to ensure that total national general, non-Medicare payment remains within the general, non-Medicare IME fund limit for the year.
An institution's Medicare capitated patients' percentage of that institution's total Medicare caseload should be calculated and used as a coefficient to appropriately modify the IME formula PPS adjustment in the formula half of Medicare IME payment to account for capitated patients in the distribution of formula IME support.
Current IME payment should be restricted exclusively to teaching hospitals. Study of the design and the effects of a wider distribution to cover indirect teaching costs in other settings that are accredited and recognized for payment by the National GME Trust Fund should be undertaken.
The amount of time residents spend in approved, affiliated ambulatory training sites as part of an institution's Accreditation Council for Graduate Medical Education/American Osteopathic Association (ACGME/AOA) approved residency program should be counted for hospital IME payment purposes just as it is for DME payment.*