The American Medical Association has backed off from a plan to finance medical education through a voucher-style system that would have reduced Medicare payments to teaching hospitals.
Convening in Atlanta last week at its interim annual meeting, the association's 447-member House of Delegates tabled a recommendation from the AMA's medical education council calling for such a voucher system.
The delegates endorsed a plan calling on all payers, including private-sector insurers, to contribute to a general fund that would reimburse providers' teaching expenses.
But the all-payer plan could hit teaching hospitals in the pocketbook as well. Reimbursement from the all-payer fund would be made directly to the sites where residents are trained, not necessarily to teaching hospitals.
Such a proposal could reduce hospitals' Medicare reimbursements for teaching expenses, projected to be $8 billion in federal fiscal 1997.
Although the delegates substituted the term "authorization system" for "voucher system" in the medical education council's report, the council said one way of authorizing payments to teaching programs from the all-payer fund would be through the use of vouchers.
That move away from exclusive endorsement of a voucher system came at the same time AMA officials met with several other provider groups-including the Association of American Medical Colleges and the Association of Academic Health Centers-to develop a "consensus statement" on how to reform government policy on graduate medical education.
The groups want to develop a consensus position to present to Congress and President Clinton when they begin discussing comprehensive reform of the Medicare program next year. A draft of that document rejects the AMA's call for a voucher system and instead seeks an all-payer fund that reimburses institutions that incur teaching costs or consortia that in turn will reimburse those institutions.
But after a public forum on the provider coalition's draft document during the Atlanta meeting, provider group leaders met in private and began revising that document.
Richard Corlin, M.D., speaker of the AMA's House of Delegates, told delegates in Atlanta that "a much stronger and more activist document" is being drafted.