Medical Education/Teaching Hospitals

Medical Education/Teaching Hospitals / en Sat, 26 Apr 2025 16:01:20 -0500 Mon, 10 Mar 25 13:57:53 -0500 Verification of Graduate Medical Education /resources/2016-04-12-verification-graduate-medical-education Over time, hospitals and their medical staff services offices have developed unique forms to verify resident training for credentialing as required for hospital accreditation.&nbsp;To help streamline and standardize the residency verification process and meet hospital credentialing needs, the AHA, in partnership with other national organizations, has developed templates to provide the necessary information to meet credentialing needs while reducing the need for program directors to complete multiple requests for information. Tue, 12 Apr 2016 00:00:00 -0500 Medical Education/Teaching Hospitals HHS investigating four unnamed medical schools, hospitals for workforce discrimination /news/headline/2025-03-10-hhs-investigating-four-unnamed-medical-schools-hospitals-workforce-discrimination The Department of Health and Human Services March 7 <a href="https://www.hhs.gov/about/news/2025/03/07/hhs-civil-rights-office-investigates-alleged-discrimination-health-care-workforce-training-restore-merit-based-opportunity.html" title="HHS investigation">announced</a> that it is investigating four unnamed medical schools and hospitals for workforce discrimination.&nbsp;The department&nbsp;said the investigations were in response to allegations received by the HHS Office of Civil Rights that certain medical schools and hospitals receiving HHS funding “may operate medical education, training, or scholarship programs for current or prospective workforce members that discriminate on the basis of race, color, national origin, or sex.”&nbsp; Mon, 10 Mar 2025 13:57:53 -0500 Medical Education/Teaching Hospitals AHA Comments on Senate Finance Committee Medicare-funded Physician Residency Draft Bill /lettercomment/2025-01-31-aha-comments-senate-finance-committee-medicare-funded-physician-residency-draft-bill January 31, 2025<table><tbody><tr><td>The Honorable Bill Cassidy, M.D. United States Senate 455 Dirksen Senate Office Building Washington, DC 20510</td><td>The Honorable Catherine Cortez Masto United States Senate 520 Hart Senate Office Building Washington, DC 20510</td></tr><tr><td>The Honorable John Cornyn United States Senate 517 Hart Senate Office&nbsp; Washington, DC 20510</td><td>The Honorable Michael Bennet United States Senate 261 Russell Senate Office Building Washington, DC 20510</td></tr></tbody></table> Dear Senators Cassidy, Cortez Masto, Cornyn and Bennet:On behalf of AHA’s nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) writes to provide comment on your draft Medicare graduate medical education (GME) reform package (KEL24743 MP2).We appreciate your thoughtful consideration of addressing longstanding physician shortages, particularly in rural and other underserved areas, through your draft bill, which would fund 5,000 new physician residency slots nationwide and effect other changes to Medicare GME funding. We look forward to working with you to develop and enact legislation to alleviate critical physician shortages and ensure that the communities we serve have access to the health care services they need.Across the nation, our member hospitals and health systems and the patients we serve experience daily the strain of workforce shortages, which are now projected to exceed 180,000 physicians by 2037, according to the Health Services and Resources Administration (HRSA). Hospitals’ ability to deliver quality, equitable care depends on attracting, retaining and supporting the dedicated health care workers essential to serving our patients and communities, and an adequate well-trained workforce is necessary to meet those objectives.To ensure a sufficient supply of well-trained physicians, Congress created the Medicare GME program. However, based on erroneous physician surplus projections, Congress included provisions in the Balanced Budget Act of 1997 that froze the number of Medicare-funded physician training positions at 1996 levels and limited the number of residents that hospitals may include in their ratio of residents-to-beds, which determines indirect medical education (IME) payments. Now 28 years later, that 1997 law continues to severely restrict hospitals' ability to train the next generation of providers and contributed to a shortage of physicians, especially in behavioral health, primary care and general surgery. Without congressional action, the limitation on the number of residents for which each teaching hospital is eligible to receive GME reimbursement remains a major barrier to easing physician shortages.To mitigate these shortages, the AHA, along with several other national organizations, has long supported the Resident Physician Shortage Reduction Act — bipartisan, bicameral legislation that would add 14,000 Medicare-funded residency slots over seven years. Additionally, the legislation would require the Government Accountability Office to study strategies for increasing the diversity of the health professional workforce and report its findings and recommendations to Congress within two years of enactment.Lifting the cap on Medicare-funded residency positions would enhance access to care and help hospitals better meet the needs of the communities they serve. Increasing Medicare-funded residency slots would provide hospitals more flexibility to expand training programs, including both primary care and specialty programs. In addition, an increase in slots would allow health systems to train residents in more facility types, such as smaller rural hospitals that may not have sufficient resources to operate their own training programs. This would benefit the quality of physician education and care rendered to their patients.Additionally, we appreciate your attention to addressing shortages in rural communities. Rural hospitals compose about 35% of all hospitals in the U.S. Nearly half of rural hospitals have 25 or fewer beds, with just 16% having more than 100 beds. Given that rural hospitals tend to be much smaller, patients with higher acuity often travel or are referred to larger hospitals nearby.Recruitment and retention of health professionals have long been a persistent challenge for rural hospitals. Acute workforce shortages and increasing labor expenses resulting from the pandemic have placed additional pressure on rural hospitals. Many rural providers are seeking novel approaches to recruit and retain staff. Existing federal programs, such as the National Health Service Corps, which the AHA strongly supports, work to incentivize clinicians to work in rural areas. Other programs, such as the Rural Public Health Workforce Training Network Program, help rural hospitals and community organizations expand public health capacity through health care job development, training and placement. Additional and continued support to help recruit and retain health care professionals in rural areas is needed from the federal government.Following are our responses to specific provisions in the draft legislation.