitals' calculation of “reasonable costs.”
Why did Congress create Medicare in 1965?
Feb 19, 2019 · Medicare Graduate Medical Education Payments: An Overview The federal government makes significant investments in graduate medical education (GME) funding through various programs that support medical residency training; it invested an estimated $16 billion in 2015. A Government Accountability Office (GAO) analysis released in 2018
Is GME funded by Medicare or Medicaid?
Direct Graduate Medical Education (DGME) Section 1886 (h) of the Act, as added by section 9202 of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. L. 99-272) and implemented in regulations at existing §§413.75 through 413.83, establish a methodology for determining payments to hospitals for the costs of approved graduate medical education …
How are Medicare DGME payments paid to teaching hospitals?
With the advent of the Medicare prospective payment system (PPS) for acute care hospitals in 1983, two separate GME funding streams were established for teaching hospitals 2: (1) Direct Graduate Medical Education (DGME) funding to cover the direct expenses associated with residency training (e.g., residents' and faculty salaries and benefits and certain administrative …
Where does GME funding come from?
GME is funded by multiple mechanisms, including federal, state, and private entities, with the federal government being by far the largest contributor to GME funding. The mechanism by which federal funds flow is through Direct GME (DGME) and Indirect Medical Education (IME).Dec 16, 2019
Why does Medicare fund GME?
Medicare GME payments are intended to cover Medicare's share of the costs of operating a GME program and the higher costs of teaching hospitals relative to non-teaching hospitals.Feb 19, 2019
What is GME Medicare?
• Direct GME (DGME) is the amount. Medicare pays the hospital for Medicare's. share of the direct cost of the residency. – Resident salaries, faculty teaching, administration, building maintenance, personnel, etc.
How Does Medicare pay GME?
Medicare direct GME payments are calculated by multiplying the PRA times the weighted number of full-time equivalent (FTE) residents working in all areas of the hospital (and non-hospital sites, when applicable), and the hospital's Medicare share of total inpatient days.Apr 15, 2022
How does GME funding work?
Direct GME payments are based on current costs and are paid either through a disbursement agreement with the sponsoring organization or directly to residents. Accredited residency and fellowship years are fully funded.
What is the purpose of GME?
The Graduate Medical Education Committee (GMEC) supervises, coordinates, reviews and assures quality education of all graduate medical education programs, which includes training programs for interns, residents, and fellows.
What is Medicare IME?
The indirect medical education (IME) and disproportionate share hospital (DSH) adjustments to Medicare's prospective payment rates for inpatient services are generally intended to compensate hospitals for patient care costs related to teaching activities and care of low income populations.
What is a GME cap?
Medicare sets caps on both of its types of physician graduate medical education (GME) payments (direct and indirect) to teaching hospitals. Caps on these payments determine the number of physician trainees—known as residents—that each payment type supports.May 21, 2021
How are teaching hospitals typically reimbursed?
How are teaching hospitals typically reimbursed? Rationale: For teaching hospitals, the services of the resident are typically paid through Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payment or reasonable cost payments made by the Part A MAC.
What is the 5503 FTE cap?
Section 5503 of the Affordable Care Act provides for reductions in the direct GME and IME FTE resident caps for certain hospitals, and authorizes a “redistribution” to certain hospitals of the estimated number of FTE resident slots resulting from the reductions. Effective for portions of cost reporting periods occurring on or after July 1, 2011 for direct GME and IME, a hospital's FTE resident caps will be reduced by 65 percent of the “excess” resident slots if its “reference resident level” is less than its “otherwise applicable resident limit.” The Secretary is authorized to increase the otherwise applicable FTE resident cap for each qualifying hospital that submits a timely application by a number that the Secretary may approve, effective for portions of cost reporting periods occurring on or after July 1, 2011. Section 5503 specifies that the slots are to be distributed in the following manner: 70 percent of the resident slots are to be distributed to hospitals located in States with resident-to-population ratios in the lowest quartile, and 30 percent of the resident slots are to be distributed to hospitals located in a State, a territory of the United States, or the District of Columbia that are among the top 10 States, territories, or Districts in terms of the ratio of Health Professional Shortage Area (HPSA) population to the total population, and/or to hospitals located in rural areas. Hospitals not located in these states or in a rural area do not qualify for redistributed slots. CMS issued a listing of which hospitals would receive additional slots under section 5503 on August 15, 2011, with the effective date of the slots retroactive to July 1, 2011. To see the list of awardees, see the link below called Section 5503 Cap Decreases and Increases - Posted 8/15/2011 .
