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Accountability and Transparency in Graduate Medical Education Expenditures

      Graduate medical education (GME) funding in the US supports over 110,000 residents and fellows each year.
      Accreditation Council for Graduate Medical Education (ACGME)
      Planning the Future of Graduate Medical Education: 2010 Annual Report.
      Funding is divided into direct medical expenditures (DME) (ie, salary and fringe) and indirect medical expenditures (a Medicare add-on to offset the extra cost teaching hospitals are thought to incur by having residents provide care). The passage of the Affordable Care Act combined with national and statewide fiscal shortfalls has caused the amount and administration of GME funding to come under greater scrutiny.
      111th Congress: 2009-2010
      H.R. 3590: Patient Protection and Affordable Care Act.
      • Igelhart J.K.
      The uncertain future of Medicare and graduate medical education.
      The Medicare Payment Advisory Commission (MedPAC) has called for greater transparency in GME funding and recommends residency programs be held financially accountable for the training resulting from public funds.
      Medicare Payment Advisory Commission
      Report to Congress: Aligning incentives in Medicare (June 2010).
      Recent discussions of the Joint Select Committee on Deficit Reduction (ie, the “Super Committee”) also have highlighted an opportunity to reduce GME payments as a mechanism to offset the nation's multi-trillion-dollar deficit.
      • Internal Medicine Residency Program Directors, representing 20% of all trainees in the country, confirm the belief that funds are not flowing transparently from Medicare to their hospitals and down to their training programs.
      • Less than 2/3 of directors made an attempt at obtaining funding information and less than half of these were successful at finding out.
      • Increasing the transparency and accountability of graduate medical education will help leverage GME's ability to act as a transformative force in American healthcare.
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      References

        • Accreditation Council for Graduate Medical Education (ACGME)
        Planning the Future of Graduate Medical Education: 2010 Annual Report.
        (Accessed October 30, 2011)
        • 111th Congress: 2009-2010
        H.R. 3590: Patient Protection and Affordable Care Act.
        (Accessed October 30, 2011)
        • Igelhart J.K.
        The uncertain future of Medicare and graduate medical education.
        N Engl J Med. 2011; 365: 1340-1345
        • Medicare Payment Advisory Commission
        Report to Congress: Aligning incentives in Medicare (June 2010).
        (Accessed October 30, 2011)
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