<h2>SECTION 2 — Additional Distribution of Medicare GME Residency Positions to Rural Areas and Key Specialties in Shortage</h2>You asked whether the 30-slot cap proposed in Section 2 of the draft would be appropriate for the distribution of residency slots across hospitals. The AHA supports the 30-slot cap and fully understands the need to ensure that hospitals across all geographical areas and types have a fair opportunity to compete for slots. We recommend that, as the 5,000 slots are being awarded, should any slots be unused, those hospitals that have received 30 slots (and are therefore ineligible to receive additional ones) be afforded the opportunity to apply for them. Newly funded Medicare residency slots should be allocated efficiently and fully distributed to hospitals.<h2>Changes to the Per Resident Amount (PRA)</h2>We appreciate the attempt to update the current per-resident amount (PRA), which is insufficient for many teaching hospitals. The PRA was based on the direct costs of a teaching hospital in the 1980s and does not reflect the actual GME costs hospitals now incur. As such, we support approaches that better align the PRA to current cost structures, including increasing the PRA for hospitals that serve historically marginalized and underserved populations. However, this proposal does not appear to do so. In fact, the proposal appears to reduce the PRA for certain teaching hospitals, which would create financial instability for the targeted facilities that are applying for slots.We strongly recommend that you consider the implications this provision may have on hospitals whose support may decrease as a result of these changes.<h2>SECTION 3 — Encouraging Hospitals to Train in Rural Areas</h2>We support expanding the Medicare Rural Hospital Flexibility Program to assist all rural hospitals in applying for and securing Medicare GME slots.Remote supervision of residents in rural teaching settings has been a key enabler to expand training opportunities, maximize limited supervising physician capacity, and increase access to care in areas with physician shortages. Specifically, remote supervision flexibilities have allowed teaching physicians to meet requirements for key or critical portions of services through virtual presence (real-time audio-visual communications technology). Historically, supervision required the immediate in-person availability of the supervising practitioner.In 2021, the Centers for Medicare &amp; Medicaid Services (CMS) established that after the COVID-19 public health emergency (PHE), teaching physicians could meet requirements for key or critical portions of services through virtual presence (real-time audio-visual communications technology), but only for services furnished in residency training sites in non-metropolitan service areas (MSAs). During the COVID-19 PHE and then through the calendar year 2024, waivers for virtual supervision were extended to include MSAs. we support permanently extending virtual supervision flexibilities across teaching settings.In 2024, CMS limited virtual supervision flexibilities to apply in clinical instances when the service was furnished completely virtually, with no in-person component. However, for many hospitals and health systems, supervising physicians may be geographically dispersed or balancing supervisory functions with care delivery and administrative tasks. We encourage flexibility to maximize the benefit of virtual modalities (i.e., to connect geographically dispersed supply with demand). For example, there may be instances where the resident is physically with the patient and the supervising physician is at a different location. The resident should be able to “dial in” the supervising physician in these instances. We urge Congress to codify virtual supervision flexibilities permanently and extend flexibilities for virtual services and instances where the resident and patient may be in the same location and the supervising physician is remote.In addition to remote supervision flexibilities, other complementary policies can support access to care, especially in areas with physician shortages. For example, we have supported the expansion of services eligible for the primary care exception. The primary care exception allows teaching physicians to bill for certain services performed by residents in certain training settings when the physician is not present with the resident so long as certain conditions are met. Expanding eligible services, such as including higher levels of evaluation and management services, would allow more time for physicians to perform supervisory (including being immediately available) and other duties while enabling residents to practice to the fullest extent of their skills and training. This may particularly benefit rural areas with limited primary care capacity.Additionally, the AHA supports the following legislative proposals to increase the number of physicians working in rural and underserved communities.<ul><li>Rural and Underserved Pathway to Practice Training Programs. The AHA supports the proposal to create Rural and Underserved Pathway to Practice Training Programs, which would establish 1,000 medical school scholarships annually to promote diversity in the medical workforce and exempt residency positions filled by graduates of this program from statutory caps on residency slots. The program would incentivize those from rural and underserved communities to become physicians and to practice in those communities through a scholarship and stipend for qualifying medical students to attend medical school or post-baccalaureate and medical school. Students eligible for this program include first-generation college or professional students, Pell Grant recipients, and those who live in medically underserved, rural or health professional shortage areas.