KAREN R. BORMAN, MD, FACS MEDICARE and MEDICAID REIMBURSEMENT for GRADUATE MEDICAL EDUCATION A...
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KAREN R. BORMAN, MD, FACS KAREN R. BORMAN, MD, FACS MEDICARE and MEDICAID MEDICARE and MEDICAID REIMBURSEMENT for REIMBURSEMENT for GRADUATE MEDICAL GRADUATE MEDICAL EDUCATION EDUCATION A REVIEW FOR A REVIEW FOR COORDINATORS COORDINATORS
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Transcript of KAREN R. BORMAN, MD, FACS MEDICARE and MEDICAID REIMBURSEMENT for GRADUATE MEDICAL EDUCATION A...
KAREN R. BORMAN, MD, FACSKAREN R. BORMAN, MD, FACS
MEDICARE and MEDICAID MEDICARE and MEDICAID REIMBURSEMENT for REIMBURSEMENT for GRADUATE MEDICAL GRADUATE MEDICAL
EDUCATIONEDUCATION
A REVIEW FOR A REVIEW FOR COORDINATORSCOORDINATORS
SCOPE OF GME ECONOMICSSCOPE OF GME ECONOMICSCOSTS AND FINANCING COSTS AND FINANCING
SOURCESSOURCESROLE OF MEDICAREROLE OF MEDICARE ROLE OF MEDICAIDROLE OF MEDICAID CONTROVERSIES AND CONTROVERSIES AND
CHALLENGESCHALLENGES
A REVIEW FOR COORDINATORSA REVIEW FOR COORDINATORS
GMECONOMICS IS BIG BUSINESS!!!GMECONOMICS IS BIG BUSINESS!!!
GMECGMEC
SOURCE: CMS, MEDICARE COST REPORT FILESOURCE: CMS, MEDICARE COST REPORT FILE
GME PAYMENTS ARCS STEERING COMMITTEEGME PAYMENTS ARCS STEERING COMMITTEE
IME DMETOTAL GME
PCP FTE
PCP PRA
SPEC FTE
SPEC PRA
AGRETTO 5270670 3044802 8315472 5.8 102177 2.8 96752
GUINTO 41789695 20352746 62142441 188.2 97235 304.9 92073
SCHULZ 10507318 6337737 16845055 82.1 85520 116.7 80980
FULBRIGHT 9460295 3639976 13100271 80.2 74742 65.8 70858
DEL COGLIN 20970154 8106191 29076345 99.1 74381 104.3 70576
OLENWINE 15858501 3962006 19820507 73.4 68359 41.6 64730
ST. PIERRE 42854191 11477698 54331888 205.9 67750 187.7 64229
CAMERON 15808970 5013549 20822519 90.7 64345 61 61001
CARTER 5628496 1648711 7277707 27.6 50428 25.3 50428
ACGME PROGRAMS 2007
4008, 48%
4347, 52%
CORE SUBSPECIALTY
PROGRAMS 8,400*PROGRAMS 8,400*
GMECONOMICS BASICS: PROGRAMSGMECONOMICS BASICS: PROGRAMS
SPONSORING INSTITUTIONS 700SPONSORING INSTITUTIONS 700PARTICIPATING INSTITUTIONS 2,900PARTICIPATING INSTITUTIONS 2,900
GMECONOMICS BASICS:GMECONOMICS BASICS:SPONSORS + AFFILIATESSPONSORS + AFFILIATES
ACGME PROGRAMS SPONSORED 2007
46%54%
ONE MULTIPLE
AAMC COTH MEMBERS 400AAMC COTH MEMBERS 400
GMECONOMICS BASICS: TYPES GMECONOMICS BASICS: TYPES OF TEACHING HOSPITALSOF TEACHING HOSPITALS
COTH DISTRIBUTION
129, 32%
68, 17%203, 51%
AMC VA OTHER
ALL COTH FACULTYALL COTH FACULTY 125,000125,000
GMECONOMICS BASICS: FACULTYGMECONOMICS BASICS: FACULTY
