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4 The Role of Graduate Medical Education Consortia in the Postregulatory Era in New York State
4 The Role of Graduate Medical Education Consortia in the Postregulatory Era in New York State
Pages 71-87
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From page 71... ...
As defined by the New York State Council on Graduate Medical Education (NYSCOGME) , GME consortia are organizations convened around a meclical school and embracing both hospital and nonhospital institutions engaged in training (New York State Council on Graduate Meclical Eclucation, 1988~.
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From page 72... ...
Of 230 licensed acute care hospitals in New York State, 103 participate in teaching programs. Powerful financial incentives built into the Medicare hospital payment system combined with equally powerful incentives provided by five iterations of New York State's regulated all-payer hospital reimbursement system (New York Prospective Hospital Reimbursement Methodology ENYPHRM ~ to V]
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From page 73... ...
The state commission anc3 the council called for the tighter linkage between educational goals anc3 statewide workforce policy goals for residency programs through the development of GME consortia. The council defines a GME consortium as "an organization of institutions, both teaching hospital anc3 non-hospital sites, convened around a medical school, empowered to ensure the educational integrity of training programs anc3 to serve as a vehicle to achieve policy goals anc3 objectives with regard to workforce reform" (New York State Commission on Graduate Medical Eclucation, 1986; New York State Council on Graduate Medical Eclucation, 1988~.
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From page 74... ...
In the years since its formation, it has successfully acted as the institution of record for all graduate medical programs sponsored by the nine affiliated teaching institutions of the State University of New York at Buffalo. Uncler an agreement with the state, the consortium's institutions have pooled GME funds to help centrally administer all residency programs and to develop programs to meet state training goals, particularly in primary care (New York State Council on Graduate Medical Education, 1991~.
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From page 75... ...
This analysis highlighted the extraorclinary numbers of residents being trained in specialties in which a clear oversupply existed according to a host of different workforce need methodologies. The analysis also highlighted the fact that nearly half of the graduate medical residents in New York State are international meclical school gracluates, precisely the pool of gracluate trainees singled out for reductions by these national studies (Salsberg, 1996~.
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From page 76... ...
The Hospital Association of New York State published a set of tables establishing the winners anc3 losers uncler one reform proposal (Hospital Association of New York State, 19964. Upstate hospitals, particularly those in nonteaching environments, began to see the prospect of pooled clolIars flowing from upstate premiums to downstate hospitals to fund the training of unwanted doctors anc3 the care of the uninsured; nonteaching hospitals throughout the state couIc3 see their competitive price ac3vantage with managed care companies eroclec3 by these subsidies; anc3 financially stable institutions collie see continued "taxation" to support financially clistressec3 hospitals in the face of eroding margins.
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From page 77... ...
The paper outlinecl specific goals and objectives for training in the state and proposed a mechanism for funding GME via consortia, with financial incentives proposed to be used to help phase in this method of payment over a 4-year period (New York State Counci} on Gracluate Meclical Eclucation, 1995~.
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From page 78... ...
Costs were higher at Strong primarily because of acic3-ons to cover GME. This decision by Kociak caused such an uproar that it galvanized the University of Rochester into proposing to Kociak and the Rochester Health Commission, a business council that has traditionally been very active in fostering communitywicle health planning, the creation of a GME consortium to rationally plan and distribute pooled funds for training programs.
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From page 79... ...
The Department of Health guaranteec3 this system for a 6-month period prior to the expiration of the NYPHRM V legislation. It postponed consideration of the use of GME consortia as the vehicle for rationally planning for workforce needs and channeling GME funds until the post-NYPHRM debate.
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From page 80... ...
Furthermore, the act called for 43 percent of this pool to be clistributec3 to upstate hospitals, reflecting the approximate percentage of distribution of the payer surcharges that wouIcl fund the pool. As a result, New York City teaching programs that orclinarily receive 80 percent of the GME dollars would receive only about a third of what they would normally get in direct medical education payments.
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From page 81... ...
The council responclec3 with a second position paper outlining what it thought were the key essential ingredients for a successfu} consortium and setting forth a process for certification and clear outcomes measures consistent with overall state workforce goals (New York State Council on Graduate Medical Education, 1996~. These guiclelines were largely incorporated into the New York Senate version of the post-NYPHRM legislation with the concurrence of the Department of Health and the governor's office.
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From page 82... ...
Health care reform, welfare reform, proposed changes in the workman's compensation system, school reform, anc3 a bevy of other high-profile issues shared the limelight in this debate. Within the health care reform Deb ate, the move to negotiated rates, funding for public goods, reform of the method of funding uncompensated care, continued support of 20 New York City-basec3 financially clistressec3 hospitals, equity issues between upstate anc3 downstate hospitals, competitive issues surrounding pooled resources for GME anc3 uncompensated care, anc3 a myriad of health care initiatives to encourage expansion of insurance for the uninsured were among the host of issues crowding the discussion of the use of consortia to channel cleclicatec3 monies for GME.
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From page 83... ...
The delay set a record for tardiness in the state. In the end, the New York Health Care Reform Act of 1996 was a grand set of compromises that preserved a good clear of the current system while charting new waters.
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From page 84... ...
A new market environment with market rules emphasizing winners and losers and competition over limited funds further unclerminec3 these precepts. This new market environment coIc3ly called into question the timehonorec3 value that New York State put into support for research, teaching, and eclucation, which were considered public goocls.
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From page 85... ...
The Medicare program responclec3 by inviting the state to develop a full proposal to uncouple funding from the number of graduate medical residents with the goal of rationalizing the scope of New York State training programs (Greater New York Hospital Association, 1996c)
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From page 86... ...
Deliberations of the Graduate Medical Education Subcommittee. Considerations in Developing a Policy for the Financing of Graduate Medical Education in New York State.
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From page 87... ...
Presentation to the New York State Council on Graduate Medical Education Plenary Meeting, New York, March 25.
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