</li><li>Conrad State 30 Program. We urge Congress to pass the Conrad State 30 and Physician Access Reauthorization Act to extend and expand the Conrad State 30 J-1 visa waiver program, which waives the requirement to return home for a period if physicians holding J-1 visas agree to stay in the U.S. for three years to practice in federally-designated underserved areas.</li><li>International Workforce. The AHA urges Congress to pass the Healthcare Workforce Resilience Act, bipartisan legislation that would recapture 25,000 unused employment-based visas for foreign-born nurses and 15,000 for foreign-born physicians to help address staffing shortages.</li><li>Loan Repayment Programs. We urge Congress to pass the Restoring America’s Health Care Workforce and Readiness Act to significantly expand National Health Service Corps funding to provide incentives for clinicians to practice in underserved areas, including rural communities. AHA also supports the Rural America Health Corps Act to directly target rural workforce shortages by establishing a Rural America Health Corps to provide loan repayment programs focused on underserved rural communities.</li></ul><h2>SECTION 4 — Establishment of Medicare GME Policy Council to Improve Distribution of Slots to Specialties in Shortage</h2>You also asked the AHA’s view on creating a GME Policy Council to guide future slot allocations. We believe a council would be redundant, as the Council on Graduate Medical Education (COGME), under the HRSA, is charged with advising and making recommendations to the Department of Health and Human Services Secretary and Congress on numerous areas involving physician workforce adequacy and training. We would support expanding the focus and responsibilities of COGME rather than creating an additional entity to make recommendations on those matters.<h2>SECTION 5 — Improvements to Medicare GME Treatment of Hospitals Establishing New Medical Residency Training Programs</h2>The AHA supports allowing hospitals with low caps to reset their caps permanently.<h2>SECTION 7 — Improving GME Data Collection and Transparency</h2>We appreciate that your draft legislation explicitly requires reporting on federal GME programs by CMS and that CMS would be required to utilize existing data collected through Medicare Cost Reports and other entities to compile such reports. It is our understanding that CMS already collects the data enumerated in the draft.To the extent that additional reporting by hospitals would be necessitated by this provision, we have specific concerns. First, for small hospitals, the requirement to report would be overly burdensome, and, in some instances (e.g., specialty, gender and race/ethnicity) it raises privacy concerns given the small size of some residency programs. Further, we are uncertain what program concern is related to the need for data on the remediation, probation, transfer, withdrawals or dismissals of residents.<h2>Conclusion</h2>We appreciate your willingness to seek bipartisan solutions to address the urgent need for additional physician residency slots. We look forward to continuing working with you to develop comprehensive legislation to help ensure the Medicare GME program continues to meet the needs of patients and communities.Sincerely,/s/Lisa Kidder Hrobsky Senior Vice President, Advocacy and Political Affairs Fri, 31 Jan 2025 12:43:25 -0600 Medical Education/Teaching Hospitals Medical school enrollment hits new record /news/headline/2025-01-10-medical-school-enrollment-hits-new-record Total medical school enrollment has reached a new high of 99,562 students for 2024-2025, a 1.8% increase from the previous school year, according to data (<a href="https://www.aamc.org/news/medical-school-enrollment-reaches-new-high" target="_blank" rel="noreferrer noopener">https://www.aamc.org/news/medical-school-enrollment-reaches-new-high</a>) released yesterday by the Association of American Medical Colleges. The figure marks a decade-long trend of increasing enrollment. First-year enrollees also rose 0.8% to a new high of 23,048.&nbsp; &nbsp; The report also noted that the number of applicants declined for a third consecutive year but at a slower rate than previous years. Applicants were down 1.2% (51,946) for 2024-2025, compared to 4.7% (52,577) in 2023-2024 and 11.6% (55,189) in 2022-2023. AAMC said the declines appear to be a pattern following the COVID-19 pandemic when applications reached all-time highs. Fri, 10 Jan 2025 15:34:03 -0600 Medical Education/Teaching Hospitals AHA Comments on Senate Finance Committee Bipartisan Working Group on GME /lettercomment/2024-06-24-aha-comments-senate-finance-committee-bipartisan-working-group-gme June 24, 2024<table><tbody><tr><td>The Honorable Ron Wyden Chairman United States Senate Washington, DC 20510</td><td>The Honorable Michael Bennet Committee on Finance United States Senate Washington, DC 20510</td></tr><tr><td>The Honorable Marsha Blackburn Committee on Finance United States Senate Washington, DC 20510</td><td>The Honorable Bill Cassidy, M.D. Committee on Finance United States Senate Washington, DC 20510</td></tr><tr><td>The Honorable John Cornyn Committee on Finance United States Senate Washington, DC 20510</td><td>The Honorable Catherine Cortez Masto Committee on Finance United States Senate Washington, DC 20510</td></tr><tr><td>The Honorable Bob Menendez Committee on Finance United States Senate Washington, DC 20510</td><td>The Honorable Thorn Tillis Committee on Finance United States Senate Washington, DC 20510</td></tr></tbody></table>Dear Chairman Wyden, Senators Bennet, Blackburn, Cassidy, Cornyn, Cortez Masto, Menendez and Tillis:On behalf of AHA’s nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) writes to provide comment on sections of the Senate Finance Committee Bipartisan Medicare Graduate Medical Education (GME) Working Group’s draft proposal.We appreciate that the working group is considering ways to thoughtfully address the longstanding issue of physician shortages, particularly in rural and underserved areas. Following are our comments on your draft proposal. We look forward to working with you to develop and enact legislation to address these critical shortages and ensure that the communities we serve have access to the health care services they need.