AAMC Links and Resources:
FIRST (Financial Information Resources and Tools)
FIRST is a free resource provided by the AAMC that allows currently enrolled medical students and residents to organize their loan information and view different repayment plans custom-tailored to their individual needs. All that is required for free premium access is your AAMC username and password.
Newly debuted by FIRST is a video & podcast series covering various financial topics specific to medical students. Be sure to check them out on the FIRST website.
FIRST is a free resource provided by the AAMC that allows currently enrolled medical students and residents to organize their loan information and view different repayment plans custom-tailored to their individual needs. All that is required for free premium access is your AAMC username and password.
Newly debuted by FIRST is a video & podcast series covering various financial topics specific to medical students. Be sure to check them out on the FIRST website.
Official AAMC webpage for ACA news & updates
Even though the Supreme Court ruling in the Affordable Care Act has already passed, new information and updates on this landmark bill continue to come out daily. The link above is an subpage of the AAMC website filled with plenty of pertinent information, especially tailored to medical students and others in the academic medicine community.
Even though the Supreme Court ruling in the Affordable Care Act has already passed, new information and updates on this landmark bill continue to come out daily. The link above is an subpage of the AAMC website filled with plenty of pertinent information, especially tailored to medical students and others in the academic medicine community.
Medicare Direct Graduate Medical Education (DGME) Payments -- Explained
The AAMC has published an excellent primer on how DGME payments are calculated and allocated. Also included is a brief history of the legislative history that has helped to shape the current DGME environment.
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Essentially, since Medicare was founded in 1965, Congress has allocated funding specifically for the educational training of future physicians. A hospital's DGME represents the combined expense of resident salary and benefits, teaching faculty salary and benefits, overhead expenses, and the salaries of hospital GME clerical staff. Medicare pays hospitals based upon a "per resident amount" (PRA), that is calculated from the hospital's total DGME costs in 1985 (as audited by Medicare) divided by the total number of residents, and adjusted annually for inflation. Importantly, the COBRA Act of 1985 tied annual growth in DGME payments to inflation only, meaning that hospitals could not increase their received PRA payments in the event that costs outpaced inflation.
Additionally, due to restructuring of the DGME inflation calculations in 1994, hospitals have two different PRAs, where primary care resident PRAs are slightly higher than non-primary care PRAs. Furthermore, Medicare DGME payments for subspecialty training (fellowship) are slashed by 50%.
Because of how DGME payments are calculated, one can see how this creates an artificial "cap" on residency slots (now based off of full-time residents practicing in 1996). Although a program's true residency limit is set by its ACGME accreditation, if this number exceeds the program's PRA, then those additional costs would have to be borne by the hospital. Notably, ACGME accreditation does not require programs to fill their maximum number of accredited residency slots, and often programs take fewer residents than their theoretical maximum due in part to DGME payment caps.
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The total picture is much more complicated an nuanced than the explanation I provided above, but hopefully this gives you a launching pad for delving further into the material. See the link below for the official AAMC primer on DGME payments.
https://www.aamc.org/advocacy/gme/71152/gme_gme0001.html
The AAMC has published an excellent primer on how DGME payments are calculated and allocated. Also included is a brief history of the legislative history that has helped to shape the current DGME environment.
----------
Essentially, since Medicare was founded in 1965, Congress has allocated funding specifically for the educational training of future physicians. A hospital's DGME represents the combined expense of resident salary and benefits, teaching faculty salary and benefits, overhead expenses, and the salaries of hospital GME clerical staff. Medicare pays hospitals based upon a "per resident amount" (PRA), that is calculated from the hospital's total DGME costs in 1985 (as audited by Medicare) divided by the total number of residents, and adjusted annually for inflation. Importantly, the COBRA Act of 1985 tied annual growth in DGME payments to inflation only, meaning that hospitals could not increase their received PRA payments in the event that costs outpaced inflation.
Additionally, due to restructuring of the DGME inflation calculations in 1994, hospitals have two different PRAs, where primary care resident PRAs are slightly higher than non-primary care PRAs. Furthermore, Medicare DGME payments for subspecialty training (fellowship) are slashed by 50%.
Because of how DGME payments are calculated, one can see how this creates an artificial "cap" on residency slots (now based off of full-time residents practicing in 1996). Although a program's true residency limit is set by its ACGME accreditation, if this number exceeds the program's PRA, then those additional costs would have to be borne by the hospital. Notably, ACGME accreditation does not require programs to fill their maximum number of accredited residency slots, and often programs take fewer residents than their theoretical maximum due in part to DGME payment caps.
----------
The total picture is much more complicated an nuanced than the explanation I provided above, but hopefully this gives you a launching pad for delving further into the material. See the link below for the official AAMC primer on DGME payments.
https://www.aamc.org/advocacy/gme/71152/gme_gme0001.html