Success in Academic Surgery: Developing a Career in Surgical Education by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030191795
Publisher: Springer International Publishing

Overview of Current Funding for GME

Medicare

As a result of the Medicare Prospective Payment System (PPS) in 1983, Medicare payments for GME are administered through Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) funds. Before the inception of PPS, teaching hospitals were reimbursed for trainees’ education based on hospital cost. Currently, approximately 30% of GME Medicare funding is from DGME and the remaining 70% is from IME. DGME covers the direct cost of training residents which includes resident and faculty salaries, resident benefits, overhead cost and administrative cost. The calculation for DGME is comprised of a weighted resident count, per-resident amount (PRA) and a Medicare day ratio. The weighted resident count is based on residents within the minimum timeframe for board eligibility or within 5 years of training (whichever is earliest). Residents within the described timeframe are eligible to be counted for 1.0 full time equivalent (FTE) and others outside of the criteria are counted as 0.5 FTE. Unfortunately, the calculation of the PRA is based on hospital cost obtained in the mid-1980s. Consequently, hospitals that were judicious in their use of resources during that timeframe are penalized with less funding today. The Medicare day ratio is a ratio of the hospitals Medicare inpatient days to total inpatient days. The IME is a payment adjustment to offset increased use of cutting edge technology, higher acuity patients and the reduction in productivity secondary to resident involvement in clinical care.

The Balanced Budget Act (BBA) of 1997 placed a cap on Medicare-funded training positions which continues to this day; although it should be noted that despite the cap, there has been a 27% increase in residency positions since the BBA went into effect.

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