<h2>INTRODUCTION</h2>Across the nation, our member hospitals and health systems and the patients we serve experience daily the strain of workforce shortages. According to the Association of American Medical Colleges, shortages are projected to exceed 86,000 physicians by 2036. Hospitals’ ability to deliver quality, equitable care depends on attracting, retaining and supporting the dedicated health care workers essential to serving our patients and communities, and an adequate, well-trained workforce is necessary to meet that objective.To ensure a sufficient supply of well-trained physicians, Congress enacted the Medicare GME program. However, based on projections of a physician surplus, Congress included provisions in the Balanced Budget Act of 1997 that froze the number of Medicare-funded physician training positions at 1996 levels and limited the number of residents that hospitals may include in their ratio of residents-to-beds, which determines indirect medical education (IME) payments. Now 27 years later, that 1997 law continues to severely restrict hospitals' ability to train the next generation of providers and has contributed to a shortage of physicians, especially in behavioral health, primary care and general surgery. Without congressional action, the limitation on the number of residents for which each teaching hospital is eligible to receive GME reimbursement remains a major barrier to easing physician shortages.SECTION 2 — Additional and Improved Distribution of Medicare GME Slots to Rural Areas and Key Specialties in ShortageHow many additional Medicare GME slots are needed to address the projected shortage of physicians?The AHA has long supported the Resident Physician Shortage Reduction Act (S. 1302/H.R. 2389), bipartisan, bicameral legislation that would add 14,000 Medicare-funded residency slots over the next seven years. The bill would require the Government Accountability Office to study strategies for increasing health professional workforce diversity and report its findings and recommendations to Congress within two years of enactment.Lifting the cap on Medicare-funded residency positions would enhance access to care and help hospitals better meet the needs of the communities they serve. Increasing Medicare-funded residency slots would provide hospitals more flexibility to diversify and maintain training programs, including both primary care and specialty programs. In addition, an increase in slots would allow health systems to train residents in more diverse facility types, such as smaller rural hospitals that may not have sufficient resources to operate their own training programs. This would benefit the quality of physician education and the care rendered to their patients.Would the proposed changes to the definition of rural hospitals in the CAA [Consolidated Appropriations Act], 2023 GME allocation formula outlined above improve the distribution of slots to rural communities?The Centers for Medicare &amp; Medicaid Services (CMS’) own data from the most recent round of allocations indicates that too few rural hospitals are applying for slots. Congressional efforts should be targeted toward policies that encourage rural hospitals to apply for residency slots rather than changing the definition of rural hospitals.Beyond the proposed changes to the definition of rural hospitals, is it necessary to provide further clarification in the existing statute to ensure that CMS allocates GME slots to particular categories as specified in the CAA, 2023 GME allocation formula?CMS continues to use the same method finalized in the FY 2022 inpatient prospective payment system (PPS) final rule to distribute additional residency slots. That is, at least 10% of the aggregate number of total residency positions would be made to each of the four categories of hospitals: 1) hospitals located in rural areas; 2) hospitals operating above their residency caps; 3) hospitals in states with new medical schools; and 4) hospitals that serve health professional shortage areas (HPSAs), prioritizing the fourth category based on the HPSA score. We have previously expressed to CMS concerns regarding the use of the HPSA scores to prioritize certain slots, which is detailed in our FY 2022 inpatient PPS <a href="/lettercomment/2021-06-28-aha-comments-inpatient-pps-proposed-rule-fy-2022" target="_blank" title="FY 2022 inpatient PPS proposed rule comment letter">proposed rule comment letter</a> and a subsequent <a href="/lettercomment/2022-02-23-aha-comments-cms-hospital-inpatient-prospective-payment-system-final-rule" target="_blank" title="Final rule comment letter">final rule comment letter</a>.We urged the agency in 2022 to prioritize slot distribution based solely on the four categories included in the law and give priority to hospitals that qualify in more than one, with the highest priority given to hospitals qualifying in all four categories. CMS’ use of HPSA scores during the initial phase of the distribution “[did] not reflect statutory intent [and that] this reliance on HPSAs minimize[d] Congress’ other priorities to expand training slots for hospitals in rural areas, training above their cap, and in states with new medical schools” and questioned whether it would meet statutory requirements.We continue to urge our original approach and believe that it would be less burdensome and offer a clearer metric for qualifying hospitals. This approach is consistent with the statutory criteria, which do not place any additional emphasis on HPSA service areas or scores, and it still supports teaching hospitals serving underrepresented and historically marginalized populations.Section 4112 of the CAA,2023 requires the distribution of an additional 200 residency positions in FY 2026. At least 100 of those positions must be for psychiatry or psychiatry subspecialty residency training programs. The CAA limits a qualifying hospital to receiving no more than 10 additional full-time equivalents (FTEs), and CMS is proposing to first distribute slots such that each qualifying hospital receive up to 1.0 FTE. If any residency slots remain after distributing up to 1.0 FTE to each qualifying hospital, CMS will prioritize the distribution of the remaining slots based on the HPSA score associated with the program for which each hospital is applying.For the slots that were distributed under Section 126 of the CAA of 2021, CMS is proposing, for the remainder of the distribution, to prioritize hospitals qualifying under category four, regardless of HPSA score, because the agency did not meet the statutory requirement to distribute at least 10% of the residents to each of the four categories.How should Congress approach the role of hospitals which engage in “rural reclassification,” wherein