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On Implementing a National Graduate Medical Education Trust Fund
appropriated fund amount. To avoid adversely effecting any student currently in training current funding of hospitals with undergraduate, provider-operated nursing programs should be phased out over not more than 4 years, so that students now in these training programs have graduated.
Summary Plan: Nursing
The Health Care Financing Administration (HCFA) counts the number of full-time-equivalent (FTE) graduate nurses undergoing clinical training as the responsibility of the sponsoring institutions.
HCFA divides the amount of direct medical education funds set aside for graduate nursing by the number of FTE graduate nurses in clinical training to get a standard per graduate nurse payment amount.
All sponsoring institutions are paid the standard per graduate nurse payment for their graduate nurses in clinical training.
The committee only briefly considered allied health programs. They constitute only 1%–1.5% of GME expenditure (B. Wynn, personal communication February 21, 1997). Allied health training is presently supported in the same way as nursing training, through partial reimbursement to hospitals for the submitted costs of accredited programs. The committee recommends that consideration be given to paying the costs of allied health programs in ways that are proportional to the limits proposed for nursing and other parts of GME payment. If GME support is distributed from an annually determined fund, the committee does not want support of allied health programs to grow at the expense of other professionals. A number of allied health professions, not currently eligible for Medicare GME support, proposed that they should become eligible. The committee cannot speak to the merits of all these applicants but notes that some allied health professionals can substitute for residents and physicians and also pursue advanced clinical training—such as physician assistants, and in some cases, perhaps clinical psychologists, for example.