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

MD and DO Medical School Graduation Projections from 2008 - 2021 Academic MD Graduates DO Graduates Total Graduates Graduation Year 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 Sources: AAMC and ACCOM *Notes extrapolated data **Notes projected data

New Entrants into GME: Entrants into GME Without Prior GME 2010-2013 30,000 29,292 28,871 29,000 28,450 28,000 27,489 27,198 26,692 27,000 25,959 26,084 26,220 26,000 25,105 25,151 25,384 25,617 25,574 Entrants 25,000 24,000 23,000 22,000 21,000 20,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year Sources: NCHWA analysis of data from AAMC and AACOM, April 2012; Number for 2011 is provisional; Number for 2013 is from NRMP and AOA

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