a hospital changes its designation from urban to rural, then back to urban within one calendar year for the purposes of receiving Medicare GME payment?We are unaware of any circumstance in which a hospital has changed its designation for the express purpose of receiving Medicare GME slots.How could Congress improve the recruitment of physicians to work in rural or underserved communities? For example, would adding criteria to allocate GME slots for hospitals affiliated with centers of excellence, HBCUs, or MSIs and for hospitals affiliated with non-academic hospital settings improve the distribution of physician training and recruitment in rural and underserved areas?The AHA supports the following legislative proposals to increase the number of physicians working in rural and underserved communities.Rural and Underserved Pathway to Practice Training Programs. The AHA supports the proposal to establish Rural and Underserved Pathway to Practice Training Programs, which would establish 1,000 medical school scholarships annually to promote medical workforce diversity and exempt residency positions filled by program graduates from statutory caps on residency slots. The program would incentivize those from rural and underserved communities to become physicians and to practice in those communities through a scholarship and stipend for qualifying medical students to attend medical school or post-baccalaureate and medical school. Students eligible for this program include first-generation college or professional students; Pell Grant recipients; those who lived in a medically underserved, rural or health professional shortage areas; and graduates of historically Black colleges and universities.The proposal would exclude from a hospital’s residency caps those residents who participated in Rural and Underserved Pathway to Practice Training Programs at certain applicable hospitals that are recognized by the Accreditation Council for Graduate Medical Education for committing to train physicians with additional requirements, such as increased mentorship, structural and cultural competency training, and training in the community.Conrad State 30 Program. We urge Congress to pass the Conrad State 30 and Physician Access Reauthorization Act (S. 665 / H.R. 4942) to extend and expand the Conrad State 30 J-1 visa waiver program, which waives the requirement to return home for a period if physicians holding J-1 visas agree to stay in the U.S. for three years to practice in federally-designated underserved areas.International Workforce. The AHA urges Congress to pass the Healthcare Workforce Resilience Act (S. 3211 / H.R. 6205), bipartisan legislation that would recapture 25,000 unused employment-based visas for foreign-born nurses and 15,000 for foreign-born physicians to help address staffing shortages.Loan Repayment Programs. We urge Congress to pass the Restoring America’s Health Care Workforce and Readiness Act (S. 862) to significantly expand National Health Service Corps funding to provide incentives for clinicians to practice in underserved areas, including rural communities. AHA also supports the Rural America Health Corps Act (S. 940 / H.R. 1711) to directly target rural workforce shortages by establishing a Rural America Health Corps to provide loan repayment programs focused on underserved rural communities.SECTION 3 — Encouraging Hospitals to Train Physicians in Rural AreasTo address nationwide physician shortages in a timely manner, the AHA supports the distribution of additional Medicare-funded residency positions as required by the CAA of 2021. The CAA requires CMS to distribute at least 10% of the 1,000 slots to rural hospitals, a category that includes geographically urban hospitals that have reclassified as rural.AHA supports this goal and we appreciate the working group’s interest in ensuring that rural hospitals fully participate in the GME program. We share your dismay that few rural hospitals are applying for slots. According to CMS, in the first round of GME slot allocations, only eight geographically rural hospitals applied, and five were granted slots.The AHA is committed to working with Congress to assist rural hospitals with any financial, regulatory or administrative burdens that prevent them from applying for or receiving GME slots.Additionally, the AHA supports the THCGME Program, which augments the primary care workforce by supporting primary care and dental residency programs and promoting opportunities for residents to provide care to underserved communities.What barriers exist for hospitals in rural and underserved areas to launch new residency programs supported by Medicare GME?Rural hospitals and health systems are the lifeblood of their communities and are committed to ensuring local access to health care. At the same time, these hospitals are experiencing unprecedented challenges that jeopardize access and services. These include the aftereffects of a worldwide pandemic, crippling workforce shortages, soaring costs of providing care, broken supply chains, severe underpayment by Medicare and Medicaid, and an overwhelming regulatory burden.Rural hospitals make up about 35% of all hospitals in the U.S. Nearly half of rural hospitals have 25 or fewer beds, with just 16% having more than 100 beds. Given that rural hospitals tend to be much smaller, patients with higher acuity often travel or are referred to larger hospitals nearby. As a result, in rural hospitals, the acute care occupancy rate (37%) is less than two-thirds of their urban counterparts (62%). Compared to their non-rural counterparts, a significantly higher percentage of rural hospitals are owned by state and local governments — 35% compared to just 13% of urban hospitals.Recruitment and retention of health professionals have long been persistent challenges for rural providers. Acute workforce shortages and increasing labor expenses resulting from the pandemic have placed additional pressure on rural hospitals. Many rural providers are seeking novel approaches to recruit and retain staff. Existing federal programs, such as the National Health Service Corps, which the AHA strongly supports, work to incentivize clinicians to work in rural areas. Other programs, such as the Rural Public Health Workforce Training Network Program, help rural hospitals and community organizations expand public health capacity through health care job development, training and placement. Additional and continued support to help recruit and retain health care professionals