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Graduate Medical Education That Meets the Nation's Health Needs (2014) / Chapter Skim
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Appendix F: Illustrations of the Phase-In of the Committee's Recommendations
Pages 203-210

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From page 203...
... EXAMPLE OF A PHASED-IN ALLOCATION OF MEDICARE GME FUNDING TO THE OPERATIONAL AND TRANSFORMATION FUNDS Aggregate funding levels in the Operational Fund will be reduced initially to 90 percent of current graduate medical education (GME) funding levels and transition to 70 percent by Year 5.
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From page 204...
... Other specialty hospitals include psychiatric facilities, rehabilitation hospitals, other. CHGME = children's hospital graduate medical education; DGME = direct graduate medical education; GME = graduate medical education; IME = indirect medical education; OF = Operational Fund; PRA = per-resident amount; TF = Transformation Fund.
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From page 205...
... Next, we calculated an average GAF-adjusted IME payment per resident for general acute care hospitals that would be budget neutral to estimated IME payments if IME operating payments were reduced by 50 percent, consistent with the Medicare Payment Advisory Commission's finding that the current levels are twice the amount empirically attributable to higher patient care costs (MedPAC, 2010)
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From page 206...
... DGME $2,910 79,278 $36,700 Adjustment for –$2 –3,317 $565 children's hospitals Net DGME for $2,908 75,961 $38,280 $37,300 combined PRA IME: PPS $6,996 78,625 hospitals only 50 percent reduction in –$3,318 operating IME Net IME for $3,678 $46,775 $43,435 combined PRA Combined PRA for residents in initial $80,735 residency period Combined PRA for residents beyond $62,085 initial residency period Weighting factor for residents 77% beyond initial residency period NOTE: DGME = direct graduate medical education; GAF = geographic adjustment factor; IME = indirect medical education; PPS = prospective payment system; PRA = per-resident amount. SOURCE: IOM analysis of the 12/31/13 CMS Healthcare Cost Report Information System update.
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From page 207...
... Nevertheless, the illustration uses the resident counts to determine IME and DGME payments under current Medicare policies. The committee suggests that a single policy for counting residents (with appropriate weighting)
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From page 208...
... –33% –17% 5: => 58.1 percent 204 5,794 $340 $726 $487 $184,124 (100,055) –32% –22% Medicare discharge quintile 1: < 1,941 discharges 203 6,140 $145 $276 $533 $68,573 18,167 –31% 58% 2: 1,941–3,558 discharges 203 10,039 $339 $625 $891 $96,081 (7,374)
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From page 209...
... –33% 28% NOTE: DGME = direct graduate medical education; IME = indirect medical education; PRA = per-resident amount.
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Key Terms

  • medical education
  • graduate medical
  • gme funding
  • initial residency
  • indirect medical

  • direct graduate
  • medicare payment
  • total gme
  • ime payments
  • residency period

  • geographic adjustment
  • payment advisory
  • residents beyond
  • medicare gme
  • dgme funding

  • current ime
  • ime payment
  • gme payments
  • dgme payments
  • care hospitals

  • cost report
  • transformation funds
  • operational fund
  • budget neutral
  • amount table

  • adjustment factor
  • acute care
  • operating payments
  • resident counts
  • funding levels


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