{ "id": "R44376", "type": "CRS Report", "typeId": "REPORTS", "number": "R44376", "active": true, "source": "EveryCRSReport.com", "versions": [ { "source": "EveryCRSReport.com", "id": 597938, "date": "2018-12-27", "retrieved": "2019-12-20T20:15:48.077276", "title": "Federal Support for Graduate Medical Education: An Overview", "summary": "Access to health care is, in part, determined by the availability of physicians, a function of the physician supply. Policymakers have demonstrated a long-standing interest in access to care, both in general and for specific populations. Moreover, federal support for medical residency training (a.k.a., graduate medical education [GME]) is the largest source of federal support for the health care workforce. Although the health workforce includes a number of professions, the size of the federal investment in GME\u2014estimated at $16 billion in 2015\u2014makes it a policy lever often considered to alter the health care workforce and impact health care access. This report describes federal programs that provide GME support. Although these programs may also support training for other health professions, this report focuses on training for physicians, who receive the bulk of GME support. The report examines GME support in Medicare, Medicaid, the Department of Veterans Affairs, the Department of Defense, and programs administered by the Health Resources and Services Administration, such as the Children\u2019s Hospital and Teaching Health Center GME payment programs. The report details the mechanisms that various federal programs use to support GME and provides data, when available, on funding and the number of trainees. As noted in the table below, the data available vary by program. \nProgram Name\nControl over trainees\nTotal Funding\nNumber of Trainees\nCost Per Trainee\n\nMANDATORY FUNDING\n\nMedicare GME Payments\nThe number of Medicare-supported residents and per-resident payment amount is capped for each hospital, but hospitals determine staffing needs and types of residents with the exception of certain primary care residents. \nFY2015 (est.):\n$10.3 - $12.5 billion\n\n\nFY2015 (est.):\n85,712 - 87,980 FTE (DGME) slots\n85,578 - 88,416 FTE (IME) slots\nFY2015 (est. average): \n$112,000 - 129,000\nper FTE \n\nMedicaid GME Payment\nStates are permitted to make these payments using their own criteria to determine which providers are eligible for payments.\nN/A.\nN/A The Medicaid program does not require states to report these data. \nN/A. The Medicaid program does not require states to report these data.\n\nTeaching Health Centers GME Payment Program \nFunding to applicant teaching health centers that meet the program\u2019s eligibility requirements.\nFY2018:\n$126.5 million (est.)\n\nAY2016-AY2017:\n742 FTE slots\n771 total residents trained \nN/A.\n\nDISCRETIONARY FUNDING\n\nVeterans Affairs GME Payments\nVA facilities determine their staffing needs and the number and type of residents supported.\nFY2017:\n$1.78 billion\nAY2016-AY2017:\n11,000 FTE slots and \n> 43,565 residents spent part of their training at a VA facility \nFY2015 (est.):\n$137,792/resident\n\nChildren\u2019s Hospital GME Payment Program\nGrant funding awarded to applicant children\u2019s hospitals that meet the program\u2019s eligibility requirements.\nFY2019:\n$325 million \nFY2016-FY2017\n58 hospitals received payments to support 7,164 FTE slots\nN/A\n\nDepartment of Defense GME Payments\nDivisions of the armed forces determine their staffing needs and the number and type of residents supported.\nFY2012:\n$16.5 million\nFY2017:\n3,983 FTE residents \nN/A\n\nSources: CRS analysis of agency data, including review of various agency budget justification and The Robert Graham Center program data sourced from CMS Medicare hospital cost report data, and GAO report, Physician Workforce: HHS Needs Better Information to Comprehensively Evaluate Graduate Medical Education Funding (GAO-18-240, 2018). \nNotes: AY = Academic year; Academic year 2016-2017 began on July 1, 2016, and concluded on June 30, 2017. DGME = direct graduate medical education. est. = estimate. FTE = full time equivalent. FY = fiscal year. IME = Indirect Medical Education. N/A = not available. VA = the Department of Veterans Affairs.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R44376", "sha1": "32edc7b0f617d127b391e52a9b84b3293b66e447", "filename": "files/20181227_R44376_32edc7b0f617d127b391e52a9b84b3293b66e447.html", "images": { "/products/Getimages/?directory=R/html/R44376_files&id=/0.png": "files/20181227_R44376_images_74f499172410b77210cbe82d4f2346aba4adb27f.png", "/products/Getimages/?directory=R/html/R44376_files&id=/1.png": "files/20181227_R44376_images_49d7261d2ba179a8d8a16e4f6665d9e9f2b0faf7.png" } }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R44376", "sha1": "a5081dc6f80437524aff1d526bf583f00f0a9a84", "filename": "files/20181227_R44376_a5081dc6f80437524aff1d526bf583f00f0a9a84.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4788, "name": "Health Care Delivery" }, { "source": "IBCList", "id": 4819, "name": "Medicaid & CHIP" }, { "source": "IBCList", "id": 4849, "name": "Veterans & Military Health Care" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 449893, "date": "2016-02-12", "retrieved": "2016-04-06T17:11:09.440798", "title": "Federal Support for Graduate Medical Education: An Overview", "summary": "Access to health care is, in part, determined by the availability of physicians, a function of the physician supply. Policymakers have demonstrated a long-standing interest in access to care, both in general and for specific populations. Moreover, federal support for medical residency training (a.k.a., graduate medical education [GME]) is the largest source of federal support for the health care workforce. Although the health workforce includes a number of professions, the size of the federal investment in GME\u2014estimated at $15 billion in FY2012\u2014makes it a policy lever often considered to alter the health care workforce and impact health care access. \nThis report describes federal programs that provide GME support. Although these programs may also support training for other health professions, this report focuses on training for physicians. The report examines GME support in Medicare, Medicaid, the Department of Veterans Affairs, the Department of Defense, and programs administered by the Health Resources and Services Administration, such as the Children\u2019s Hospital and Teaching Health Center GME payment programs. The report details the mechanisms that various federal programs use to support GME and provides data, when available, on funding and the number of trainees. Although some federal advisory groups have raised concerns about the transparency of federal GME investments, this report does not address such concerns; instead, it discusses some of the data gaps relevant to each of the federal GME programs.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44376", "sha1": "31d36227817ab7d87c3492ea174e7ac2dd1a2ee6", "filename": "files/20160212_R44376_31d36227817ab7d87c3492ea174e7ac2dd1a2ee6.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44376", "sha1": "ffdae4b6d80c57a1d37880b2b50e4891185a0785", "filename": "files/20160212_R44376_ffdae4b6d80c57a1d37880b2b50e4891185a0785.pdf", "images": null } ], "topics": [] } ], "topics": [ "Health Policy", "National Defense", "Veterans Policy" ] }