The Biden administration needs to overhaul how it will distribute a major influx of new graduate medical education (GME) slots to hospitals starting next year, provider groups say.
Several hospital groups gave feedback to the Centers for Medicare & Medicaid Services (CMS) on how to improve health equity in GME. A federal spending law passed last year awarded 1,000 new Medicare-funded residency slots that will be phased in starting next year.
Hospitals were concerned CMS’ methodology for doling out the GME slots relies so heavily on the score and training time in a Health Professional Shortage Area (HPSA), which details areas with a shortage of primary, mental health or dental providers. Groups did not want Medicare to prioritize the new slots to only the HPSA areas.
The American Hospital Association (AHA) wrote in comments that reliance on HPSAs doesn’t reflect Congress’ intent when it expanded the GME slots.
“Per statute, only one category out of four eligible categories requires that hospitals serve areas designated as HPSAs,” AHA said. “Yet, the agency has required a high threshold of training time to occur in HPSAs and instituted a HPSA score to prioritize residency slots across all four eligible categories.”
Relying on just HPSAs also goes against Congress’ wishes to expand training slots for hospitals in rural areas and in states that have new medical schools, AHA added.
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CMS in the Inpatient Prospective Payment System rule would rely on a HPSA score of training sites as the only criteria for prioritizing which hospitals get slots. Qualifying for a priority slot also requires at least 50% of the training of a medical program to occur in an HPSA.
The Association of American Medical Colleges (AAMC) wrote in comments that CMS should instead prioritize slots to hospitals that meet all four of the qualifying criteria followed by those with three, two and one.
Many teaching hospitals, for example, are located close to an HPSA and can provide care to residents in such areas, but more than 50% of the training will occur outside of a HPSA, AAMC said.
CMS could look at hospitals that are close to HPSAs to prioritize.
“Another possibility is that a hospital would be eligible for slot prioritization when it serves a certain percentage of the population that resides in the HPSA,” the group added.
AAMC conceded that CMS imposed the requirement for 50% training in a HPSA with the hopes that physicians who train in such an area will remain there.
“However, this is unlikely to affect the area where a physician practices as there are complex decisions made to determine where a particular physician decides to practice,” the group said.
AHA noted that CMS needs to move fast on distributing the residency slots as the deadline to apply for the fiscal year 2023 slots is quickly approaching.
Congress could also act to add more Medicare-supported GME slots. A version of the Build Back Better Act included funding for 4,000 additional slots, but the legislation that passed the House has stalled in the Senate due to centrist objections.