TEACHING FACULTY ALL TYPES
67%
33%
MEN WOMEN
ACGME APPROVED RESIDENTSACGME APPROVED RESIDENTS 106,000* 106,000*
GMECONOMICS BASICS: RESIDENTSGMECONOMICS BASICS: RESIDENTS
ACGME RESIDENTS + FELLOWS
89607, 84%
16776, 16%
CORE SUBSPECIALTY
RESIDENT SALARY + BENEFITSRESIDENT SALARY + BENEFITSSUPERVISING FACULTY PAYMENTSSUPERVISING FACULTY PAYMENTSEDUCATION OVERHEADEDUCATION OVERHEAD
EDUCATIONAL PRODUCTS + SERVICESEDUCATIONAL PRODUCTS + SERVICESSIMULATIONSIMULATION
ADMINISTRATIONADMINISTRATIONPROGRAM COORDINATOR + DIRECTORPROGRAM COORDINATOR + DIRECTOR
ACCREDITATION FEESACCREDITATION FEES
RECRUITINGRECRUITING
OTHER (e.g., PAGERS, COATS, TRAVEL)OTHER (e.g., PAGERS, COATS, TRAVEL)
GMECONOMICS: DIRECT GME COSTS (DME)GMECONOMICS: DIRECT GME COSTS (DME)
RESIDENTSRESIDENTS 106,000 106,000**
DME SALARY + BENEFITSDME SALARY + BENEFITS
SALARY + BENEFITS ALL PGY 2003-2007
40000
45000
50000
55000
60000
65000
70000
2003 2004 2005 2006 2007
PGY1 PGY2 PGY3 PGY4 PGY5
INEFFICIENT CARE BY RESIDENTSINEFFICIENT CARE BY RESIDENTS EMERGING TECHNOLOGY USAGEEMERGING TECHNOLOGY USAGE CASE MIX / SPECIALIZED CASE MIX / SPECIALIZED
SERVICESSERVICES ?PAYER MIX (DSH)?PAYER MIX (DSH) ?OTHER TRAINEES (TITLE VII)?OTHER TRAINEES (TITLE VII) OPERATING EXPENSESOPERATING EXPENSES EDUCATION RELATED FACILITIESEDUCATION RELATED FACILITIES CAPITAL EXPENSESCAPITAL EXPENSES
GMECONOMICS: INDIRECT GME COSTS (IME)GMECONOMICS: INDIRECT GME COSTS (IME)
GMECONOMICS: FINANCING SOURCESGMECONOMICS: FINANCING SOURCES
MEDICARE: DME + IME + DSHMEDICARE: DME + IME + DSH CHILDRENS’ HOSPITALS GME VIA HRSACHILDRENS’ HOSPITALS GME VIA HRSA DEPARTMENT OF VETERANS AFFAIRS DEPARTMENT OF VETERANS AFFAIRS
(VA): DIRECT SUPPORT APPROPRIATION(VA): DIRECT SUPPORT APPROPRIATION MEDICAID: PER DIEM / CASE RATESMEDICAID: PER DIEM / CASE RATES STATES LINE ITEM / GOAL-DIRECTEDSTATES LINE ITEM / GOAL-DIRECTED PRIVATE PAYERS: HIGHER INPT RATESPRIVATE PAYERS: HIGHER INPT RATES MEDICAL SCHOOLS: PRACTICE PLANSMEDICAL SCHOOLS: PRACTICE PLANS HOSPITALS: FROM TOTAL MARGINHOSPITALS: FROM TOTAL MARGIN
GMECONOMICS: FINANCING SOURCESGMECONOMICS: FINANCING SOURCES
GME FUNDING SOURCES
64
3.2
0.3
7
2.3
2
1.1
3.3
16
87
0.2
0.5
0 10 20 30 40 50 60 70 80 90 100
REVENUES
STATE/CITY
MGD CARE
VA
FACULTY
UNIVERSITY
NIH
OTHER FED
ENDOWMENT
OTHER GRANT
OTHER
2003 2007
SOURCE: AAMC HOUSESTAFF REPORTS 2003-2007SOURCE: AAMC HOUSESTAFF REPORTS 2003-2007
GMECONOMICS: OPERATING BUDGETGMECONOMICS: OPERATING BUDGET
0
1
2
3
4
5
6
7
8
9
10
2003 2004 2005 2006 2007
SALARY + BENEFITS AS MEDIAN % HOSPITAL OPERATING BUDGET BY HOSPITAL TYPE
