AMA gears up to fight cuts to GME

Chicago -- Medical residents won support from the AMA in several areas during its June Annual Meeting, including an effort to stop the Centers for Medicaid & Medicare Services from reducing graduate medical education payments.

Delegates voted to actively petition CMS to reverse changes to its payment rules that would prevent hospitals from counting resident hours in formal instruction, such as lectures, journal clubs and seminars, when tallying residents' time for Medicare GME payments. The change will reduce teaching hospitals' reimbursements, though these activities are still required by the Accreditation Council for Graduate Medical Education.

Although the changes are technically in place, it's unclear if any CMS fiscal intermediaries have implemented them, government watchers said. The AMA hopes CMS will change its interpretation and sent a letter to CMS Administrator Mark McClellan, MD, PhD, to that effect in June.

In the letter, AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote, "The activities cited are an integral component of the patient care activities engaged in by residents during their residency programs, and serve to improve care of individual patients. Disallowing time spent on these activities is at odds with your personal goal of improving the quality of care."

CMS could reverse the decision in August or could leave it in place.

Other resident issues the House of Delegates voted to support include:

• Monitoring enforcement of the duty-hour limits the ACGME set.
• Waiving medical board continuity requirements and granting credit for partial years for residents forced to move due to program closures.
• Working with CMS, ACGME and other organizations to permit Medicare GME funding to follow residents in the event of temporary or permanent residency program closures.
• Encouraging hospitals to consider residents' level of training, cost of living, work in an underserved area and other relevant factors when determining their salaries.