Rep. Schock on GME Funding

CMS introduces academic community to strong physician supporter

By Elizabeth Sidney

A Meeting convened by the Chicago Medical Society brought academic leaders face-to-face with the architect of a CMS-backed bill to expand graduate medical education (GME). U.S. Rep. Aaron Schock (R-IL), sponsor of several GME-related proposals that would add new Medicare-funded residency slots, reported on the bill’s prognosis before an audience of medical educators, including deans.

The “Training Tomorrow’s Doctors Today Act,” introduced in 2013 by Rep. Schock, has 68 cosponsors. A CMS-led coalition was critical to securing the support of eight Illinois representatives. CMS continues to work closely with the Peoria congressman to educate lawmakers in Washington, and to organize the state’s medical school deans and students into advocacy coalitions.

Rep. Schock spoke on June 2 at the CMS-hosted gathering. His address also coincided with the launch of a letter campaign from CMS medical student members to their legislators in Washington. Enlisting students to tell their personal stories is a key component of CMS’ all-out fight to raise the 1997 caps on Medicare-funded residency slots.

In March, a CMS-led contingent of deans made their case in Washington with House Ways and Means Committee members, who oversee Medicare, along with Senate Finance Committee leaders, and Illinois lawmakers. Reinforcing this advocacy, CMS rallies each year on Capitol Hill for expanding the physician workforce.

These face-to-face discussions complement CMS’ letter campaigns, such as one last fall to the entire Illinois Delegation, signed by leaders of the state’s eight teaching institutions.

Lifting the caps on GME funding is an urgent priority for CMS, whose members practice in every teaching hospital and academic medical center in Cook County.

Rep. Schock, who grew up on a strawberry farm and is the son of a physician, has been relentless in warning that the U.S. is on the cusp of a crisis in both specialty and primary care physicians. “Every eight seconds another Baby Boomer turns 65 and 10,000 Baby Boomers are expected to retire every day for the next 20 years. It’s incumbent upon us to ensure we have a prepared physician workforce in place to meet the growing health care demands on our country,” Rep. Schock said.

“The primary way our country can address the physician shortage is by increasing the number of medical school graduates who will receive hands-on training in a patient care setting.”

While there will be more than 74 million American seniors in need of health care services within 20 years, experts estimate that 130,000 new physicians will be necessary to eliminate the workforce shortage by 2025.

GME slots are funded primarily by Medicare for the purpose of training medical school graduates in patient settings.

Provisions of Schock-Schwartz Bill

The “Training Tomorrow’s Doctors Today Act,” which now includes Allyson Schwartz (D-PA) as co-sponsor, would bring much-needed reforms to the nation’s GME system and help to preserve access to specialty care.

The bill increases the number of GME residency slots by 15,000 over the next five years, directing half of the newly available positions to training in shortage specialties. The proposal also specifies priorities for distributing the new slots (e.g., states with new medical schools); and studying the needs of the U.S. health care system in order to allocate residencies accordingly.

Hospitals will be allowed to apply for the slots through one of two pools, but no hospital will be able to earn more than 75 slots. This limit ensures smaller and rural hospitals are able to compete for the slots in the same manner as larger hospitals and hospital systems.

The first path a hospital can choose is through a “cap relief pool.” A hospital is awarded new slots on the basis of how long it has trained residents out of its own bottom line (“residents trained over the cap”) as well as how many total residents have been trained over the cap.

This criteria reward hospitals for training new medical doctors despite the current freeze on medical residency slots; 1,000 slots per year will be available through the cap relief pool.

The second pool is the “priority pool,” which awards GME slots through priority criteria. The criteria give hospitals a second pathway to apply for the slots. There will be 2,000 slots available through this second option. A hospital can choose to apply for slots through one or both pathways but is limited to receiving 75 slots annually.

The Schock-Schwartz legislation also requires teaching hospitals to report the full cost of their medical residency programs, such as the cost of a medical resident’s laboratory and research training.

In addition, the bill requires the Government Accountability Office (GAO) to update its report on specialties in which there is a physician shortage, and to issue two new reports.

The GAO would recommend ways to increase diversity in the health care workforce and to review the competency of doctors who serve seniors as well as improve that level of care.

But before reforming GME, Rep. Schock says Congress must repeal and replace the sustainable growth rate (SGR) formula, a fight that is consuming a lot of time and energy. He predicts that Congress and the public will find common ground. Solutions to the SGR crisis may involve asking those with higher incomes to pay for more of their own health care.

Rep. Schock took audience questions, including a suggestion to substitute “residency” for “GME” funding. While the meaning of GME is apparent to the medical community, the public needs to understand that the shortfall refers to the training of new physicians, not to the education of physicians already in practice. The physician-educator pointed out that the public might confuse GME with post-training studies.

It is also important to distinguish between academic medical centers and teaching centers, the audience member said.

Finally, the congressman thanked CMS members and guests in attendance. “Legislation is only as good as the information we get,” said Rep. Schock.

“There’s a lot of expertise in this room, so please come to Washington, DC. We need your insight and expertise.”