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Recent rule-making and agency interpretations by the
Centers for Medicare and Medicaid Services (CMS)
have created a chilling effect on physician
residency training programs across the country.
These residency programs are often the lifeblood for
essential health care services in rural communities
throughout Maine and the country. Unfortunately,
these actions by CMS have gone against Congressional
intent to expand and enhance residency training
beyond the hospital setting and to increase access
to care by improving the likelihood that physicians
will establish practices in these communities.
Congress included Graduate Medical Education (GME)
provisions in the Balanced Budget Act of 1997 (BBA)
so that teaching hospitals would not be adversely
impacted for non-hospital residency programs. The
aim was clear - train our future physicians outside
the traditional hospital environment to enhance
their training in facilities where they likely to
practice and increase the number of physicians
working in rural and underserved areas.
Unfortunately in August 2003, CMS decided to deny
GME payments to hospitals if the residency program
had not been totally supported by hospital funding.
The effect of this rule was that it has severely
jeopardized over 500 non-hospital based residency
training positions, which would adversely affect
thousands of poor, uninsured, underinsured, and
other individuals who were served in those
locations, including five existing residency
programs in Maine. At the Maine General Medical
Center in Augusta, Maine Medical Center in Portland,
Eastern Maine Medical Center in Bangor, Southern
Maine Medical Center in Biddeford, and Central Maine
Medical Center in Lewiston all are affected by this
decision by CMS.
If CMS' policies are not reversed, the education
and training of medical residents will be severely
and adversely affected. These policies could force
hospitals to train all residents in a hospital
setting, reducing the valuable experience that
future physicians gain by working in community
settings where they are likely to practice in the
future.
During negotiations culminating in the Medicare
Modernization Act (MMA) to establish a prescription
drug benefit within Medicare, I fought to include a
provision to help keep these residency programs
operating in community settings. These efforts
resulted in a one-year moratorium as of January 1,
2004 so that hospitals could continue to receive
payments for their family practice residency
programs this year.
The provision also required the Inspector General
of the Department of Health and Human Services (OIG)
to conduct a study on the appropriateness of
"alternative payment methodologies" for the costs of
training residents in non-hospital settings and
issue a report with recommendations to Congress no
later than one year after the law's enactment - in
other words by December 8, 2004.
We just recently received this OIG Report that
recommends before implementing any changes, CMS work
with Congress to further analyze the current
financial arrangements and incentives among teaching
hospitals, nonhospital settings, and supervisory
physicians in nonhospital settings; study the
potential impact of any revisions to the current
policy, and clarify the definition of the costs
associated with training residents in nonhospital
settings.
This OIG Report while not making any definitive
recommendation, will be the starting point for my
continuing efforts next year to help teaching
hospitals retain their residency programs. With the
existing moratorium scheduled to expire on December
31, 2004, I urge CMS to defer denying GME payments
to hospitals until Congress has had an opportunity
to review this report. I will continue my
longstanding efforts to pass legislation - if
necessary - next year to find a permanent solution
to this problem.
The federal government should be giving our
underserved communities the tools they need to help
their citizens live better, more healthy lives.
Allowing medical residents to gain the experience
they need by training in community health centers,
physician offices and other settings outside the
hospital has been done for years and just makes good
sense.
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