House bill requires the largest increase in GME slots in decades

House bill requires the largest increase in GME slots in decades


House version of President Joe Biden’s domestic policies pack Including what hospitals have been pushing for decades: Medicare paid for thousands of resident doctor seats.

If it passes, it will be the biggest expansion Graduate Medical Education Program For decades, this has been a victory for the hospital group that anticipates an imminent shortage of doctors caused by an aging population and retired doctors.

The question is whether the 4,000 new seats will be retained after the bill is submitted to the Senate. Democrats must make difficult choices about priorities in the Senate to ensure the approval of the more moderate members of its core group.

However, lobbyists hope that the impact of COVID-19 on hospitals, especially those in rural and other underserved communities, will force Congress to take action on the shortage of health professionals.

“The COVID has indeed intensified Labor issues, Especially in terms of doctors, but then it became the entire healthcare field,” said Jon Cooper, senior vice president of government affairs, communications, and public policy for the Greater New York Hospital Association. “This caused the House Senate to want to move forward. , Do something bigger. “

The House of Representatives has not yet voted on the $1.75 trillion domestic policy package — which Biden and congressional Democrats call the “Better Rebuild Act” — and it is unclear when it will take place.

House Speaker Nancy Pelosi (California Democrat) hopes to hold a vote on Friday, but a handful of moderate Democrats asked the nonpartisan Congressional Budget Office to conduct an analysis before proceeding.

The House bill is expected to be relatively similar to what the Senate will ultimately consider. The leaders of the Democratic Party of the two houses worked closely together to draw up a passable agreement.

The GME clause has received strong bipartisan supporters in the Senate, including Majority Leader Chuck Schumer (DN.Y.) and Budget Committee Chairman Bernie Sanders (I-Vt.), and is not considered controversial.

Nonetheless, the bill also includes less than 14,000 new GME slot provider groups aimed at alleviating the growing shortage of doctors in the American Medical College. project It will reach 40,000 by 2034.

Leonard Marquez, senior director of government relations and legislative advocacy at AAMC, said: “We realize that obviously not everyone can get everything they want.” “In the end, their foothold will help greatly. To improve patients’ access to care and help diversify the workforce.”

FB01Since Congress was concerned about wasting expenses and creating a doctor’s surplus, new medical insurance-funded residents have been a priority for hospitals for decades, so the number of new residents was basically frozen in 1997.

Although AAMC and other groups have promote For several years of GME expansion, COVID-19 has prompted lawmakers to take action.

As part of the COVID-19 relief bill enacted in December, Congress and President Donald Trump broke the decades-long freeze. Add to 1,000 new Medicare GME slots. The law stipulates that the percentage of these vacancies will be used in rural and underserved areas, new medical schools and hospitals, and training beyond its medical insurance limit.The Medicare and Medicaid Service Center has not yet been finalized rule Enforce this part of the law.

The pending House bill stipulates how to subdivide these periods in a similar manner, but also prioritize primary care and psychiatry, which excites the group of providers seeking these changes in the GME program. In the first two distribution cycles, 25% of new places must be granted to primary care residents, and 15% of new places must be granted to psychiatric residents.

The legislation will also set aside 10% of new places in hospitals in states with the lowest ratio of medical residents to population. This could benefit rural states such as Alaska, Idaho, Montana, and Wyoming, which are among the states with the lowest number of medical residents per 100,000. Niskanen Center, Think tank.

The legislative affairs manager of the American Academy of Family Physicians, John Aguilar, said: “This is the first time in recent history that Congress has stipulated this.” “In fact, now Congress has finally begun to pay attention to the Federal GME and say, “We How can we really align it with labor demand?’-This is a huge victory in itself, because usually it’s just,’How can we get more GME seats? ,'” he said.

According to a recent report by the Government Accountability Office, the federal government spent US$15 billion on medical insurance GME payments in 2018.

Some experts believe that concerns about the shortage of doctors have been exaggerated, and the bigger problem is the geographical difference of doctors’ work locations.Although about 20% of the population lives in rural areas, only about 10% of doctors Practice there.

The location and funding density of GME is highest in the northeast, resulting in uneven geographic distribution of doctors, who are likely to practice near the training location.

It is especially difficult in rural areas to recruit and retain doctors from areas outside of their hometown.

The domestic policy package will also create a new “Road to Practice” program that will provide 1,000 annual medical scholarships to students from underserved, rural or health professionals shortage areas starting in 2023. Recipients must have at least one year of internship in each scholarship year in these areas.

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