Family Medicine Residents

ACGME Graduate Medical Education Committee

After nearly two years of deliberation, the (GME) has issued its report. It presents a strong case for the need for change and a strong case for its recommendations.

The members of the Committee and the IOM are to be commended for their hard work, vision, and a high quality report. The report presents a clear path to a system that would help produce a physician workforce better aligned with the nation’s needs and a framework for a rational and defensible expenditure of nearly 15 billion dollars in public funds each year on GME.

Issues related to GME financing have been contentious for many years. In 1965, Congress included GME financing under Medicare reimbursement in what was intended to be a temporary arrangement. Nearly 50 years later, we are still trying to find a permanent and more rational way to finance and pay for the training of physicians as an alternative to the current complex, arcane formula built on Medicare inpatient days. Despite the well-documented shortcomings of the current system and numerous studies, attempts to find agreement on how to change and improve GME financing have been unsuccessful.

In fact, in recent years, some of the major players have been pushing in opposing directions: each year the administration proposes to reduce GME funding; and just as consistently, academic medicine organizations and their legislative allies propose legislation to increase funding for GME. Neither proposal has come close to passing.

Into this environment comes the new report from the IOM with specific recommendations for reform. The expertise and experience of the 21 experts on the committee is quite impressive. The Committee was co-chaired by Gail Wilensky and Don Berwick, two leaders in the field representing very divergent views on health policy. While both are former directors of Centers for Medicare and Medicaid Services or its predecessor, the Health Care Financing Administration, one was under a Republican president, the other under a Democratic president. I had my doubts that such a diverse group dealing with such a difficult issue would be able to come to consensus. And I worried that if they did, the recommendations would have to be so watered down and so general as to be almost meaningless.

Thus, I was very pleased to see that the Committee did not shy away from the difficult issues and reached consensus on bold recommendations that provide a path for meaningful reform. The report is well organized and makes a very strong case why reform is needed now. Hopefully, policy makers and the leaders of the medical education community will read the report carefully and give it serious consideration.

What Does The IOM Report Recommend?

The following is my effort to briefly summarize the, which would for the most part require Congressional action.

CMS proposes removing CME exclusion from Sunshine Act regulations, citing ..  — Lexology
.. physician or teaching hospital (Covered Recipient) or physician owner/investor, or by an Applicable GPO to a physician owner/investor, for speaking at a continuing medical education (CME) program need not be reported if the following conditions are ..

CAP Receives Re-Accreditation as Premier CME Provider  — Newswise
The College of American Pathologists was resurveyed by the Accreditation Council for Continuing Medical Education (ACCME) and awarded Accreditation with Commendation for six years as a provider of continuing medical education (CME) for physicians.

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