ALL STATE MED SCHOOL NON PROFIT
SOURCE: AAMC HOUSESTAFF REPORTS 2003-2007SOURCE: AAMC HOUSESTAFF REPORTS 2003-2007
GMECONOMICS: OPERATING BUDGETGMECONOMICS: OPERATING BUDGET
0 5 10 15 20
2003
2004
2005
2006
2007
RESIDENT PACKAGE AS % HOSPITAL OPERATIONS MEAN BY REGION
ALL NORTHEAST SOUTH MIDWEST WEST
GME FUNDING: MEDICARE’S ROLEGME FUNDING: MEDICARE’S ROLE
MEDICARE BECOMES LAW, 1965 MEDICARE BECOMES LAW, 1965 (SOCIAL SECURITY ACT)(SOCIAL SECURITY ACT)
GME FUNDING: MEDICARE’S ROLEGME FUNDING: MEDICARE’S ROLE
“…“…educational activities enhance the educational activities enhance the quality quality of care in an institution, and it is intended, of care in an institution, and it is intended, until until the community undertakes to bear the community undertakes to bear such educational costs in some other waysuch educational costs in some other way, , that that partpart of the net cost of such activities of the net cost of such activities (including stipends of trainees, as well as (including stipends of trainees, as well as compensation of teachers and other costs) compensation of teachers and other costs) should be borne to an should be borne to an appropriateappropriate extent extent by the by the hospitalhospital insurance program” insurance program”
MEDICARE: PROGRAM PARTSMEDICARE: PROGRAM PARTS
SOURCE: MedPAC DATA BOOK, 2006SOURCE: MedPAC DATA BOOK, 2006
PART D: SUPPLEMENTARY PART D: SUPPLEMENTARY MEDICAL INSURANCE Rx DRUGSMEDICAL INSURANCE Rx DRUGS
GME FUNDING: MEDICARE’S ROLEGME FUNDING: MEDICARE’S ROLE
PART B: SUPPLEMENTARY PART B: SUPPLEMENTARY MEDICAL INSURANCE PROVIDERSMEDICAL INSURANCE PROVIDERS
GME FUNDING: MEDICARE’S ROLEGME FUNDING: MEDICARE’S ROLE
FACULTY-GENERATED PATIENT CARE REVENUES FACULTY-GENERATED PATIENT CARE REVENUES
PART A: HOSPITAL INSURANCE PART A: HOSPITAL INSURANCE TRUST FUNDTRUST FUND
GME FUNDING: MEDICARE’S ROLEGME FUNDING: MEDICARE’S ROLE
GME GME FUNDINGFUNDING
ACUTE CAREACUTE CARE HIPPS, HOPPS, HIPPS, HOPPS,
PSYCHIATRIC, ASCsPSYCHIATRIC, ASCs POST-ACUTE CAREPOST-ACUTE CARE
SNF, IRF, LTCH, HOME SNF, IRF, LTCH, HOME HEALTH, HOSPICEHEALTH, HOSPICE
OTHEROTHER DIALYSIS, CLINICAL DIALYSIS, CLINICAL
LABORATORYLABORATORY
PART A: HI TRUST FUNDPART A: HI TRUST FUND
GME GME FUNDING?FUNDING?
PART A: HOSPITAL INSURANCE TRUST PART A: HOSPITAL INSURANCE TRUST FUNDFUND
HOSPITAL INPATIENT HOSPITAL INPATIENT PROSPECTIVE PROSPECTIVE PAYMENT SYSTEM PAYMENT SYSTEM (HIPPS)(HIPPS)
PART A: HI TRUST FUNDPART A: HI TRUST FUND
GME GME FUNDING!FUNDING!
