GAO Report Looks At Diverting GME Money To Train NPs and PAs

Do you like the idea of "diverting Medicare GME funding for medical residents to NPs and Pas"?

  • yes

    Votes: 2 4.3%
  • no

    Votes: 45 95.7%

  • Total voters
    47

msnbc2020

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DECEMBER 20, 2019

The United States Government Accountability Office (GAO) Dec. 18 released a report on providing Medicare graduate medical education (GME) funding for nurse practitioner (NP) and physician assistant (PA) graduate training. The report was requested as part of the Departments of Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill in 2018 (S. Rep. No. 115-150).

Specifically, GAO examined the possibility of diverting Medicare GME funding for medical residents to NPs and Pas. The report also provided limited estimates of NP and PA graduate training costs. GAO noted that some members of Congress suggested that “expanding the scope of the Medicare GME program to include NPs and PAs could help mitigate the effects of a physician shortage.”
 
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Ironspy

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We have a bunch of US and internationally trained physicians who can't match due to limited GME-funded residency slots. So the solution is to divert money away from training physicians to train more nurses to relieve the physician shortage. mmmkay
 
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Goro

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The only way this can be solved is to call (not email) or write your Congressperson and Senators and enlighten them on what you do, what midlevels can't do, and why this diversion is a medically bad idea.

And in a dream world, maybe the AMA and AOA will get off their asses and do something to look out for y'all.
 
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NotAProgDirector

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If you actually read the report, you'll see that the word "diverting" isn't in there at all. Someone studied whether funding GME for NP/PA's is worthwhile, and how much it might cost. The report was created because this was in the bill/law:

Graduate Medical Education.--The Committee recommends that
the Comptroller General of the United States conduct a study on
the potential of making graduate medical education payments
under the Medicare program for mid-level health providers (such
as physician assistants and nurse practitioners) to allow
physicians and other health care providers to perform to their
full scope of practice; and to identify the current, actual
costs involved in training residents in different residency
specialty types. The Comptroller General shall provide the
report within one year of the enactment of this act and shall
consult with the Committees on Appropriations of the House of
Representatives and the Senate as well as the Senate Finance
Committee and House Committee on Ways and Means and keep the
Committees apprised of progress quarterly.

There's a single section where people who were interviewed opined that they were concerned about funding:

Potential limitations on Medicare funding for physician training. Officials from seven of the nine stakeholder organizations we interviewed—four NP, one PA, and two physician organizations— expressed concern that expanding the Medicare GME program to increase the number of NPs and PAs without increasing overall funding may negatively impact the funding available for physician training.
I'm already confused about the premise of the question. GME funding is fixed by statute. Congress can't just decide to change it's appropriation like it can for other departments. They would need to pass a whole new law to replace what already exists. If Congress were to pass some expansion of GME funding for NP/PA programs, it would be in addition to what they spend for physician training unless stated otherwise.

For example, officials from one stakeholder organization said that reallocating available Medicare GME dollars could be problematic and potentially diminish needed resources for others. An official from one of these stakeholder organizations said that there is currently not enough funding to provide residency training for all qualified physicians, and adding NPs and PAs to the existing pool of underfunded residency candidates would worsen the funding shortage.

What? I assume they are suggesting that some hospitals function above their cap. But again, this report doesn't suggest cutting any funding. Or they are suggesting that some students go unmatched completely, and if they increased funding for physician spots then there would be more physicians -- which is certainly true.

Officials from another stakeholder organization echoed this concern by noting that expanding the Medicare GME program could force NPs to compete with physician residents for patients and space.

This is certainly a real concern, although it's possible that NP/PA training would happen in different sites and not compete at all.

There are plenty of problems with our GME funding system. The wildly different amounts that hospitals get paid per resident based on ridiculous accounting (i.e. hospitals that overcharged medicare in the 1980's get much more money) is one. Whether Medicare should be paying for GME at all is another. But if this goes forward (which it probably won't), it almost certainly will just increase funding without any sort of income source -- that's exactly what Congress has done for the last 20 years or so. Even when they do try to "pay" for something, they almost certainly repeal or delay the payment part -- see the ACA, or the recent tax cuts (which were "paid for" by sunsetting tax cuts early, yet Congress knows they will reverse those ultimately because it wouldn't be "fair" or would be a huge shock to the economy.
 

BoardingDoc

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Do you really think GME funding is untouchable?
Federal Reserve Chair Jerome Powell has repeatedly called out the ballooning U.S. national debt. He did so again while testifying to Congress on Tuesday.
"The U.S. federal government is on an unsustainable fiscal path,” Powell told the Senate Banking Committee, noting that “debt as a percentage of GDP is growing, and now growing sharply... And that is unsustainable by definition.
He continued: “We need to stabilize debt to GDP. The timing the doing that, the ways of doing it —through revenue, through spending — all of those things are not for the Fed to decide.”
Powell later added that the “single biggest thing” that drives the “unsustainability” is health care delivery. “We spend 17% of GDP, everyone else spends 10%. ... It’s not that benefits themselves are too generous. We deliver them in inefficient ways.”
What do you think is more likely to face cuts in the future: Social security benefits, SNAP, Medicare benefits, Medicaid benefits, WIC, Head Start, or GME funding?
Good Lord man, when it comes to the art of ranting and then tangentially responding to any criticisms of said rants, you are truly this forum's Picasso.
 
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msnbc2020

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Good Lord man, when it comes to the art of ranting and then tangentially responding to any criticisms of said rants, you are truly this forum's Picasso.
Can you please point out the "rant" you are referring to?
I fail to see how directly quoting the AAMC is a rant.
Here is the OP which I directly quoted:
1578401666003.png
Did the AAMC rant?
 

NotAProgDirector

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Of course GME funding isn't untouchable. Any funding is adjustable. I'm just saying that our current political process appears to just spend and spend, and I'm afraid it's going to keep doing so until the economy collapses. It's sad. SAD!!!!!!

The AAMC statement purposefully spun the GAO report and used inflammatory language to make people upset and generate outrage. It appears to have worked.
 
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GoSpursGo

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Given that it appears that the idea of diverting GME funding to pay for NP/PA training is just speculation at this point, I don't think this has much to do with residency training. Moving to Topics in Healthcare.
 

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