Web Exclusive: The future of graduate medical education — MedPAC’s recommendations

By Tim Tidwell, ASTRO government relations intern

A proposal by the Medicare Payment Advisory Commission (MedPAC) has Congress considering some major changes to graduate medical education funding that could impact the way radiation oncology programs train the next generation of cancer doctors.   

In MedPAC’s June 2010 report, the commission gave concrete recommendations on only one issue: Medicare’s financing of graduate medical education (GME). These recommendations focused on aligning GME with delivery system reforms that the commission termed “essential” for increasing the value of the U.S. health care system.  Driving the commission’s recommendations were two concerns: quality of residency training and workforce diversity.

The MedPAC report asserts that there must be an improvement in the quality of our residency training to produce health professionals needed for a high performance delivery system. To this end, the commission recommends creating accountability measures ensuring that all Medicare resources used to support medical education (e.g., GME or indirect medical education) fund programs that meet national standards of quality. The commission reasons that institutional responsibility to the public will guarantee quality in their educational programs.

Another issue the commission outlines in its report is the diversity of the health care workforce. One of its recommendations is to decouple GME from the fee-for-service payment methodology. The rationale behind this recommendation is that this payment model offers financial incentives that improperly drive both medical student specialty selection as well as the type of residency programs educational institutions offer. Additionally, the report recommends that Congress conduct studies so that the health care workforce represents those from underrepresented racial and ethnic minorities, lower income families, and rural locations.

At the June 23 House Energy and Commerce Committee hearing on the MedPAC June 2010 Report, it was no surprise that much of the attention focused on the report’s recommendations regarding GME financing. There was bipartisan support of improving the quality of our current GME system while at the same time ensuring that we maintain the GME system that is already present in the U.S.

Reps. John Shimkus (R-Ill.) and Frank Pallone (D-N.J.) questioned the soundness of MedPAC’s recommendation to decrease funding to hospitals that did not meet the “to-be-determined” quality standards for GME in a period of such economic stability.

Reps. Michael Burgess (R-Texas) and Kathy Castor (D-Fla.) spoke about the need to address costs in our current fee-for-service system. MedPAC Chair Glenn Hackbarth, the sole witness in the hearing, understood both concerns and assured the members of Congress that implementation of these policy recommendations would take time so that sufficient studies could be done to verify MedPAC’s recommendations would not have unintended consequences.