DIRECT MEDICAL EDUCATIONDIRECT MEDICAL EDUCATION
DME = PRA X FTE X % Medicare DaysDME = PRA X FTE X % Medicare Days PRA = PER RESIDENT AMOUNTPRA = PER RESIDENT AMOUNTFTE = RESIDENT COUNTFTE = RESIDENT COUNT
PRIMARY CARE VS OTHERPRIMARY CARE VS OTHER
PRA CORRIDOR 85-140% NATIONAL PRA CORRIDOR 85-140% NATIONAL AVERAGEAVERAGE
HOSPITAL INPATIENT HOSPITAL INPATIENT PROSPECTIVE PAYMENT PROSPECTIVE PAYMENT SYSTEM, 1983SYSTEM, 1983 CBO PREDICTED -7% TEACHING CBO PREDICTED -7% TEACHING
HOSPITALS / +7% NON-HOSPITALS / +7% NON-TEACHINGTEACHING
DIRECT GME EXCLUDED FROM DIRECT GME EXCLUDED FROM PPSPPS
INDIRECT GME ADD ON TO INDIRECT GME ADD ON TO BASE RATE 11.6BASE RATE 11.6
PART A: ORIGINS OF IMEPART A: ORIGINS OF IME
$ IME ADJUSTMENT STATUTORY IME ADJUSTMENT STATUTORY FORMULA, OPERATIONSFORMULA, OPERATIONS$ 90% PPS PAYMENTS90% PPS PAYMENTS
$ IME % = 1.32 * [(1 + IRB) IME % = 1.32 * [(1 + IRB) .405 .405 - 1 ] x - 1 ] x 100100
$ IME ADJUSTMENT STATUTORY IME ADJUSTMENT STATUTORY FORMULA, CAPITALFORMULA, CAPITAL$ 10% PPS PAYMENTS10% PPS PAYMENTS$ AVG DAILY CENSUS INSTEAD OF IRBAVG DAILY CENSUS INSTEAD OF IRB
INDIRECT MEDICAL EDUCATIONINDIRECT MEDICAL EDUCATION
1983 HIPPS 11.6%1983 HIPPS 11.6% 1986 DSH 8.1%1986 DSH 8.1% 1988 DSH EXPANSION 7.7%1988 DSH EXPANSION 7.7% 1997 BBA1997 BBA
TARGET 5.5% BY 2001TARGET 5.5% BY 2001 TARGET BEING REACHED 2008TARGET BEING REACHED 2008 RESIDENT CAPSRESIDENT CAPS
IME ADJUSTMENT HISTORYIME ADJUSTMENT HISTORY
IME ADJUSTMENT 1984 - 2008IME ADJUSTMENT 1984 - 2008
THE TRUTH ABOUT IMETHE TRUTH ABOUT IME
1984 1987 1990 1993 1996 1999 2002 2005 2008
Fiscal year
0
2
4
6
8
10
12
14
IME
ad
justm
en
t p
erc
en
tag
e
RESIDENT FTERESIDENT FTE
““SLOTS” / “CAPS” / “THE COUNT”SLOTS” / “CAPS” / “THE COUNT” USED IN DME AND IME FORMULASUSED IN DME AND IME FORMULAS BASE YEAR 1996BASE YEAR 1996 THREE YEAR ROLLING AVERAGETHREE YEAR ROLLING AVERAGE INITIAL ELIGIBILITY PERIOD = 1.0 INITIAL ELIGIBILITY PERIOD = 1.0
FTE / ALL ELSE = 0.5 FTEFTE / ALL ELSE = 0.5 FTE HOSPITAL VS AMBULATORYHOSPITAL VS AMBULATORY REDISTRIBUTION 2003 2500 SLOTS @ REDISTRIBUTION 2003 2500 SLOTS @
IME 2.7%IME 2.7%
THE TRUTH ABOUT THE CAPTHE TRUTH ABOUT THE CAP
DISPROPORTIONATE SHARE DISPROPORTIONATE SHARE FUNDING (DSH)FUNDING (DSH) HOSPITAL-SPECIFIC ADD-ON TO HOSPITAL-SPECIFIC ADD-ON TO
OPERATING AND CAPITAL OPERATING AND CAPITAL PAYMENTSPAYMENTS
MEDICAID DAYS/TOTAL PATIENT MEDICAID DAYS/TOTAL PATIENT DAYS + DUAL ELIGIBLE PATIENT DAYS + DUAL ELIGIBLE PATIENT DAYS/TOTAL MEDICARE PATIENT DAYS/TOTAL MEDICARE PATIENT DAYSDAYS
