Centers for Medicare and Medicaid Services. 2014.Washington, DC: National Academies Press. 3. The Department of Graduate Medical Education understands that you may have special interest in a certain field of training. Unfortunately, these various incentives are misaligned, creating competing demands that, without a computer match algorithm, can lead to significant psychological turmoil for trainees. Ethical approval: Reported as not applicable. The closing programs want to ensure that all trainees continue their education without interruption and with the fewest possible needing to relocate; thus, they are incentivized to ensure a good fit between each trainee and their landing program and to advocate for top trainees to get offers from “top programs” in the area to preserve local capacity. A final example of the monetization of this GME displacement showed up at the eleventh hour. On June 26, 2019, it was announced that Hahnemann University Hospital (HUH), a historic safety-net hospital that had served Philadelphians since 1848, was to close in less than 3 months.1,2 By August 6, all training programs were formally closed, and more than 550 trainees (residents and fellows) had been displaced to other programs. Wolters Kluwer Health chief academic officer and designated institutional official, Hahnemann University Hospital. This summer in Philadelphia, the behavior of teaching hospitals and their systems seemed to harken back to our collective image of lawless California goldfields during the Gold Rush. The authors review the complexity of GME funding and how the owners of Hahnemann University Hospital leveraged this in an attempt to offset debt. 111-148, § 5506, 124 Stat. For teaching hospital closures that occurred on or after March 23, 2008 through August 3, 2010, CMS issued a listing of which hospitals would receive the slots from the various closed teaching hospitals on  February 28, 2012 (see link below Section 5506 Cap Increases Related to Applications Due April 1, 2011 - Posted 2/28/12 ). Section 1886(h) of the Act, as added by section 9202 of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. 9. Please try after some time. For most hospitals, the limits were the number of allopathic and osteopathic FTE residents training in the hospital's most recent cost reporting period ending on or before December 31, 1996. L. 99-272) and implemented in regulations at existing §§413.75 through 413.83, establish a methodology for determining payments to hospitals for the costs of approved graduate medical education (GME) programs. L. 99-272) and implemented in regulations at existing §§413.75 through 413.83, establish a methodology for determining payments to hospitals for the costs of approved graduate medical education (GME) programs. June 26, 2019.Personal communication with department chairs and program directors of Hahnemann University Hospital. In the survey, 44% of deans voiced concerns about their students’ ability to find residencies. Residents and fellows want to secure the very best programs; thus, they are incentivized to delay decisions and ask for offer extensions. The unprecedented displacement of more than 550 trainees that occurred because of the closure of Hahnemann University Hospital has demonstrated that the medical education community, Centers for Medicare and Medicaid Services, and the Accreditation Council for Graduate Medical Education were unprepared for a graduate medical education (GME) crisis of this scale. This can be likened to a gold rush for teaching hospitals—additional manpower at no additional cost, something precious and rare and aggressively fought for. RAMS Oppose the Sale of Graduate Medical Education Slots. graduate medical education startup bonus designed to expand the number of residency slots to physician specialties that are in statewide supply shortage. The accelerated and compressed timeline created a free-market environment with few protections for the individual orphaned resident or fellow. The Graduate Medical Education (GME) Gold Rush: GME Slots and Funding as a Financial Asset Acad Med . JW: This is provided through state appropriations. Currently, there is an arbitrary cap on hospital graduate medical education slots. This is the first time in over 20 years that Medicare has increased the GME caps on most teaching hospitals. Milestones. Graduate medical education (GME) is the supervised hands-on training after medical school that all physicians must complete in order to be licensed and practice independently. Increasing graduate medical education slots would provide a potential solution to health care workforce issues and alleviate the staffing burden that has plagued New Jersey’s hospitals during the COVID-19 pandemic. A large proportion of teaching hospitals, out of necessity, now self-fund strategic expansion of GME above the CMS cap. L.S. What is amazing to me is that we are still dealing with a recession and the fallout from the recession, and