Reforming graduate medical education funding tops the list of issues to be debated by leaders of the American Medical Association this week in Atlanta.
Georgia's capital is the site of this year's interim winter meeting of the AMA's 447-member House of Delegates. The association holds the interim gathering to affirm or rewrite AMA policy; its location varies each year. The delegates also hold an annual meeting, always in Chicago, during the summer.
At this year's interim meeting, the delegates will consider a package of reforms to the graduate medical education system that calls for more private-sector contributions to residency training and reimbursement to more types of providers involved in teaching.
The graduate medical education reform package, prepared by the AMA's medical education council, also recommends giving vouchers to residents to pay for their education costs at the specific site where they receive their training, not strictly at teaching hospitals.
Under such a proposal, hospitals would stand to lose some of their Medicare medical education reimbursement, which the Congressional Budget Office estimates will be $8 billion in fiscal 1997, which began Oct. 1.
But the medical education council's proposal also recommends that alternative options be developed to support teaching hospitals for their loss of residents' labor, as well as the loss of so-called Medicare "indirect" medical education payments.
Indirect medical education reimbursement helps defray the higher costs at teaching hospitals attributable to the extra resources demanded by the presence of medical residents. The CBO estimates indirect education payments will represent two-thirds of the fiscal 1997 graduate medical education reimbursement.
Other issues scheduled for debate by the AMA delegates include a resolution calling for a three-year phase-in to changes in the Medicare physician fee schedule that are expected to benefit primary-care doctors. In 1998, the methodology for Medicare practice-expense reimbursement will change. Ophthalmologists, saying the data necessary to implement this change are inadequate, are seeking a one-year delay, a three-year phase-in and a limit of 20% on how much any fee can be reduced as a result of the change.
In conjunction with the interim meeting, the AMA also is hosting a special forum on physician work-force development.