MINIMUM THRESHOLD - >100%MINIMUM THRESHOLD - >100% MULTIPLE FORMULAS BY HOSPITAL MULTIPLE FORMULAS BY HOSPITAL
SIZE AND LOCATIONSIZE AND LOCATION
TRULY INDIRECT GME: DSHTRULY INDIRECT GME: DSH
DISPROPORTIONATE SHARE FUNDING DISPROPORTIONATE SHARE FUNDING (DSH)(DSH)
INTRODUCED 1986, EXPANDED 1988INTRODUCED 1986, EXPANDED 1988 ““POOR PATIENTS ARE MORE COSTLY POOR PATIENTS ARE MORE COSTLY
TO TREAT”TO TREAT” COST SHIFT TO MEDICARE PATIENTSCOST SHIFT TO MEDICARE PATIENTS TEACHING HOSPITALS LESS TEACHING HOSPITALS LESS
COMPETITIVECOMPETITIVE ““PUBLIC GOOD SUBSIDIZINGPUBLIC GOOD SUBSIDIZING
UNCOMPENSATED CARE”UNCOMPENSATED CARE”
TRULY INDIRECT GME: DSHTRULY INDIRECT GME: DSH
DSH PAYMENTS % HOSPITAL DSH PAYMENTS % HOSPITAL BASE PAYMENTSBASE PAYMENTS
0
2
4
6
8
10
12
14
1987 1989 1991 1993 1995 1997 1999 2001 2003
Fiscal year
Per
cent
CARING FOR THE POOR CARING FOR THE POOR ≠≠ DSH DSH
THE TRUTH ABOUT DSHTHE TRUTH ABOUT DSH
MOST DSH GOES TO TEACHING MOST DSH GOES TO TEACHING HOSPITALSHOSPITALS
THE TRUTH ABOUT DSHTHE TRUTH ABOUT DSH
Urban Rural Major teaching Other teaching Non-teaching0
4
8
12
16
20
Pe
rce
nt
IME add-onDSH add-on
TEACHING HOSPITAL MARGINSTEACHING HOSPITAL MARGINSMAJOR TEACHING HOSPITALS LEAD OVERALL MAJOR TEACHING HOSPITALS LEAD OVERALL
MEDICARE MARGIN CURVEMEDICARE MARGIN CURVE
OVERALL MEDICARE MARGIN 2002-2005 BY HOSPITAL GROUP
-10.0
-5.0
0.0
5.0
10.0
15.0
All
Majorteaching
Otherteaching
Nonteaching
MAJOR TEACHING HOSPITALS TOTAL MARGINS MAJOR TEACHING HOSPITALS TOTAL MARGINS ARE COMPETITIVEARE COMPETITIVE
TEACHING HOSPITAL MARGINSTEACHING HOSPITAL MARGINS
DMEDME $ 2.6 BILLION 2004$ 2.6 BILLION 2004 IMEIME $ 5.3 BILLION 2004$ 5.3 BILLION 2004 DME + IME = $ 7.9 BILLIONDME + IME = $ 7.9 BILLION DSHDSH $ 7.7 BILLION 2004$ 7.7 BILLION 2004 IME + DSH = 14% ALL ACUTE CARE IME + DSH = 14% ALL ACUTE CARE
HOSPITAL PPS PAYMENTSHOSPITAL PPS PAYMENTS TOTAL TO GMETOTAL TO GME $ 15.6 BILLION$ 15.6 BILLION
GME FUNDING: MEDICARE’S ROLEGME FUNDING: MEDICARE’S ROLE
CREATED WITH MEDICARE IN 1965CREATED WITH MEDICARE IN 1965 VOLUNTARY PARTICIPATION BY VOLUNTARY PARTICIPATION BY
STATES (ALL SINCE 1982)STATES (ALL SINCE 1982) FEDERAL GUIDELINESFEDERAL GUIDELINES
MATCHING FEDERAL DOLLARSMATCHING FEDERAL DOLLARS STATE-ADMINISTEREDSTATE-ADMINISTERED
DEFINE ELIGIBILITY AND BENEFITSDEFINE ELIGIBILITY AND BENEFITS LOW INCOME + SPECIAL NEEDLOW INCOME + SPECIAL NEED
ON AVERAGE, 22% OF STATE BUDGETSON AVERAGE, 22% OF STATE BUDGETS
