Outdated graduate medical education slots limit NJ hospitals from training more physicians

NORTH JERSEY - On April 10, 2020, U.S. Representatives Josh Gottheimer (NJ-5) and Bill Pascrell, Jr. (NJ-9) requested that measures to increase graduate medical education slots for hospitals be included in the forthcoming coronavirus economic relief package, as New Jersey continues to rank as the second largest outbreak in the nation by total number of COVID-19 cases. Increasing graduate medical education slots would provide a potential solution to health care workforce issues and alleviate the staffing burden that has plagued New Jersey’s hospitals during the COVID-19 pandemic.

Currently, there is an arbitrary cap on hospital graduate medical education slots. Because of this outdated calculation, some New Jersey medical programs lack the adequate slots to train as many physicians as possible here, and New Jersey keeps losing highly-trained medical students to other states. 

“This arbitrary cap has made it difficult for a handful of hospitals across the country to train new physicians and grow their health care workforce,” Reps. Josh Gottheimer (NJ-5) and Bill Pascrell, Jr. (NJ-9) wrote in a letter this week to House Speaker Nancy Pelosi and Ways and Means Committee Chairman Richard Neal. “Because of the ongoing COVID-19 pandemic, our hospitals need every available resource to ensure workforce needs are met.”

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The New Jersey Department of Health (NJDOH) has reported that the pandemic has not yet peaked in New Jersey and is expected to worsen in the coming weeks.

The Members also wrote, “As you formulate the next COVID-19 legislative package, we urge you to consider updates to the arbitrary caps placed on the GME program.”   

"North Jersey's brave front-line medical workers are fighting incredibly hard to get our community through this outbreak and to keep our residents safe and protected. It is because of their vital work that we will make it through this crisis. Increasing our hospitals' graduate medical slots will not only make sure they have what they need now, but that our hospitals are prepared for the next health crisis too," said Gottheimer. 

Gottheimer and Pascrell, along with U.S. Senators Bob Menendez (NJ) and Cory Booker (NJ), announced legislation earlier this Congress to fight New Jersey’s doctor shortage by increasing graduate medical education slots for hospitals. This bill corrects an arbitrary and outdated cap on hospital graduate medical education slots, and will provide qualifying hospitals with the opportunity to finally adjust their residency caps to better reflect their workforce needs.

A copy of the letter is available HERE, the text of which is provided below.

The Honorable Nancy Pelosi                         The Honorable Richard Neal

Speaker                                                           Chairman, Ways and Means Committee

U.S. House of Representatives                       U.S. House of Representatives

Washington, DC 20515                                  Washington, DC 20515

 

Dear Speaker Pelosi and Chairman Neal,

 

We write to you regarding the Graduate Medical Education (GME) program and to provide a potential solution to health care workforce issues faced by our nation’s hospitals during the COVID-19 pandemic. As you formulate the next COVID-19 legislative package, we urge you to consider updates to the arbitrary caps placed on the GME program.

As you know, GME payments consist of DGME (Direct Graduate Medical Education), which pays a portion of direct teaching and resident costs, and IME (Indirect Medical Education), which is an add-on to Medicare inpatient payments to help support teaching residents. Under current rules, if a non-teaching hospital provides clinical rotations for medical residents from another facility’s residency program for short periods of time, it risks establishing a very low permanent cap on the number of medical resident “slots” Medicare will fund at the non-teaching hospital in the future.

The Balanced Budget Act of 1997 established limits on the number of allopathic and osteopathic residents that hospitals can count for purposes of calculating DGME payments. The DGME and IME caps were established based on the number of un-weighted resident FTEs (full-time equivalents) training in the hospital during the Medicare cost reporting period ending December 31, 1996. Thus, for most hospitals, the caps were set at the number of resident FTEs reported in that period’s cost report.

This arbitrary cap has made it difficult for a handful of hospitals across the country to train new physicians and grow their health care workforce. Currently, if a hospital wishes to begin a resident training program, having had a small number of rotating residents more than two decades ago may preclude them from a GME program today.

Because of the ongoing COVID-19 pandemic, our hospitals need every available resource to ensure workforce needs are met. We urge you to include a fix to the GME program that allows any hospital that had a stagnant number of GME slots or a reduction in slots that remained the same between October 1997 and the date of enactment the legislation to establish new GME caps. This would help alleviate the staffing burden that has plagued so many hospitals across the country, and especially in Northern New Jersey, which has been hit particularly hard by the COVID-19 pandemic.

We appreciate your attention to this matter and look forward to working with you on the next COVID-19 response package.

 

Sincerely,

 

Josh Gottheimer                                              Bill Pascrell, Jr.

MEMBER OF CONGRESS                           MEMBER OF CONGRESS