Grappling with dwindling resources to pay for medical education and an overabundance of specialists, Utah is moving toward the establishment of a state council that would control funding for medical education.
State officials hope the proposed Council of Medical Education would create a more equitable system to fund physician training. Hospitals are finding it harder to underwrite such training as they're being squeezed by payers on the reimbursement side. As envisioned, the council would receive contributions from a variety of government and private sources, including hospitals and health plans.
Legislation to create the council will be introduced during the state's legislative session that begins Jan. 20.
The University of Utah operates the state's only medical school, and there are only seven teaching facilities among Utah's 51 hospitals. Those seven facilities-among Utah's largest hospitals-traditionally paid for the education of medical students, resident physicians, nurses, pharmacists and physician assistants in part by shifting costs to patients. However, the growth of managed care in the state means there are fewer health plans willing to pay the extra charges.
"Doing the education adds 20% to 30% to the average bill," said Dave Gessel, vice president of government relations and legal affairs for the Utah Association of Health Care Providers, which supports the council's creation.
Utah's bill for medical education is $115 million a year, according to a study by Deloitte & Touche that was commissioned by the state.
"This trend toward managed care might affect the funding of quality medical education," said Gar Elison, a senior policy consultant for the Utah Health Policy Commission, a bipartisan panel of lawmakers and health officials that is drafting the bill.
State Rep. Brent Haymond, a Republican from Provo and commission member, intends to sponsor the legislation.
Elison noted that some teaching hospitals receive large annual sums for medical education from the federal government through Medicare. But other institutions, such as 208-bed Primary Children's Medical Center, receive no such money because they don't treat Medicare patients.
A second prong of the effort would be for the state to apply for a special waiver from HCFA next spring. The waiver would allow the new council to receive and disburse the roughly $25 million in annual Medicare/Medicaid funding earmarked for medical education. Elison believes a law mandating the creation of the council will help spur the waiver along.
With control over medical education funding, officials also hope the board can direct funding toward specific programs that would affect the health of residents in the state.
"We want more primary-care residents, and we don't want to pay for specialists that aren't needed," Elison said. "Another thing the council would have the authority to do is to try and change the training sites and exposure. Too much of it now is based in acute inpatient institutions, and we know people also have to have primary care in rural, remote or clinical settings."
The proposal is not without potential roadblocks. While the plan has received broad support from the healthcare industry, Elison said all parties are concerned about two things: how much their annual contribution would be, and who would sit on the council, which is expected to contain five to nine commissioners. There are also smaller questions, such as whether the council would pay for the retraining of specialists to become primary-care physicians.
Meanwhile, the creation of a council also must be weighed against pleasing Utah's conservative Legislature.
"There's not a big love for big government in Utah," Elison said.