The Institute of Medicine called for a major overhaul of the United States' graduate medical education (GME) system in a report released today.
The federal government spends about $15 billion a year on funding for GME, with the bulk of that--nearly two-thirds--coming from Medicare. Although the report calls for the government to maintain current levels of public funding, it also recommends it change the way Medicare funds physician training over the next 10 years.
"The system has evolved over the many, many years; there's been attempt to both provide some funding to the institutions for potential additional costs associated with training," Dave Asprey, Ph.D, an IOM committee member and physician assistant educator, told FierceHealthcare in an exclusive interview.
"I think the biggest change [IOM recommends] is to try to put into effect some recommendations that would increase the accountability for the funds that are being allocated for graduate medical education," he said. "In the current system there's not a lot of direct outcome measures that are linked to the money that flows toward graduate medical education, and so this is an attempt to improve upon that."
The report also calls for a change in GME governance by establishing a two-branch infrastructure. Specifically, the government should create a GME Policy Council within the Office of the Secretary of the Department of Health and Human Services, which would oversee decision- and policy-making, and a GME Center within the Centers for Medicare & Medicaid Services, which would handle payment reforms and demonstrations of new payment models.
The report further recommends the creation of a two-tiered Medicare GME fund: the Operational Fund, which would sponsor continuing residency training, and the Transformation Fund, which would help develop new infrastructure, programs, payment demonstrations and performance methods.
"Really, the transformation fund is an attempt for us to encourage the residency programs and the hospitals and other healthcare entities that sponsor those programs to propose for us ways that we can try to ensure that the dollars allocated for graduate medical education are used in a way that helps us prepare a workforce that's well-equipped to deliver on the healthcare needs of our nation," Asprey told FierceHealthcare.
The GME system also contributes to the primary care shortage, Daniel Burke, M.D., of the University of Colorado Family Medicine Residency, said in a June press briefing. Burke noted hospitals that receive GME payments don't sponsor enough residencies to produce the next generation of primary care providers, FierceHealthcare previously reported.