The Institute of Medicine (IOM) today released a report, initiated with support from a number of private foundations, the U.S. Department of Veterans Affairs, and the Health Resources and Services Administration, that examines the goals, governance, and financing of the graduate medical education (GME) system.
The 21-member IOM committee focused most of its attention on Medicare GME funding, which makes up the bulk of public support for clinician training. In its report, the committee recommended that GME funding remain at current levels, updated for inflation, but that the allocation of the funding be altered greatly. The IOM recommended that the current Medicare GME and indirect medical education (IME) funding streams be abolished and be replaced with a performance-based system of Medicare GME funding that would strive to reward performance, ensure accountability, and incentivize innovation.
The committee recommended the establishment of a two-part Medicare GME Fund – a GME Operational Fund to finance residency training costs on a per-resident basis and a Transformational Fund to fund new training slots in priority areas, pilot alternative payment demonstrations, determine appropriate GME performance measures, and evaluate new programs. The committee also recommended that a GME Policy Council be created within the U.S. Department of Health and Human Services to oversee policy development and decision-making and that a GME Center be established within the Centers for Medicare & Medicaid Services to function as an operations center and to manage payments.
The committee also called for further transparency and accountability for Medicaid GME programs. Because the distribution of Medicare GME and IME funding is set in statute, any changes to these program would require legislative action by Congress.