Skip to main content

Currently Skimming:

4 Governance
Pages 107-130

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 107...
... Federal GME funding is guaranteed except for a requirement that residency programs be accredited to receive federal support. GME accreditation is essential to ensuring that GME programs meet professional standards and produce physicians that are ready to enter practice with required knowledge, experience, and skills.
From page 108...
... No one entity oversees the GME system -- particularly with respect to the use of public monies -- and comprehensive information on the standards and processes that GME governance comprises is not available. Other than a requirement that residency programs be accredited by the Accreditation for Graduate Medical Education (ACGME)
From page 109...
... on various GME related issues. NOTES: ABMS = American Board of Medical Specialties; ACGME = Accreditation Council for Graduate Medical Education; AOA = American Osteopathic Association; CMS = Centers for Medicare & Medicaid Services; COPTI = Council on Osteopathic Postgraduate Training Institutions; DGME = direct graduate medical education; HRSA = Health Resources and Services Administration; IME = indirect graduate medical education.
From page 110...
... The legislative record regarding the original intent of Medicare GME funding is somewhat ambiguous. It is unclear, for example, whether the original intent for the program went beyond physician training to include other health professionals.
From page 111...
... As Chapter 1 notes, the committee agreed that Medicare GME funding should be explicitly purposed to encourage production of a physician workforce better prepared to work in, to help lead, and to continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost. Many researchers, ­ policy makers, and stakeholders have articulated similar objectives for physician training (ACP, 2011; AHA, 2012; Boult et al., 2010; COGME, 2000, 2007b, 2010, 2013; Fuchs, 2012; Ludmerer, 2012; Ludmerer and Johns, 2005; MedPAC, 2009, 2010; Reddy et al., 2013; Salsberg, 2009; Skochelak, 2010; Weinstein, 2011)
From page 112...
... . Although not directly accountable for GME funding, several federal advisory groups and research centers, described below, are engaged in relevant activities: • Council on Graduate Medical Education (COGME)
From page 113...
... . However, because Medicare GME funding accounts for less than 2 percent of total Medicare spending, it is not a princi pal MedPAC focus.
From page 114...
... As a result, many of the most fundamental questions about the outcomes and effectiveness of the Medicare GME program are currently unanswerable. These include, for example: • What is the financial impact of residency training programs on teaching hospitals and other GME training sites that sponsor them?
From page 115...
... NOTE: CMS = Centers for Medicare & Medicaid Services; DGME = direct graduate medical education; FTE = full-time equivalent; GME = graduate medical education; HRSA = Health Resources and Services Administration; IME = indirect medical education.
From page 116...
... 6  The CHGME reporting requirements were introduced in its 2006 reauthorization. When this report was drafted, future CHGME funding was uncertain.
From page 117...
... of Certification American Comprehensive Council on 18 Bureaus of AOA Council Osteopathic Osteopathic Osteopathic Osteopathic on Continuing Association (AOA) Medical Licensing Postdoctoral Specialists Medical Examination Training Education Stage in Physician Education Continuum National Board of Osteopathic Allopathic Medicine Medical Examiners Osteopathic Medicine FIGURE 4-1 Program accreditation and physician certification and licensure.
From page 118...
... Although it is voluntary, most physicians pursue certification. Board certification -- which does not qualify programs for federal GME funding -- is a designation conferred by one or more of the specialty boards and is intended to ensure the public that certified physicians have the knowledge, experience, and skills that the relevant board deems necessary for delivering high-quality care (ABMS, 2013a,b; Shaw et al., 2009)
From page 119...
... specialty develop and administer boards certifying exams RRCs Have delegated authority from RRC members are nominated by the the ACGME to set standards for AMA Council on Medical Education, and accredit residency training ABMS, and the Council of Medical programs Specialty Societies. NOTES: AACOM = American Association of Colleges of Osteopathic Medicine; AAMC = Association of American Medical Colleges; ACCME = Accreditation Council for Continuing Medical Education; AHA = American Hospital Association; AHME = Association for Hospital Medical Education; AMA = American Medical Association; AMOPS = Association of Military Osteopathic Physicians and Surgeons; AODME = Association of Osteopathic Directors and Medical Educators; BOH = Bureau of Hospitals; BOME = Bureau of Osteopathic Medical Educators; CMSS = Council of Medical Specialty Societies; ECFMG = Educational Commission for Foreign Medical Graduates; FSMB = Federation of State Medical Boards; GME = graduate medical education; NBME = National Board of Medical Examiners; NMA = National Medical Association; OPTI = Osteopathic Postdoctoral Training Institution.
From page 120...
... 120 GRADUATE MEDICAL EDUCATION TABLE 4-4 GME Governance: Standard Setting, Accreditation, Certification, and Licensing Organizations Other Osteopathic Specialty Colleges BOE & AOA Board Specialty Boards Specialty Boards Other Medical Osteopathic of Trustees NBOME ACGME ECFMG COPTI NBME ABMS COPT PTRC RRCs BOS Functions Sets standards: GME training programs GME training institutions Specialty certification GME Osteopathic Consortia Accredits: GME training programs GME training institutions GME Osteopathic Consortia Certifies: IMG trainees' eligibility for GME Specialty board certification of individual trainees Physician licensing NOTES: ABMS = American Board of Medical Specialties; ACGME = Accreditation Council for GME; AOA = American Osteopathic Association; BOE = Bureau of Osteopathic Education; BOS = Bureau of Osteopathic Specialists; COPT = Council on Postdoctoral Training; COPTI = Council on Osteopathic Postdoctoral Training Institutions; ECFMG = Educational Commission for Foreign Medical Graduates; GME = graduate medical education; NBME = National Board of Medical Examiners; NBOME = National Board of Osteopathic Medical Examiners; PTRC = Osteopathic Program & Training Review Council; RRC = Residency Review Committee. pare physicians for contemporary health care delivery (AOA, 2013b; Buser and Hahn, 2013; Nasca et al., 2010)
From page 121...
... Performance Metrics Performance metrics that are tied to financial incentives are increasingly used by CMS, private payers, and others to improve the delivery and outcomes of health care (Berenson et al., 2013; GAO, 2012; Kaiser Health News, 2012; National Quality Forum, 2013; RTI International and Telligen, 2012)
From page 122...
... In its 2010 review of the educational priorities in GME financing, MedPAC recommended that Medicare's GME payments be performance based and contingent on agreed-upon objectives for the GME system (without systematically advantaging or disadvantaging particular types of training institutions or programs) (Hackbarth and Boccuti, 2011; MedPAC, 2010)
From page 123...
... Under the status quo, there are no mechanisms or basic infrastructure to make this possible. The Medicare GME program clearly needs an organizational infrastructure for strategic policy development and implementation and program oversight.
From page 124...
... • Regulatory authority to administer Medicare GME spending and oversee GME payment policies -- The governing entities should have the ability to collect administrative data and to direct changes in practices. This requires a close organizational linkage with the Medicare program.
From page 125...
... . ACGME (Accreditation Council for Graduate Medical Education)
From page 126...
... 2013. Towards graduate medical education accountability: Measuring the outcomes of GME institutions.
From page 127...
... 2013. Accelerating physician workforce transforma tion through competitive graduate medical education funding.
From page 128...
... 2001. Chapter 10 -- Treatment of the initial residency period in Medicare's direct graduate medical education payments.
From page 129...
... Recom mendations for graduate medical education to meet the needs of the public. Proceedings of a conference sponsored by the Josiah Macy Jr.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.