Osteopathic groups are pushing Congress to repeal a law allowing HCFA to pay hospitals to train fewer physicians.
Promoting a new system of osteopathic graduate medical education, the American Osteopathic Association said it was testing congressional support for legislation that would annul a GME-related provision of the balanced-budget law enacted last year.
The AOA and other osteopathic organizations have unveiled a new system of consortia to be formed with osteopathic medical schools and hospitals, ambulatory surgical centers, primary-care clinics and other subacute providers to permit osteopathic residents to learn in outpatient settings.
Each consortium will include one or more of the 19 schools of osteopathic medicine in the U.S.
The balanced-budget provision being targeted asks hospitals to reduce the number of residency positions they sponsor in their teaching programs. In return, Medicare will continue to pay them for a period of time as if they had made smaller cuts in their residency rosters. The provision is designed to reduce an oversupply of physicians by giving hospitals an incentive to teach fewer residents. Hospitals are reluctant to shrink their teaching programs because it reduces their Medicare income.
The program started as a pilot project for New York teaching hospitals. But fearing that the provision's subsidies will further intensify an undersupply of physicians in rural areas, Rep. Jim Nussle (R-Iowa) has introduced legislation that would repeal the program. The legislation is getting the support of the AOA, which brought in more than 50 of its members to lobby Congress earlier this month.
"We'll be talking about Nussle's bill to determine the viability of that legislation," said John Crosby, the AOA's executive director.
Medicare will pay teaching programs a total of $6.3 billion in federal fiscal 1998, which ends Sept. 30, according to the Congressional Budget Office. Under previous law, GME payments would have reached $7.5 billion in fiscal 1998. Savings under the Balanced Budget Act will accrue from a number of changes in GME payment policies.
The AOA fears the GME provisions in the balanced-budget law could inhibit its proposed system of educational consortia. As HCFA tightens the screws on the number of physician residencies, the AOA and other osteopathic organizations want to make sure they will be able to shift residency positions within their system.
Each consortium may qualify for Medicare GME payment as a single institution under a pilot project authorized by the balanced-budget law. But the groups fear HCFA won't allow one institution within a consortium to add residency positions when another institution in the consortium cuts its roster.