Subcommittee Seeks Public Comment on GME Policy

A bipartisan group of members of the Health Subcommittee of the House Energy and Commerce Committee released an open letter requesting comments on federal funding of graduate medical education (GME). The letter, which was released December 8, 2014, was signed by Subcommittee Chair Joseph R. Pitts (R-Pa), Ranking Member Frank Pallone (D-NJ), and Members Gene Green D-Texas), Diana DeGette (D-Colo), Cathy McMorris Rodgers (R-Wash), Peter Welch (D-Vt), Morgan Griffith (R-Va), and Kathy Castor (D-Fla).

The IOM Report

The members want to know whether, or the extent to which, other stakeholders agree with the findings and recommendations made by the Institute of Medicine in a July 2014 report (see GME system needs major overhaul, July 31, 2014). The IOM found that the current financing structure favors urban universities in the Northeast, encourages the concentration of residents in specialties rather than primary care, and fails to prepare them to serve patients with chronic conditions or to use office-based technology. The letter describes the IOM report as recommending “sweeping changes to our nation’s financing, governance, and program design” for GME and requests additional input as Congress “prepares to review the IOM recommendations.”

Specific Questions

The subcommittee’s questions focus primarily on changes to the financing system, i.e., whether : (1) any changes could be “leveraged” to improve efficiency, effectiveness, and stability; (2) federal funding should make training opportunities available in rural as well as urban areas; and (3) the current funding system is adequate to meet the needs of the health care workforce going forward. The subcommittee expressed particular interest in: (1) whether to continue the separation of direct and indirect costs or to have funding follow the resident rather than the institution; (2) the extent to which the financing structure affects the availability of primary and specialty care and whether, or how, it should do so in the future; (3) the improvements Congress should make to improve program quality, training, and accountability; and (4) whether the system under which residents are allocated should be changed to meet the needs of the health care work force.

The deadline for submission of comments is January 16, 2015.