IOM GME Report And the Fight for the Soul of Medicine Fitzhugh - - PowerPoint PPT Presentation

IOM GME Report And the Fight

for the Soul of Medicine Fitzhugh Mullan, MD

Murdock Head Professor of Medicine and Health Policy George Washington University

National Physicians Alliance Webinar April 28, 2015

IOM Committee on Governance and Financing of GME

Donald M. Berwick, M.D., M.P.P., FRCP (Co-Chair) Institute for Healthcare Improvement Gail R. Wilensky, Ph.D. (Co-Chair) Project HOPE Brian Alexander, M.D., M.P.H. Brigham and Women’s Hospital and Dana-Farber Cancer Center David A. Asch, M.D., M.B.A. University of Pennsylvania & Philadelphia VA Medical Center David Asprey, Ph.D., PA-C University of Iowa Carver College of Medicine Alfred Berg, M.D., M.P.H. University of Washington School of Medicine Peter I. Buerhaus, Ph.D., R.N., FAAN Vanderbilt University Medical Center Amitabh Chandra, Ph.D. Kennedy School of Government, Harvard University Denice Cora-Bramble, M.D., M.B.A., FAAP Children’s National Medical Center Michael J. Dowling, M.S.W. North Shore-Long Island Jewish Health System Kathleen A. Dracup, Ph.D., R.N., FNP, FAAN University of California, San Francisco, School of Nursing Anthony E. Keck, M.P.H. South Carolina Department of Health and Human Services Octavio N. Martinez, Jr., M.D., M.P.H., M.B.A. Hogg Foundation for Mental Health Fitzhugh Mullan, M.D. The George Washington University Roger Plummer, B.S. Plummer Consulting Deborah E. Powell, M.D. University of Minnesota Medical School Barbara Ross-Lee, D.O., M.A.T., FACOFP New York Institute of Technology Glenn D. Steele, Jr., M.D., Ph.D. Geisinger Health System Gail L. Warden, M.A. Henry Ford Health System Debra F. Weinstein, M.D. Partners HealthCare System Barbara O. Wynn, M.A. The RAND Corporation

Context for the Deliberations: Perceived Problems

• Mismatch between the health needs of the population

and size, specialty make-up, and geographic distribution of the physician workforce

• Gap between knowledge/skills of GME graduates and

competencies required for current medical practice

• Lack of fiscal transparency, accountability for public

funding

• Questions re: justification for public funding of GME
• “Overpayment” of IME

Committee Observations

• Medicare GME payments are based on rigid, dated,

statutory formulas

• Net financial impact of sponsoring residency programs

is poorly understood

• ↑Federal funding for GME (in the current system)

would not address specialty or geographic needs

• ↑GME trainees isn’t dependent on ↑federal funding

– 17.5% ↑ 2003-12 despite cap on Medicare-funded slots

IOM GME Report Recommendations

# 1 - Invest Strategically

• Maintain Medicare GME support at the

current aggregate amount, adjusting for inflation

IOM Recommendations (cont.)

# 2 -- Build a GME policy and financing

infrastructure

• Establish a GME Policy Council in the in the

Office of the Secretary, DHHS

• Establish a GME Center in CMS

IOM Recommendations (cont.)

# 3 -- Create one Medicare GME fund with two subsidiary funds

• An Operational Fund
• A Transformation Fund

Overview of Proposed Funding Streams

IOM Recommendations (cont.)

# 4 -- Modernize Medicare GME payment methodology

• Merge DME and IME into one fund
• Set national per resident amount (PRA)
• Pay sponsoring organizations directly
• Implement performance-based payments for

Transformation Fund awards

IOM Recommendations (cont.)

# 5 -- Medicaid GME

• Establish the same level of transparency and

accountability in Medicaid GME

What Next and What to Do?

• AHC leadership – Promote deliberation
• “Plan(s) B”
• Understand your GME – Who gets the money?
• Demographics of GME outcomes
• Ability to articulate and modify impact on local and national

needs

• GME performance research
• Role of residents and residency in transformed health system

Definition of Social Mission of Medical Schools

The social mission of a medical school is the contribution of the school in its mission, programs, and the performance of its graduates in addressing the critical and unmet health problems of the society in which it exists

Manifestations of Social Mission in Medical Education

• Community Engagement
• Diversity promotion
• Disparities reduction
• Cost/value concern
• Engagement with social determinants of health

The Beyond Flexner Alliance

• Alliance
• Communications Platform
• Clearing House
• Social Mission Standards
• Strategically Disruptive
• Beyond Flexner – 2016

– Florida International University – Fall, 2016

Medical Education Futures Study

http://www.medicaleducationfutures.org/

Source: The Washington Post, March 11, 2013

Academic Graduation Year MD Graduates DO Graduates Total Graduates

2008-2009 16,467 3,588 20,055 2009-2010 16,836 3,631 20,467 2010-2011 17,362 4,159 21,521 2011-2012 17,343 4,458 21,801 2012-2013 18,156 4,726 22,882 2013-2014* 18,665 5,428 24,093 2014-2015* 19,230 5,788 25,018 2015-2016* 19,517 5,986 25,503 2016-2017* 20,055 6,449 26,504 2017-2018** 20,654 6271 26,925 2018-2019** 21,053 6,222 27,275 2019-2020** 21,255 6,179 27,434 2020-2021** 21,434 6,675 28,109

MD and DO Medical School Graduation Projections from 2008 - 2021

Sources: AAMC and ACCOM *Notes extrapolated data **Notes projected data

New Entrants into GME: Entrants into GME Without Prior GME 2010-2013

Sources: NCHWA analysis of data from AAMC and AACOM, April 2012; Number for 2011 is provisional; Number for 2013 is from NRMP and AOA

25,105 25,151 25,384 25,617 25,574 25,959 26,084 26,220 26,692 27,198 27,489 28,450 28,871 29,292 20,000 21,000 22,000 23,000 24,000 25,000 26,000 27,000 28,000 29,000 30,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Entrants Year

Growth in US Medical School Graduates and GME Entrants, 2008-2021