in rural areas is needed from the federal government.At the same time, hospitals exploring the establishment of residency programs confront daunting challenges. A new residency program can take approximately two years to establish, and start-up costs can be prohibitive — requiring resources that small rural hospitals cannot afford given their financial constraints.What revisions to IME payment are needed in order to improve financial support for rural hospitals interested in establishing residency training programs, or otherwise improve the Medicare GME program to support rural hospitals?Congress should ensure that Medicare Advantage (MA) plans are providing appropriate direct GME (DGME) payments to hospitals.Medicare beneficiaries are increasingly enrolling in MA plans, which has implications for teaching hospitals and their GME payments. Medicare makes DGME payments for beneficiaries’ inpatient hospital utilization. Generally, these payments are based on a hospital’s per resident amount (PRA), a weighted number of FTE residents and the hospital’s Medicare share of total inpatient days. Although the hospital’s weighted FTE residents is subject to a cap, its PRA is updated for inflation, so DGME payments per resident increase over time.While these payments will reflect growth in MA utilization, they are reduced to finance reasonable cost payments to hospitals receiving nursing and allied health (NAH) education payments based on their MA utilization.Medicare also makes payments for traditional Medicare beneficiaries’ share of hospital costs incurred in connection with approved education activities, including NAH programs. Unlike Traditional Medicare, MA NAH payments are subject to a dollar amount cap of $60 million annually, an amount that has not been updated since 1999. This cap is routinely reached each year. Thus, as beneficiaries move from Traditional Medicare to MA, hospitals’ Traditional Medicare NAH payments are decreasing, but their MA NAH payments are not increasing (proportionately or otherwise).These two limitations are eroding Medicare’s support of GME. This is very troublesome given that hospitals and health systems already face mounting and critical physician shortages that will jeopardize access to care in communities across the nation. These and other clinician shortages — combined with an aging population, a rise in chronic diseases and behavioral health conditions, physician burnout and state-of-the-art care delivery advancements — all underscore the need for Medicare to at the very least maintain its GME funding. Without this support, it will be extremely difficult to adequately prepare America’s health care workforce for the health system of the future and ensure continued access to care.What other telehealth flexibilities should the working group consider that would benefit resident physicians who are being trained in teaching hospitals, particularly those located in rural or underserved areas?CMS established that after the COVID-19 public health emergency (PHE), teaching physicians could meet requirements for key or critical portions of services through virtual presence (real-time, audio-visual communications technology) but only for services furnished in residency training sites in non-Metropolitan Service Areas (MSAs). During the COVID-19 PHE, flexibilities for virtual supervision were extended to include MSAs. CMS is exercising enforcement discretion through calendar year 2023.The AHA has urged CMS to make permanent virtual supervision flexibilities for both MSAs and non-MSAs. Flexibilities to enable virtual supervision of residents in both non-MSAs and MSAs have improved access for patients and maximized limited teaching physician capacity. They have also provided real-world telehealth experience for residents across geographies, with physicians able to virtually supervise care safely and effectively. This will be essential in training the next generation of clinicians. In addition, provider shortages and staffing challenges are not limited to non-MSAs, particularly for specialties such as behavioral health.SECTION 4 — Establishment of Medicare GME Policy Council to Improve Distribution of Slots to Specialties in ShortageDoes the existing Council on Graduate Medical education (COGME), a federal advisory committee that assesses physician workforce trends, fulfill the goals of this new Medicare GME Policy Council? How can Congress enhance the work of the COGME?The AHA supports Congress providing robust funding necessary for COGME to carry out its responsibilities.SECTION 5 — Improvements to Medicare GME Treatment of Hospitals Establishing New Medical Residency Training ProgramsThe AHA supports allowing hospitals with low caps to reset their caps. We do not have a recommendation for a specific time frame.SECTION 6 — Improvements to the Distribution of Resident Slots under the Medicare Program after a Hospital ClosesWould the proposed changes to the formula for redistributing slots from closed hospitals improve the distribution of GME slots to regions of the country facing greater physician shortages?To improve the distribution of resident slots after a hospital closes, we support the working group’s proposal to retain the requirements that CMS distribute slots to hospitals in the same core-based statistical area and state as the closed hospital and to eliminate the requirement that CMS prioritize hospitals in the same region as the closed hospital.<h2>CONCLUSION</h2>We appreciate the working group’s willingness to seek bipartisan solutions to the urgent crisis of physician shortages. We look forward to continuing to work with you to develop comprehensive legislation to help ensure that the Medicare GME program continues to meet the needs of patients and communities.Sincerely, /s/ Lisa Kidder Hrobsky Senior Vice President, Advocacy and Political Affairs&nbsp; Mon, 24 Jun 2024 10:19:08 -0500 Medical Education/Teaching Hospitals AHA, other national groups urge Congress to increase funding for CHGME program /news/headline/2024-05-17-aha-other-national-groups-send-letter-congress-requesting-funding-increase-chgme-program The AHA and other national health care organizations May 16 sent a <a href="/lettercomment/2024-05-16-aha-others-urge-congress-increase-funding-childrens-hospitals-graduate-medical-education-program">letter</a> to Senate and House appropriations leaders requesting $758 million in funding for the Children’s Hospitals Graduate Medical Education program for fiscal year 2025, an increase over prior funding allocations. Each year, the CHGME program trains thousands of general pediatricians and pediatric specialists, such as child and adolescent psychiatrists, pediatric surgeons, pediatric cardiologists, dentists, podiatrists and other specialists.