What is section 1886?
Section 1886 (h) (4) (F) of the Act established limits on the number of allopathic and osteopathic residents that hospitals may count for purposes of calculating direct GME payments.
Why are GME and IME FTE slots lost?
Prior to the passage of the ACA, generally, if a teaching hospital closed, its direct GME and IME FTE resident cap slots would be “lost,” because those slots are associated with a specific hospital's Medicare provider agreement that has terminated.
What is DGME in medical?
Direct Graduate Medical Education (DGME) Section 1886 (h) of the Act, as added by section 9202 of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. L. 99-272) and implemented in regulations at existing §§413.75 through 413.83, establish a methodology for determining payments to hospitals for the costs ...
When was the base period for Medicare?
The base period is, for most hospitals, the hospital's cost reporting period beginning in FY 1984 (that is, the period of beginning between October 1, 1983, through September 30, 1984). Medicare direct GME payments are calculated by multiplying the PRA times the weighted number of full-time equivalent ...
What does GME mean?
In simple terms, GME means residency and fellowship. This is an easy distinction for us to make but, to the general public, this is often a point of confusion. GME is funded by multiple mechanisms, including federal, state, and private entities, with the federal government being by far the largest contributor to GME funding. ...
How many residents does the THCGME program support?
This is one of the few opportunities to increase GME funding outside of direct Medicare-supported positions. The THCGME Program currently supports 728 residents and has the added benefit ...
When did CMS limit GME funding?
CMS had no spending limits for GME spending, until the Balanced Budget Act of 1997. With that act, Congress capped the number of residents that would be paid for under DGME funding. 4 Multiple presidential budgets have come out since then, some asking for increasing GME funding and some asking to limit GME funding.
When did GME start?
The History of GME Funding. GME funding has a long history that goes back to the early 1900s. Back then, training institutions and hospitals paid their own money to train residents. In 1965 when Congress created Medicare, they knew that an increase in health coverage would require a concordant increase in physicians that could not be solely ...
What is the Resident Physician Shortage Reduction Act?
The “Resident Physician Shortage Reduction Act of 2019” (S.348) is a bill that has been discussed among Congressional leadership for multiple years but has recently found new life. This bill, sponsored by Sen. Robert Menendez (D-NJ), would increase GME slots by 15,000 over a 5-year period.
What is the NHSC program?
The bill also further funds the National Health Service Corps (NHSC) which is an important program that allows physician’s unique help with loan repayment if they practice in a physician shortage area.
Is GME funding proportioned correctly?
There is an argument that GME funding is currently not proportioned correctly. In 2016, the Medicare Payment Advisory Commission (MedPAC) found that IME payments may be overestimating the indirect costs of residency training.
Does a hospital count bench research?
For DGME payments, a hospital may count the time a resident spends performing research, including bench research, as long as the research takes place in the hospital and is part of an approved training program. For IME payments, a hospital may only count the time a resident spends performing clinical research that is associated with the treatment or diagnosis of a particular patient.
Do children's hospitals receive Medicare?
Because children’s hospitals treat few Medicare patients, they receive very little funding from the Medicare program for their GME expenses. However, these hospitals are eligible to receive payments through the Children’s Hospitals GME (CHGME) Payment Program, which is funded by Congress through general federal appropriations dollars and administered by the Health Resources and Services Administration. This program generally follows the Medicare rules for counting residents and setting caps on the number of funded positions. More information on the CHGME program is available
What percentage of hospitals have one or both caps?
Medicare data show that in 2018, 70 percent of hospitals were over one or both caps on Medicare-funded residents, and 20 percent of hospitals were under one or both caps.
Do physicians practice medicine independently?
Fast Facts. Before physicians practice medicine independently, they receive on-the-job training as residents in teaching hospitals. These residents are vital providers of health care during their training, and many stay in the geographic area to practice after their training is completed. Medicare pays these hospitals to offset some of the costs ...