Achieving Accountability for Graduate Medical Education

atulAtul Grover, MD, PhD
Executive Vice President
Association of American Medical Colleges
Washington, DC

“Accountability” is a word that comes up often in all aspects of my professional endeavors, whether it is the emergence of accountable care organizations (ACOs) — which have eclipsed the health maintenance organizations (HMOs) of a generation ago — or the employee accountability required to effectively run any large organization, agency, or association. Additionally, Congress has directed the administration to implement “pay for performance” for physicians — reimbursement based on the cost and quality of the outcome of the care we provide, no longer simply based on the volume of services provided.

The call for accountability in graduate medical education (GME) — including for Medicare indirect medical education (IME) payments — is a recommendation that represents common ground for both those who are confident, as I am, that Congress needs to increase Medicare GME support as part of a broader strategy for avoiding a worsening physician shortage, and those who believe GME expansion is unwarranted.

AAMCThe Association of American Medical Colleges (AAMC) has played a leading role in championing GME accountability and transparency, along with targeted health care delivery and financing reforms, as part of a larger strategy of expanding the number of Medicare-supported residencies. We believe that greater transparency around the GME funding academic health centers (AHC) receive only strengthens our arguments.

Members of Congress in both parties also believe that a gradual, responsible increase in Medicare support for physician training and the development of new GME accountability standards go hand in hand. We expect the “Training Tomorrow’s Doctors Today Act”— which was introduced but not acted upon in the last Congress — will be reintroduced this year. The last version of the bill had broad-based support from nearly 20 physician, hospital, and other groups, including the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. This bipartisan bill couples support for training an additional 3,000 to 4,000 physicians a year for the next five years with accountability measures (patient care priority measures), performance standards and reporting requirements that lead to greater transparency. Here’s what the legislation would do:

  • Create Patient-Care Priority Measures. These measures would encourage training in a variety of settings, enhance education about the cost and benefits of care and improve patient care coordination. The Secretary of the U.S. Department of Health and Human Services (HHS) would develop the measures as previously identified by the Medicare Payment Advisory Commission (MedPAC) and endorsed by an accrediting organization.
  • Establish Performance Standards and Reporting Requirements. The HHS Secretary would develop standards for compliance with these measures. Failure to meet them would trigger penalties, including a reduction in a hospital’s Medicare IME payments of up to two percent.
  • Increase Transparency. Within two years of the bill becoming law, the HHS secretary would issue an annual report on Medicare GME payments, including a variety of data such as the Medicare direct GME (DGME) and IME payments received by each hospital, along with its DGME costs and the total number of residents training there. The annual report also will report on additional factors like unique, vital clinical care services that contribute to higher patient care costs.
  • GME Expansion. The bill would increase the number of Medicare-supported GME slots by 3,000-4,000 positions for five years. Current projections show a shortage of up to 90,000 physicians by 2025, with approximately two-thirds of those in medical and surgical specialties like neurosurgery. This would allow the nation to meet about a quarter of the physician shortage that has been projected over the next 10 years while we test new delivery models and enhance team-based care. At least half of the new residency positions would be in key shortage areas identified by Government Accountability Office (GAO), and include both primary and specialty care.

The AAMC strongly supports this bipartisan legislation. Accountability is key to making sure that the next generation of doctors receives the training they need to provide the highest quality care to their patients.  We look forward to its reintroduction in the U.S. House of Representatives and working with members on both sides of the aisle, as well as medical education stakeholders, on this critically important issue.

Editor’s Note: During the month of March, we encourage everyone to join the conversation online by using the hashtag #gmemonth.

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