Graduate Medical Education
in an era of uncertain financing
John S. Andrews, MD
Associate Dean for Graduate Medical Education
University of Minnesota Medical School
• The health of graduate medical education is
dependent upon hospitals’ willingness to pay
for it.
• The number and type of physician being
trained is determined by local economic
concerns, not by workforce analysis
1.0
0.3
Medicare GME
Medicaid
2.0
VA
CHGME
Private payer
9.5
Department of Defense
Federal funding history
• Medicare 1965
– Support for GME until society undertook to “bear such
education costs in some other way.”
• Balanced Budget Act 1997
– Support capped
• Obama budget 2013
– Reduce IME by $9.7 billion over 10 years
– IME adjustments “significantly exceed the actual added
patient care costs these hospitals incur” (MedPAC)
– Incentives
– Reduced CHGME IME
Funding
• DME (~$25,000/resident)
–
–
–
–
Hospital cost report
Medicare’s share of residency education
Resident/faculty salary & fringe
Overhead and direct costs
• IME (~$50,000/resident)
– Higher patient care costs
– Increased inpatient DRG rates
• Varies by hospital
• Fellows ½ DME
Workforce
• AAMC: Shortage of 62,900 physicians by 2015
– 15% increase in federally-funded GME slots
•
•
•
•
Affordable Care Act
16 new medical schools
National Healthcare Workforce Commission
IOM Committee on Governance and Financing
of Graduate Medical Education
The Cap
• Locally
– Federally funded cap = 1091
– Budgeted FTE 2013-14 = 1275
• Nationally
– 9000 over cap
• Additional resources are already being
committed to GME
The Future
•
•
•
•
Less money per resident
No more CMS slots
Funding tied to outcomes
Non-government funds
– Health systems
– Clinical dollars
• Preference for subspecialties
Questions
• Primary care?
• Payers
– Explicit vs. implicit support?
• Health outcomes?
• Non-hospital activities
– Administration
– Next Accreditation System
John S. Andrews, MD
612-626-4009
[email protected]