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GME Report - Do We Have Enough Physicians?

August 25, 2014

by Mike Amery, Esq, AAN Legislative Counsel 

IOM Report Sparks Controversy                 
With Congress on recess it gives us an opportunity to look at some other things happening around DC. One interesting item has been the release of a report on Graduate Medical Education (GME). Congress has heard for years that the US doesn't have enough physicians. A new report from the Institute of Medicine (IOM) raises some questions about that and makes some recommendations. 

The AAN has long been interested in GME funding as many Academy members and their institutions rely on this federal support. Each year, bills are introduced to increase residency slots, while others try to cut GME funding to pay for other programs. Because of so many divergent interest groups, Congress finds it difficult to do anything at all with GME.

But the large amount of federal money allocated for GME makes it interesting to agencies tasked with making policy recommendations. The IOM recently published recommendations about restructuring GME funding. The IOM's goal is “to support a production of a balanced physician workforce ready to provide care to underserved populations and reflecting the racial and ethnic diversity of American people.” 

One of the most controversial parts of the report is the IOM's contention that the current physician workforce is adequate. The AAN understands there are methodical limitations to studies that predict physician shortages but we are concerned that our circumstances are unique due to the increasing prevalence of neurologic conditions and aging of the population. We will continue to emphasize our data that shows significant shortages in neurology across much of the US.

The IOM report recommended maintaining current Medicare GME funding but tying it to performance metrics that reward educational outcomes such as graduates' competence in care coordination, team-based care, and cost-effective care, as well as the percentage of graduates practicing in rural areas and underserved urban areas. To get to a system of performance-based GME payments, IOM recommended creating one Medicare GME fund with two sides, one supporting current GME Programs, and another supporting innovation.

Finally, IOM recommended keeping GME support in Medicare but merging the current indirect medical education adjustment and the current direct GME funding into one payment based on a national per-resident amount with a geographic adjustment. This way GME funding is more secure and predictable than if it is subject to the annual discretionary appropriations process but has more accountability.

All of the recommendations require legislative action. Congress is hardly able to act on some basics much less a restructuring of a program as large as GME. So we aren't concerned about any imminent action but we will watch this closely, evaluate possible implications for the future supply of neurologists, and work with policymakers on this important issue.


Regulatory Corner
by Daneen Grooms, MHSA, AAN Regulatory Affairs Manager

Open Payment System Reopens, Extends Registration, Review, and Dispute Periods
For well over a year, I have been talking about the Physician Payment Sunshine Act (Sunshine Act) and the importance of neurologists registering with the Centers for Medicare & Medicaid Services (CMS) to review data submitted about them in accordance with this regulation. Since August 2013, the Sunshine Act requires pharmaceutical companies and medical device manufacturers (“industry”) to collect and report to CMS payments and other transfers of value of at least $10 made to physicians. Industry was required to submit payment data from August 2013 to December 2013 to CMS by March 2014, and CMS will release the data on a publicly accessible website on September 30, 2014. Even if you did not receive any payment or transfer of value from industry in 2013, you should still review to ensure a report was not submitted by mistake.

You probably have read about physicians being unable to register in Open Payments recently. I learned that CMS took the system offline on August 3 due to a technical issue involving intermingled data for physicians with the same first and last names. Last Monday, CMS announced the problem has been resolved and that the Open Payments system is once again available for physicians to register, review, and dispute financial payment information received from industry. If you haven't, I urge you to register now to review any data submitted about you. Physician registration has been extended to September 8 and is conducted in two phases. The first step requires user registration in the CMS Enterprise Portal. Once you complete that step, you can register in the Open Payments system to review and dispute data submitted about you. If an error is found, industry is required to work with you in resolving the disputed report. CMS will not mediate any dispute. If the dispute goes unresolved, the report will be in the public database, but will be shown as being under dispute.

The AAN has joined the American Medical Association and the Council of Medical Specialty Societies in advocating CMS to postpone the publication of the data. Many physicians are not aware of the registration requirement and feedback from physicians reveals that the registration process is overly complicated and time consuming. For more information on the Sunshine Act and for a list of FAQs, please visit the Practice Management Resources page at AAN.com.


Odds and Ends
by Tim Miller, Sr. Program Manager, Communications and State Advocacy

  • The Academy recently signed on to a letter to the FDA providing perspective on the naming issue in regards to the implementation of the Biologics Price Competition and Innovation Act (BPCIA). This perspective takes the position that biosimilars released on the market should have distinct brand names.
  • Despite a busy election season, the second year of the AAN site visit program has been a success. Recent visits include David Hart, MD, hosting Congressman Paul Tonko at his practice in Albany, NY, and Doug Redosh, MD, hosting Congressman Ed Perlmutter where he practices just outside Denver, CO. View the AAN Congressional Site Visit photo album on Facebook. 

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