2000 to 2015 Saw Increase in Medicare GME Payments

Increase mainly due to indirect payments, primarily inpatient costs rather than resident-to-bed ratio

WEDNESDAY, Oct. 9, 2019 (HealthDay News) -- Medicare graduate medical education (GME) payments increased significantly from 2000 to 2015, according to a study published online Oct. 7 in JAMA Internal Medicine.

Candice Chen, M.D., M.P.H., from George Washington University in Washington, D.C., and colleagues used 2000 to 2015 Medicare hospital cost reports to calculate annual direct, indirect, and total GME per resident full-time equivalent (FTE) payments for each teaching hospital. The mean payments were compared in 2000 and 2015. Major contributors to the observed trends were identified.

The researchers observed a significant increase in the mean per-resident GME payment from $117,323 in 2000 to $138,938 in 2015 among 1,624 teaching hospitals. The increase was mainly due to indirect payments. During the study period, the mean Medicare patient load remained relatively stable (0.44 to 0.43 from 2000 to 2015). The increase in indirect payments was mainly due to inpatient costs rather than resident-to-bed ratios (increases of 47.5 and 9.6 percent, respectively). In 2015, 47 percent of teaching hospitals received more than $150,000 per FTE. An estimated $1.28 billion was provided by Medicare in payments of more than the $150,000 rate.

"Medicare GME payments per resident FTE grew nearly 20 percent from 2000 to 2015, largely driven by increasing inpatient reimbursements," the authors write. "This raises the question of whether linking GME payments mechanically to inpatient reimbursements without assessing the association with teaching costs is sensible policy."

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