Lobbying for GME funding

Residency Program Insider, September 26, 2006

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Lobbying for GME funding

Since the United States Government passed the Medicare Law and agreed to support physician training in academic health centers, teaching hospitals have relied on these funds to support the majority of graduate medical education (GME) costs. Recently, however, tighter budgets and slashes in funding have caused a tailspin in funds.

The primary source of funding for all GME programs comes from the Federal Government through the Medicare program, which funds residencies in two ways:

  • Direct Graduate Medical Education (DGME) payments, which include the cost of a resident's salary, fringe benefits, and attending physician compensation. DGME is distributed evenly to residents, in a calculation known as per resident amount (PRA).

  • Indirect Medical Education (IME) payments, which cover the indirect costs associated with training residents; including ordering more tests, longer patient stays, sicker patient populations, and greater technological needs. IME payments are based on the number of residents working at hospital inpatient or outpatient services (e.g. the number of residents per hospital bed).

    While Medicare does an adequate job of funding teaching hospitals, when you review federal bills passed over the years for GME, the government has reduced its influence over time, and funding has become tighter and more restrictive, causing many hospitals to be more tight-fisted with funds distributed to GME.

    The Designated Institution Official's (DIO's) job is to keep the administration appraised of state and federal funding changes and to explain to those who work in finance that funds are needed for specific GME costs. Our charge from the Accreditation Council for Graduate Medical Education (ACGME) is to make sure that residents have a quality education and that we have a quality program. In order to obtain funds to maintain a quality program, the program directors and DIOs must convince their institutions to spend money in the graduate medical education department.

    One way of convincing elected officials, such as Graduate Medical Education Committee members, finance officers, and CEOs, is to show that productivity and patient care will improve. Do some research on these topics and put together a presentation outlining your ideas. In addition, if you have been cited by the ACGME during a site visit, show how increased funds will result in the correction of the citation. Keep in mind that ACGME requirements are minimums-a good way to convince higher-ups to increase funds is to remind them that you all want a program that performs beyond minimum requirements.

    Finally, all program officials must have a good relationship with their finance officer or the person that puts together the institution's cost report. Keep track of the latest changes in reimbursement and keep this person well informed of these changes. Understand the data needed for Medicare reports and know and maintain documentation for audits. Keeping on top of GME's financial situation will not only help you live up to your charge from ACGME, it will improve your relationships with relevant institution personnel.

    All the best,

    Gary D. Smith, Ed.D.

    Designated Institution Official
    Administrative director of medical education
    John Peter Smith Hospital
    Fort Worth, TX.

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