&nbsp; &nbsp; Fri, 17 May 2024 16:02:23 -0500 Medical Education/Teaching Hospitals AHA, Others Urge Congress to Increase Funding for the Children's Hospitals Graduate Medical Education Program /lettercomment/2024-05-16-aha-others-urge-congress-increase-funding-childrens-hospitals-graduate-medical-education-program May 2024<table><tbody><tr><td>The Honorable Tammy Baldwin Chair Subcommittee on Labor, Health and Human Services, Education and Related Agencies Senate Committee on Appropriations</td><td>The Honorable Shelley Moore Capito Ranking Member Subcommittee on Labor, Health and Human Services, Education and Related Agencies Senate Committee on Appropriations</td></tr><tr><td>The Honorable Robert Aderholt Chair Subcommittee on Labor, Health and Human&nbsp; Services, Education and Related Agencies&nbsp; House Committee on Appropriations &nbsp;</td><td>The Honorable Rosa DeLauro Ranking Member Subcommittee on Labor, Health and Human Services, Education and Related Agencies House Committee on Appropriations &nbsp;</td></tr></tbody></table>Baldwin, Ranking Member Capito, Chair Aderholt and Ranking Member DeLauro:The Children’s Hospitals Graduate Medical Education (CHGME) program is the most important federal investment supporting the pediatric physician workforce and access to care for the nation’s children. As groups dedicated to protecting and advancing the health of America’s children, we thank you for your longstanding bipartisan support of CHGME, including an increase in Fiscal Year (FY) 2024 funding, and ask you to provide $758 million in FY 2025 funding for the program, which is critical during the ongoing youth mental health crisis.We are grateful for Congress’ consistent bipartisan support for the CHGME program, which, over the decades, has enabled children’s hospitals to dramatically increase pediatric physician training and significantly increase the number of pediatricians and pediatric specialists who care for the nation’s children. Each year, CHGME-funded children’s hospitals train thousands of general pediatricians and pediatric specialists like child and adolescent psychiatrists, pediatric surgeons, pediatric cardiologists, dentists, podiatrists and more. As you know, our country is currently facing a national health care workforce shortage, and pediatrics is no different. Your continued support for CHGME is vital to maintaining and strengthening the pediatric physician pipeline.The CHGME program:<ul><li>Supports 1% of all hospitals in the U.S. while training the majority of the nation’s pediatricians and pediatric specialists.</li><li>Represents just 1.7% of total federal spending on graduate medical education (GME).</li><li>Supports local pediatric physician workforce with over 2/3 of CHGME-funded physicians staying in the state where they completed their residency.</li></ul>We are grateful for your work to provide $390 million (the highest level to date) for CHGME in FY 2024 as that gets the program closer to alignment with the residency training funding of other federal programs. CHGME per-resident funding is currently about one-half of per-resident funding provided through other federal training programs. We need your support to boost funding for the CHGME program to help our pediatric patients now and into the future.Boosting support for the pediatric workforce is even more important as we face the growing challenges of the children’s mental health crisis as well as future respiratory virus surges that will increasingly impact our pediatric health care workforce. CHGME supports the training of the front-line providers who are caring for our children and youth during these emergencies. Additionally, CHGME plays a critical role in combatting the worsening crisis in child and adolescent mental health, by funding the training of more than half of the developmental pediatricians and almost half of all child and adolescent psychiatrists. We cannot continue to fall behind—we must protect children’s access to care.CHGME is a critical investment in our country’s health care future to help ensure children will have the care they need across provider settings. Again, thank you for your continued leadership in investing in the health care of all children and we urge strong support for the CHGME program with $758 million for FY 2025.Sincerely,Academic Pediatric Association&nbsp; America's Essential Hospitals&nbsp; American Academy of Pediatrics&nbsp; American Association of Child and Adolescent Psychiatry&nbsp; �� Association&nbsp; American Medical Association&nbsp; American Pediatric Society&nbsp; American Psychiatric Association&nbsp; American Psychological Association&nbsp; Association of American Medical Colleges&nbsp; Association of Medical School Pediatric Department Chairs&nbsp; Catholic Health Association of the United States&nbsp; Children’s Hospital Association&nbsp; Council of Pediatric Subspecialties&nbsp; Eating Disorders Coalition for Research, Policy &amp; Action&nbsp; Family Voices&nbsp; Federation of ��s&nbsp; First Focus Campaign for Children&nbsp; National Alliance on Mental Illness&nbsp; National Association for Behavioral Healthcare&nbsp; National Association of Pediatric Nurse Practitioners&nbsp; National League for Nursing&nbsp; Pediatric Policy Council&nbsp; Premier Inc.&nbsp; REDC&nbsp; The Root Cause Coalition&nbsp; Society for Pediatric Research&nbsp; Vizient, Inc&nbsp; Youth Villages Thu, 16 May 2024 13:49:53 -0500 Medical Education/Teaching Hospitals Foundation Frontiers: A Medical Education Webinar /education-events/foundation-frontiers-medical-education-webinar Foundation Frontiers: A Medical Education Webinar&nbsp; &nbsp; Fusion Detection in Advanced Non-Small Cell Lung Cancer: Stay up to DateThursday, June 13, 2024&nbsp; 1 - 2 p.m. Eastern; noon - 1 p.m. Central; 10 - 11 a.m. Pacific<div class="webreplay"> .webreplay{ border: solid 2px #777; padding: 15px 5px; margin: 0 0 10px 15px; } @media (min-width:360px){ .webreplay{ min-width: 290px; float: right; } } <h2 class="text-align-center">On-demand Webinar</h2>&nbsp;MktoForms2.loadForm("//sponsors.aha.org", "710-ZLL-651", 3881);</div>In non-small cell lung cancer (NSCLC), targetable driver alterations include ALK*, RET**, and ROS1*** fusions. DNA-based and RNA-based next-generation sequencing each have advantages and drawbacks for detecting gene fusions. In this webinar, expert speakers will present their perspectives on fusion detection in NSCLC. &nbsp;Attendees Will Learn:<ul><li>Summary of currently approved therapies for fusions in NSCLC. &nbsp;</li><li>Methods and recommendations for fusion detection with comprehensive genomic profiling.