Advocacy

Graduate Medical Education (GME)

CAFM “Ask”

CAFM is asking Congress to modernize GME with a system in which Medicare and Medicaid (as well additional funding from private insurers) directly pay primary care residency programs.  This system, explained in the below graphic, would do a more efficient job of ensuring that training can be adequately funded in an ambulatory setting.  Our proposal does realize that at least some training will likely be done inside of a hospital as well.  The proposal calls for a purchasing agreement between the program and the hospital in this case.  For a full description of the proposal, please see our policy paper, entitled Modernizing Graduate Medical Education to Produce a Healthy America. The paper also contains the following graphic, which offers a great visual guide to the policy proposal.

Talking Points

• Payment for training should be made from Medicare directly to the training program – not the hospital – to allow programs to offer the kind of training necessary to meet community needs and be accountable for the training (see bottom graphic)
  

• The graduate medical education system does not support primary care training in all sites where care is delivered. The funding should follow the resident for the best training (see top graphic)

• The residency program must meet accreditation standards and is responsible for the product, but doesn’t have control of funding to ensure appropriate training. As the Council on Graduate Medical Education (COGME) has stated in its May 5 letter to Congress:

• “The nearly $10 billion spent annually on GME (Medicare and Medicaid) is neither monitored nor regulated by the Federal government.  Instead, the GME program portfolio is largely driven by the workforce needs of teaching hospitals. Current GME trends are not consistent with developing a more cost effective primary care-based health care system.”
  

• Incentives to attract medical students into primary care and educational reform are a necessary part of health care reform.

• Medicare GME funding was provided to ensure training of physicians to have enough well-trained physicians to care for the elderly. Successful health care reform will be adding 47 million new covered lives. In addition to the need for more primary care physicians to provide care for these additional lives, we know that a higher proportion of primary care physicians is associated with increased quality and decreased costs.

• Incremental reform to remove disincentives for training in non-hospital settings has been tried. It didn’t work. We don’t have the luxury of trying another incremental approach. It is time for a new, bold attempt to reform primary care training.

• All payers, including Medicare, have a duty to ensure the production and training of the physician workforce sufficient to provide care for the nation. If 2/3 of the 47 million currently uninsured find coverage through private insurers, the population covered through the private market will total approximately 200 million people. An annual contribution of $20 per beneficiary ($1.65/person/month) would garner $4 billion; an amount sufficient to ensure an adequate and well-trained primary care workforce. Moreover, this can be accomplished without interruption or decrease in the current funding of teaching hospitals.

• Health reform is about coverage AND care. Insurers can provide the COVERAGE; physicians must provide the CARE. We must produce more primary care physicians.

Committees and Agencies of Jurisdiction

House Committee on Ways and Means
Senate Finance Committee
Centers for Medicare and Medicaid Services

Current Landscape

CAFM is spreading the word about our policy on Capitol Hill, in an attempt to roll our ideas into the health reform package.

Currently, Sen. Nelson (D-FL) and Rep. Crowley (D-NY) are seeking co-sponsors for S. 973 and H.R. 2251, respectively.  This bill, the "Resident Physician Shortage Reduction Act of 2009," is not supported by CAFM in its present form.  To read why we do not currently support the bill, please see this email, sent by Hope Wittenberg to the academic family medicine listservs. 

Resources

Family Medicine's GME Proposal

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