AAMC and other Health Care Providers Letter to the National Bipartisan Commission on the Future of Medicare on GME

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America's Health Care Providers Supporting
Graduate Medical Education

February 19, 1999

Dear Commission Member:

The undersigned organizations write to express major concern with the proposal on Graduate Medical Education (GME) before the Commission. Although we appreciate the proposal's recognition that the Medicare program should continue to pay for indirect medical education (IME) payments, we strongly oppose the proposal's recommendation to move direct graduate medical education (DGME) payments from Medicare to the appropriations process.

We believe that all payers, including Medicare, should invest in the direct and indirect costs associated with graduate physician training. All payers benefit from physician training; Medicare sets the standard for other payers and should continue to be the model for other payers.

Medicare's time tested support is crucial given the current instabilities in the health care marketplace. Teaching hospitals are in the process of patient care redesign and restructuring to find ways to adapt to the increasingly price competitive marketplace. Medicare's willingness to provide its fair share of support for GME is more important than ever now that other payers are less willing to pay higher patient care rates to fund the special missions of teaching hospitals.

Medicare's portion of support for GME provides a stable, dependable source of funding. The residency training period varies from three to more than seven years; the appropriations process will introduce inordinate uncertainty into the complex process of training physicians, dentists and allied health providers. GME programs are not amenable to the stop and start effect of annual appropriations.

Medicare's support for GME has allowed our nation's citizens to be assured future physicians will be trained and educated to provide the very best medical care. Respectfully, we request that you reconsider this proposal.

Sincerely,

Academy of Clinical Laboratory Physicians and Scientists
Administrators of Internal Medicine
Ambulatory Pediatric Association
American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Neurology
American Academy of Otolaryngology-Head and Neck Surgery
American Academy of Pediatrics
American Association of Colleges of Osteopathic Medicine
American Association of Dental Schools
American Association of Eye and Ear Hospitals
American Association of Neurological Surgeons
American Association of Thoracic Surgery
American Board of Internal Medicine
American College of Cardiology
American College of Obstetrician and Gynecologists
American College of Osteopathic Surgeons
American College of Physicians
American College of Preventative Medicine
American College of Surgeons
American Dental Association
American Hospital Association
American Medical Student Association
American Medical Women's Association
American Neurological Association
American Osteopathic Healthcare Association
American Pediatric Society
American Podiatric Medical Association
American Psychiatric Association
American Psychiatric Nurses Association
American Society of Anesthesiologists
American Society of Cataract and Refractive Surgery
American Society of Clinical Pathologists
American Society of Hematology
American Society of Internal Medicine
American Society of Nephrology
American Society of Plastic and Reconstructive Surgeons
American Society of Transplantation
American Society of Reproductive Medicine
American Urological Association
Association of Academic Health Centers
Association of American Medical Colleges
Association of American Universities
Association of Departments of Family Medicine
Association of Family Practice Residency Directors
Association of Medical School Pediatric Department Chairs
Association of Osteopathic Directors and Medical Educators
Association of Pathology Chairs
Association of Professors of Medicine
Association of Program Directors in Internal Medicine
Association of Program Directors in Surgery
Association of Subspecialty Professors
Catholic Health Association
Clerkship Directors in Internal Medicine
Congress of Neurological Surgeons
Medical Group Management Association
National Association of Public Hospitals & Health Systems
North American Primary Care Research Group
Premier, Inc.
Society for Pediatric Research
Society of Critical Care Medicine
Society of Teachers of Family Medicine
The Society of Thoracic Surgeons
VHA
Volunteer Trustees of Not-For-Profit Hospitals