But the allocation course of put forth to place these new residency slots is overly prescriptive, its deadlines don’t align with residency program academic cycles, and the rule likely goes beyond what Congress intended.
Fairness in med ed resources
The AMA is committed to supporting the efforts of medical colleges to dismantle structural racism and improve range in the physician workforce.
Funding for 1,000 new Medicare-supported GME slots was included in the $2.3 trillion Consolidated Appropriations Act of 2021. Particulars concerning the allocation of these residency positions were included within the 2022 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals closing rule printed by the Centers for Medicare & Medicaid Providers (CMS).
The legislation calls for adding up to 200 positions yearly, and states that no hospital can get more than 25 new full-time equivalent residency positions in total.
It also requires that at the least 10% of the slots be placed in each of the following categories of hospitals which can be:
– In rural areas.
– Training residents over their Medicare GME cap.
– In states with new medical colleges or branch campuses that have opened since 1999.
– Serving areas designated as health skilled scarcity areas (HPSAs).
“The AMA hopes that this funding in extra Medicare-funded residency slots is just the primary of many,” wrote AMA Govt Vice President and CEO James L. Madara, MD, in a letter to CMS Administrator Chiquita Brooks-LaSure (PDF).
Why it’s important: While new medical colleges are opening and existing medical schools are increasing enrollment to satisfy the necessity for more physicians, federal help for residency positions remains topic to a stagnated federal cap. The U.S. is going through a shortage of as much as 124,000 physicians by 2034, including as many as 48,000 main care doctors, according to the Affiliation of American Medical Faculties.
The ultimate rule with comment interval builds off the April 2021 IPPS proposed rule. Though some adjustments were made in the ultimate rule, a majority of the AMA’s suggestions were not taken. In feedback on the ultimate rule, the AMA famous significant considerations.
The deadline for CMS to announce new slots was moved to March 31. Whereas this does give packages more time to plan, the AMA advocates moving the deadline to Oct. 1 so it aligns with residency-recruitment cycles.
The rule permits just one new slot each program year, to not exceed 5 years or 5 full-time equal (FTE) positions. This needs to be expanded up to 3 FTEs a year for a total of 15 over a 5-12 months interval, permitting for more significant enlargement of present packages.
In the meantime, the distribution methodology doesn’t adhere to statutory intent. Apart from the qualification that a minimum of 10% of latest slots be positioned in HPSAs, the laws doesn’t give such amenities preferential remedy. However the rule does, giving hospitals exterior of HPSAs the lowest priority. CMS should prioritize slot distribution based solely on the 4 categories included in the law and provides priority to hospitals that qualify in more than one of the classes.
Related Coverage
Geographic limits interfere with patient choice. CMS remains to be working on how you can account for care delivered exterior of an HPSA’s geographic boundaries to residents of a scarcity area. The AMA strongly opposes a proposed requirement that the hospital or division be physically positioned in an HPSA. Patients who reside in shortage areas could select to go to a teaching hospital outside of the HPSA as a result of it’s the closest facility or supplies providers which can be unavailable elsewhere.
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