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Wednesday, Aug. 28, 2013

For Residents

New Medicare payment rule will affect GME funding

A newly released final rule for the Medicare inpatient prospective payment system for 2014 has significant implications for the nation's teaching hospitals, according to the Association of American Medical Colleges.

While the new rule offers hospitals more in uncompensated care payments, the Centers for Medicare & Medicaid Services (CMS) will no longer allow teaching hospitals to count and be reimbursed for time residents train at critical access hospitals.

Among other changes, labor and delivery days will be considered inpatient days for purposes of determining the Medicare share for direct graduate medical education (DGME) payments. DGME payments cover a portion of the direct costs of training residents, such as residents' stipends and benefits, teaching physicians' salaries, and accreditation fees.

Visit the AMA's Graduate Medical Education (GME) financing resource Web page to learn more about how your residency funding works.

Academic health centers could face "perilous future"

Though currently esteemed as the apex of American health care, academic health centers face challenges with the increasing focus on the cost of care that has come with health care reform, according to a recent viewpoint article in the Journal of the American Medical Association (JAMA).

Author Victor Fuchs believes that the emphasis on eliminating "waste" disproportionately affects academic health centers, especially because they often are facilities equipped to provide optimum care with the latest technology. This leaves the question of whether more expensive, technologically advanced care should be used simply because it is available.

Fuchs argues that more detailed, sophisticated research is needed to identify which interventions provide a benefit to the patient that outweighs the expected cost.

These considerations have a special impact on physicians in training. Teaching residents to weigh the cost of care against the absolute best course of treatment for the individual patient is controversial. At the same time, residents are training primarily in the hospital setting, despite the fact that the number of inpatient days per capita continue to decrease and the popularity of treating in the outpatient setting continues to increase.

Graduate medical education will have to adapt to allow trainees to experience both inpatient and ambulatory settings, but funding remains a key issue. More efficient training is needed, Fuchs writes, as the cost of medical education (both direct and indirect) increases with the length of training.

Comparing medical education with the training of other professionals, Fuchs points out that it is rare for a subspecialist to obtain certification only 14 years after high school graduation. The top engineering schools in the country, meanwhile, turn out specialists (there are 17 distinct options at Stanford) just four years after high school graduation. At the same time, judging by SAT scores, the medical and engineering students at Stanford are roughly intellectual equivalents.

While adapting to changing times is never easy, the early responses among academic health centers has been encouraging. Some hospitals and clinics are transforming into accountable care organizations, while other medical schools are experimenting with shorter training. Only time will tell whether their efforts will be enough to maintain the marquee position of academic health centers in the American health care system.

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