GME FUNDING: MEDICAID’S ROLEGME FUNDING: MEDICAID’S ROLE
MEDICAID BASICS
MAKING GME PAYMENTS IS OPTIONAL MAKING GME PAYMENTS IS OPTIONAL FOR STATESFOR STATES 47 + DC MAKE PAYMENTS (IL, TX, ND)47 + DC MAKE PAYMENTS (IL, TX, ND) FORMULAS VARY BY STATEFORMULAS VARY BY STATE USUALLY PAID VIA PER CASE/PER DIEMUSUALLY PAID VIA PER CASE/PER DIEM
MOST ARE MATCHED BY FEDERAL MOST ARE MATCHED BY FEDERAL DOLLARSDOLLARS
TOTAL GME PAYMENTS BY STATES IN TOTAL GME PAYMENTS BY STATES IN 20062006 $3 BILLION$3 BILLION
GME FUNDING: MEDICAID’S ROLEGME FUNDING: MEDICAID’S ROLE
CHILDREN’S HOSPITAL GME FUNDINGCHILDREN’S HOSPITAL GME FUNDING
CHGME AUTHORIZED 2000, CHGME AUTHORIZED 2000, REAUTHORIZED 2006-2011REAUTHORIZED 2006-2011
HEALTH RESOURCE SERVICES HEALTH RESOURCE SERVICES ADMINISTRATIONADMINISTRATION
ANNUAL APPROPRIATIONS FUNDING ANNUAL APPROPRIATIONS FUNDING IN LABOR-EDUCATION-HHS BILLIN LABOR-EDUCATION-HHS BILL
1/3 DME USING NATIONAL AVG PRA1/3 DME USING NATIONAL AVG PRA 2/3 IME FORMULA WITH CASE MIX, 2/3 IME FORMULA WITH CASE MIX,
VOLUME, TEACHING INTENSITYVOLUME, TEACHING INTENSITY $ 300 MILLION 2004 TO 61 HOSPITALS$ 300 MILLION 2004 TO 61 HOSPITALS
DMEDME$ 2.6 BILLION 2004$ 2.6 BILLION 2004 IMEIME $ 5.3 BILLION 2004$ 5.3 BILLION 2004 DSHDSH $ 7.7 BILLION 2004$ 7.7 BILLION 2004 MEDICAIDMEDICAID $ 3 BILLION$ 3 BILLION CHGMECHGME $ 0.3 BILLION$ 0.3 BILLION TOTAL ANNUAL GOVERNMENT TOTAL ANNUAL GOVERNMENT
FUNDING TO GMEFUNDING TO GME $ 18.9 BILLION$ 18.9 BILLION
GME FUNDING: GOVERNMENT’S ROLEGME FUNDING: GOVERNMENT’S ROLE
HUMAN RESOURCES ISSUESHUMAN RESOURCES ISSUES WORKFORCE SHORTAGEWORKFORCE SHORTAGE AAMC EXPANSIONAAMC EXPANSION BBA CAPBBA CAP
CONTROVERSIES AND CHALLENGESCONTROVERSIES AND CHALLENGES
FUTURE GOVERNMENT FUNDINGFUTURE GOVERNMENT FUNDING MEDICARE SUSTAINABILITYMEDICARE SUSTAINABILITY MEDICAID MATCHINGMEDICAID MATCHING CHGME CONTINUATIONCHGME CONTINUATION DECLINING PART B FACULTY DECLINING PART B FACULTY
REVENUESREVENUES PART D EFFECTPART D EFFECT
CONTROVERSIES AND CHALLENGESCONTROVERSIES AND CHALLENGES
MEDICARE’S FUTURE: BABY MEDICARE’S FUTURE: BABY BOOMERSBOOMERS
MEDICARE’S FUTURE: BANKRUPTCYMEDICARE’S FUTURE: BANKRUPTCY
$0$25$50$75
$100$125$150$175$200$225$250$275$300$325$350$375$400
1970 1980 1990 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Calendar Year
Do
llars
in B
illio
ns
Actual Income Actual Expenditures
Projected Income Projected Expenditures
Table 4.5Medicare Trustee’s Report: Part A Income and Expenses, 1970-2015
.Source: CMS, Office of the Actuary.Trustees Report, 2006.
