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How Accountable to the Public Is Funding for Graduate Medical Education? The Case for State Medicaid GME Payments
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How Accountable to the Public Is Funding for Graduate Medical Education? The Case for State Medicaid GME Payments
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How Accountable to the Public Is Funding for Graduate Medical Education? The Case for State Medicaid GME Payments
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How Accountable to the Public Is Funding for Graduate Medical Education? The Case for State Medicaid GME Payments
How Accountable to the Public Is Funding for Graduate Medical Education? The Case for State Medicaid GME Payments
Journal Article

How Accountable to the Public Is Funding for Graduate Medical Education? The Case for State Medicaid GME Payments

2021
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Overview
Graduate medical education (GME) funding comes from predominantly two public sources: Medicare and Medicaid. In recent years, concerns have been voiced as to whether these GME payments to teaching hospitals and other entities are sufficiently transparent and publicly accountable. Most of these concerns have been directed at the financing and governance of Medicare GME payments. In the past 10 years, two major reports examined this issue.The main premise of the first report, a 2014 study by the Institute of Medicine (nowthe National Academy ofMedicine), is that Medicare GME payments, and federal funding for GME more broadly, lack a clear purpose. Medicare does not produce enough physicians prepared to practice in the most needed specialties or geographic areas and has insufficient oversight and infrastructure to measure GME program outcomes and reward performance. In terms of accountability, the study found that the stewardship of the public's investment in GME was critically absent. In particular, any data that teaching hospitals are required to report to the federal government has limited use for program oversight, workforce analysis, or policy development; consequently, the report concluded that most questions about the effectiveness of the Medicare GME program are unanswerable.

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