you are in a business that was hit as hard or harder than the overall majority. Aizenberg is associate professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, and former internal medicine residency program director, Hahnemann University Hospital/Drexel University, Philadelphia, Pennsylvania. Redistribution of Graduate Medical Education Slots The Patient Protection and Affordable Care Act (ACA) calls for a redistribution of unused residency slots and allocates 65 percent of the slots for primary care and general surgery positions. The frenzy of opportunistic activity was breathtaking as programs around the country applied for temporary increases in their assigned Accreditation Council for Graduate Medical Education (ACGME) complement (their maximum number of enrollees). S348/HR1763 increases the number of residency positions eligible for graduate medical education payments under Medicare by 3,000 slots annually for five years for a total of 15,000 slots. Please enable scripts and reload this page. The lessons learned from the authors’ experience can help inform the medical education community’s response to this type of crisis in the future. Brubaker H. Hahnemann residency slots auction: Main Line Health, Cooper join Temple and Jefferson in bid. Personal communication with D. Aizenberg, July 26, 2019. 2020 Apr;95(4):503-505. doi: 10.1097/ACM.0000000000003133. the hospital incurs all, or substantially all, of the costs for the training program in that setting." While U.S. medical school enrollment has increased, averting a physician shortage now depends on more residency training slots, according to the results of … The abrupt and rapid closing of the hospital identified a blind spot in the protection of a most precious public good, graduate medical education (GME). Learn More. As mentioned above, the HUH bankruptcy displaced an unprecedented number (more than 550) of residents and fellows. Lippincott Journals Subscribers, use your username or email along with your password to log in. 11. Funds allocated for the startup bonus program under s. 409.909, Florida Statutes, are provided … They are: 2 PGY-1 Dermatology Slots; 1 PGY-1 Ophthalmology Slot; In addition to 11 “traditional” transitional slots per year. One resident was given only 15 hours to decide whether she would accept an offer. One can clearly delineate each stakeholder’s incentive. Registered users can save articles, searches, and manage email alerts. L. No. Medicare fact sheet on displaced residents due to program or hospital closure. The department shall include in the Official Medicaid Forecast funding for cohorts previously funded and funding for up to 25 new or replacement slots each year. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Correspondence should be addressed to David Jacob Aizenberg, Department of Medicine, University of Pennsylvania, 3701 Market St., 7th Floor, Philadelphia, PA 19104; telephone: (215) 349-5200; email: [email protected]; Twitter: @daveaizenberg. To our knowledge, the attempt to sell the CMS provider number in order to use GME funding to offset debt is another unprecedented event, further adding to the confusion about who has final authority over the placement of displaced trainees. In an April 7th letter to Congress, U.S. Graduate Medical Education That Meets the Nation’s Health Needs. For years, however, there’s been one big problem: An out-of-date cap on graduate medical education slots has limited the abilities of New Jersey hospitals to increase the number of residency slots in the state. Calls and emails from hospitals across the country inundated HUH program directors’ and chairs’ offices. Because of this outdated calculation, some New Jersey medical programs lack the adequate slots to train as many physicians as possible here. 7. Brubaker H. Hahnemann University Hospital to close. Pressure has been growing to increase GME slots because of the growing doctor shortage. Medicare direct GME payments are calculated by multiplying the PRA times the weighted number of full-time equivalent (FTE) residents working in all areas of the hospital (and non-hospital sites, when applicable), and the hospital's Medicare share of total inpatient days. If an institution had obtained the CMS provider number while the programs were still accredited and the ACGME had approved complement increases, it is possible that all trainees would have been required to continue their training at that institution. 800-638-3030 (within USA), 301-223-2300 (international). 119. 251. The legality of holding a CMS provider number auction is currently being litigated in the courts.10. Through the Centers for Medicare and Medicaid Services (CMS), the federal government supports the salaries and other costs of training doctors in the United States.3 CMS makes these financial arrangements directly with the individual teaching hospitals that sponsor residency and fellowship programs. 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