Actual Projected
Projected Expenditures First Exceed Projected Income in 2011
MEDICARE’S FUTURE: MEDICARE’S FUTURE: BENEFICIARIESBENEFICIARIES
PART D: Rx DRUGSPART D: Rx DRUGS
SOURCE: MedPAC DATA BOOK, 2006SOURCE: MedPAC DATA BOOK, 2006
??
SOURCE: DODOO, 2007 SOURCE: DODOO, 2007 RESIDENTSRESIDENTS 106,000*106,000*
GME PAYMENTS AND COSTS PER RESIDENTGME PAYMENTS AND COSTS PER RESIDENT
2001 2002 2003 2004 2005*
Medicare81258 84746 82058 87744 63917
Medicaid24508 26811 28363 29814 31235
Payments105766 111557 110421 117558 95152
Costs85858 92219 94614 96370 87414
?Overage19908 19338 15807 21188 7738
CONTROVERSIES AND CHALLENGESCONTROVERSIES AND CHALLENGES WHY SHOULD MEDICARE PAY?WHY SHOULD MEDICARE PAY? WHAT IS MEDICARE BUYING?WHAT IS MEDICARE BUYING?
VALUEVALUE QUALITYQUALITY
WIDE VARIATION DME SUSPECTWIDE VARIATION DME SUSPECT MedPAC RECOMMENDS REDUCTION MedPAC RECOMMENDS REDUCTION
IMEIME
A REVIEW FOR COORDINATORSA REVIEW FOR COORDINATORS
CONTROVERSIES AND CHALLENGESCONTROVERSIES AND CHALLENGES RULE-MAKING SHARPLY ELIMINATES RULE-MAKING SHARPLY ELIMINATES
FEDERAL MATCHING DOLLARS FOR FEDERAL MATCHING DOLLARS FOR MEDICAID GME PAYMENTS 2007MEDICAID GME PAYMENTS 2007 MORATORIUM TO JUNE 2008MORATORIUM TO JUNE 2008 MORATORIUM EXTENSION PASSED MORATORIUM EXTENSION PASSED
HOUSE ENERGY AND COMMERCE HOUSE ENERGY AND COMMERCE SUBCOMMITTEE ON HEALTH APRIL 9, SUBCOMMITTEE ON HEALTH APRIL 9, 20082008
A REVIEW FOR COORDINATORSA REVIEW FOR COORDINATORS
CONTROVERSIES AND CONTROVERSIES AND CHALLENGESCHALLENGES
PRESIDENT’S FY 2009 PRESIDENT’S FY 2009 BUDGET ELIMINATES BUDGET ELIMINATES CHGMECHGME
A REVIEW FOR COORDINATORSA REVIEW FOR COORDINATORS
? ALTERNATIVE FUNDINGALTERNATIVE FUNDING
? SPECIFIC APPROPRIATIONSPECIFIC APPROPRIATION? OUTCOMES REQUIREMENTSOUTCOMES REQUIREMENTS
? ALL PAYER FUNDALL PAYER FUND? REDUCTION RATES BY NON-GOVT REDUCTION RATES BY NON-GOVT
PAYERSPAYERS
? PROVIDER TAXESPROVIDER TAXES
? ALCOHOL + TOBACCO FEDERAL ALCOHOL + TOBACCO FEDERAL TAXTAX
A REVIEW FOR COORDINATORSA REVIEW FOR COORDINATORS
KAREN R. BORMAN, MD, FACSKAREN R. BORMAN, MD, FACS
MEDICARE and MEDICAID MEDICARE and MEDICAID REIMBURSEMENT for REIMBURSEMENT for GRADUATE MEDICAL GRADUATE MEDICAL
EDUCATIONEDUCATION
