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The Council on Graduate Medical Education (COGME)
Current Status as of January 30, 2001
At its meeting December 13-14, 2000, the Council on Graduate Medical Education
issued its 15th report, "Financing Graduate Medical
Education in a Changing Health Care Environment." The Council
emphasized that the report should be read as a set of ideas for
discussion, not a finished policy proposal. To foster this discussion, the
Council will devote the first day of its April 11-12, 2001 meeting to
presentations from and discussions among interested organizations,
including the AAMC.
Background
In 1986 the Council on Graduate Medical Education (COGME) was
established by Congress and charged with the responsibility of assessing
physician workforce trends, identifying needs, and recommending
appropriate federal and private sector efforts to address those needs. The
Council advises the Secretary of Health and Human Services (DHHS), the
Senate Committee on Labor and Human Resources, and the House Committee on
Commerce on:
- the supply and distribution of physicians in the United
States;
- current and future shortages or excesses of physicians in medical
and surgical specialties and subspecialties;
- issues regarding international medical graduates;
- federal policies related to items l-3, including policies on
financing undergraduate and graduate medical education and on the
development of programs in graduate medical education to meet workforce
needs;
- efforts by hospitals, schools of allopathic or osteopathic medicine,
or accrediting bodies related to items 1-3; and
- deficiencies and needs for improvements in data and research on the
supply and distribution of physicians in the U.S.
The Health Professions Education Partnerships Act of 1998 reauthorized
the Council through September, 2002.
Members of the Council are
either appointed by the Secretary of DHHS or are included by statute as
representatives of the Health Care Financing Administration, the
Department of Veterans Affairs, and the Assistant Secretary for Health for
DHHS. As provided by Congress, the appointed members are selected from
among practicing primary care physicians, national and specialty physician
organizations, international medical graduates, medical student and house
staff associations, schools of medicine and osteopathy, public and private
teaching hospitals, health insurers, business, and labor.
The Council meets three times each year in Washington, DC. Members hear
reports from experts in health care, health policy, and graduate medical
education; deliberate on the issues; and formulate findings and
recommendations.
Activity
COGME is best known for its recommendations on the size and composition
of the physician workforce. The Council has disseminated its work through
a series of fifteen reports on topics related to its charge. A complete
list of its reports may be
found on the COGME Web site. Report
summaries and some complete reports may be found on this site.
The 15th report "Financing
Graduate Medical Education in a Changing Health Care Environment", sets
forth these policy objectives for GME funding:
- Provide a stable mechanism that is responsive to the community yet
consistent with national workforce objectives.
- Enable health care institutions to compete on price and quality by
subsidizing higher costs attributable to educational activities and
uncompensated care.
- Create adequate support and appropriate incentives for developing
community-based educational programs.
- Encourage effective and efficient educational models.
- Foster mechanisms to stabilize the total number of physicians while
improving distribution.
- Hold recipients of Federal and State funds accountable for producing
needed public goods.
To attain these objectives COGME makes eight recommendations:
- Create a GME fund that combines all Federal GME funding with
all-payer funds
- Establish IME accounts from the fund to pay hospitals and other
clinical training sites for the indirect costs of educational
activities.
- Establish direct GME accounts from the fund and make GME payments
directly to institutional sponsors or their designees.
- Establish a national average per resident amount for direct GME
costs
- Continue the BBA 1997 limits on the number of residents but apply
the caps to institutional sponsors rather than
hospitals.
- Establish an account of at least 10 percent of the fund from which
to support special projects and programs directed at building
community-based training capacity or achieving specific workforce
goals.
- Modify the Medicare rules related to teaching physicians to
emphasize the teaching physician's overall responsibility for the
management of a patient's care and to reduce the importance of
documentation.
- Provide additional support for hospitals and community-based
training sites that serve a disproportionate share of low-income
patients.
AAMC Action
AAMC staff commented on the draft 15th report in a July meeting with
Stanley Bastacky, COGME acting executive director, and other COGME staff.
A comment letter on the final draft will be sent in early 2001.
AAMC
Initiatives
AAMC staff members attend COGME meetings and monitor the Council's
analytic work and policy deliberations. Accounts of the meetings are
published in Washington Highlights. The AAMC also nominates candidates for
Council seats and responds to COGME requests for information and comments
on its work.
Meeting
The next meeting of COGME will occur April 11-12, 2001 in Washington,
DC.
COGME posts its statutory charge, current membership, meeting agendas,
reports and other information on the COGME Web site.
Contacts
For further information, contact Sunny
G. Yoder, Division of Health Care Affairs, AAMC directly at (202)
828-0497. |