&nbsp;</li><li>The pros and cons of DNA and RNA sequencing for fusion detection. &nbsp;</li><li>About fusion detection in the context of a hypothetical patient case. &nbsp;&nbsp;</li></ul> Speakers:&nbsp; Mark Socinski, MD &nbsp; Executive Director (Thoracic Cancer), Medical Oncologist &nbsp;&nbsp; AdventHealth Cancer Institute &nbsp; Orlando, FL &nbsp;Holli Dilks, PhD &nbsp; Senior Director, Global Head of Field Medical&nbsp; Foundation Medicine &nbsp; Boston, MA * Anaplastic lymphoma kinase (ALK)&nbsp; ** rearranged during transfection (RET)&nbsp; *** ROS proto-oncogene 1, receptor tyrosine kinase (ROS1)&nbsp; Tue, 30 Apr 2024 15:42:42 -0500 Medical Education/Teaching Hospitals CMS awards second batch of new Medicare-funded residency slots to hospitals /news/headline/2023-11-16-cms-awards-second-batch-new-medicare-funded-residency-slots-hospitals The Centers for Medicare &amp; Medicaid Services Nov. 15&nbsp;<a href="https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/direct-graduate-medical-education-dgme">allocated</a>&nbsp;200 new Medicare-funded residency slots to 100 teaching hospitals in health professional shortage areas with the greatest need, as defined in the inpatient prospective payment system final rule for fiscal year 2022. The slots are the second allocation from 1,000 new Medicare-funded residency positions authorized over five years under Section 126 of the Consolidated Appropriations Act of 2021. The application period for the third round of 200 residency positions will open in January and close on March 31. &nbsp; Thu, 16 Nov 2023 16:04:00 -0600 Medical Education/Teaching Hospitals Government Funding Talks Continue, Hospitals and Health Systems Should Monitor Situation <div class="container"> <div class="row"> <div class="col-md-8">There are nine days until the end of the federal fiscal year, and none of the 12 annual appropriations bills necessary to fund the federal government have been enacted. In addition, the House and Senate have been unable to act on a continuing resolution (CR) to temporarily keep the government running, so there is a high probability that the federal government will shut down on Oct. 1. Negotiations are expected to further intensify in the coming weeks. <h2>AHA TAKE</h2> While AHA will continue to monitor the progress of the government funding negotiations, hospital and health systems should know many programs they rely upon will continue operating without interruption. <h2>IMPACT ON HOSPITALS AND HEALTH SYSTEMS</h2> Because Medicare payments to hospitals are mandatory, they are unaffected by a government shutdown. The Centers for Medicare and Medicaid Services (CMS) has indicated Medicare, health care fraud efforts and Center for Medicare &amp; Medicaid Innovation activities will continue during a lapse in federal funding through appropriations. For additional details on the impact on other <a href="https://www.hhs.gov/about/budget/fy-2024-cms-contingency-staffing-plan/index.html" target="_blank">CMS</a> and <a href="https://www.hhs.gov/about/budget/fy-2024-hhs-contingency-staffing-plan/index.html" target="_blank">HHS</a> programs, as well as the impact on CMS and HHS personnel, please refer to the agencies’ contingency plans. <h2>HEALTH EXTENDERS</h2> The authorizations for several important health care programs expire on Sept. 30. These programs include delays of impending Medicaid Disproportionate Share Hospital (DSH) cuts, the authorizations for community health centers, the National Health Service Corps, Children’s Hospitals Graduate Medical Education (GME) and Teaching Health Center GME. Normally, these program authorizations would be extended for the duration of the short-term funding bill. Final legislation addressing these authorizations would be enacted with the last appropriations bill for the fiscal year. In the absence of a CR, these authorizations will have to be extended on a different legislative vehicle, or they will temporarily expire. With respect to the waiver of impending Medicaid DSH payments, many states will not make DSH cuts, if they are not addressed by Congress on Oct. 1 or on a CR, until near the end of 2023. However, this decision is made by each state’s Medicaid agency and some states may impose the cuts on their own schedule. <h2>BACKGROUND AND ADDITIONAL DETAILS</h2> The Federal government has seen three long shutdowns. 2018-2019: A 35-day partial government shutdown occurred from Dec. 22, 2018, to Jan. 25, 2019, because of a dispute over funding for border security. During the shutdown, the Department of Health and Human Services (HHS) continued to operate as its funding had been previously enacted. The government reopened with full-year funding adopted for all remaining departments and agencies in February 2019. 2013: A 17-day full government shutdown unfolded from Oct. 1-17, 2013, because of a dispute over defunding the Affordable Care Act. Congress passed full-year spending for all departments and agencies in January 2014. 1995-1996: A 21-day partial government shutdown occurred from Dec. 15, 1995, through Jan. 6, 1996, during a confrontation over balancing the budget. The partial shutdown affected HHS. Congress and the administration negotiated full-year funding for all affected departments in March 1996. <h2>FURTHER QUESTIONS</h2> If you have further questions, contact Mary Naylor, AHA’s senior director of federal relations and operations, at <a href="http://mailto:mnaylor@aha.org" target="_blank">mnaylor@aha.org</a>. </div> <div class="col-md-4"> <a href="/system/files/media/file/2023/09/government-funding-talks-continue-hospitals-and-health-systems-should-monitor-situation-advisory-9-22-23.pdf" target="_blank"><img alt="Government Funding Talks Continue, Hospitals and Health Systems Should Monitor Situation" data-entity-type="file" data-entity-uuid="0842b648-d26b-41cd-b57d-c25fe0ca469f" src="/sites/default/files/inline-images/cover-government-funding-talks-continue-hospitals-and-health-systems-should-monitor-situation-advisory-9-22-23.png" width="489" height="632"></a> </div> </div> </div> Fri, 22 Sep 2023 08:31:35 -0500 Medical Education/Teaching Hospitals