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GAO-18-66R 1 (2017-10-31)

handle is hein.gao/gaobaalhc0001 and id is 1 raw text is: cAO U.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 October 31, 2017 The Honorable Lamar Alexander Chairman The Honorable Patty Murray Ranking Member Committee on Health, Education, Labor, and Pensions United States Senate The Honorable Greg Walden Chairman The Honorable Frank Pallone, Jr. Ranking Member Committee on Energy and Commerce House of Representatives Physician Workforce: Expansion of the Children's Hospitals Graduate Medical Education Payment Program Physicians are required to undergo graduate medical education (GME) training in order to practice independently, and the majority of federal payments to support such training are provided to hospitals by the Medicare program.1 These payments are based, in part, on the number of Medicare patients treated by a hospital. Because Medicare primarily covers individuals age 65 and older, children's hospitals generally treat very few Medicare patients and consequently receive few GME payments from Medicare.2 Instead, many children's hospitals receive payments to support GME training through the Children's Hospitals Graduate Medical Education (CHGME) Payment Program, which is administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS). According to HRSA, hospitals that participate in the CHGME program train nearly half (48 percent) of all pediatric residents (physicians in GME training) and over half (53 percent) of pediatric subspecialty residents annually.3 Prior to 2014, eligibility for the CHGME program was generally restricted to children's hospitals that were freestanding as of December 31, 1996, and for which HHS had established a payment cap based on the number of physicians in GME training eligible for funding under Medicare GME rules.4 Similar to the Medicare GME program, CHGME program payments are also 1Medicare is the federally financed health insurance program for individuals age 65 and older and individuals under age 65 with certain disabilities or end-stage renal disease. 2For purposes of this report, a children's hospital is defined as a hospital in which more than 50 percent of its inpatients are under age 18. 3Specialty programs are educational experiences following completion of medical school (e.g., pediatrics), which can lead to board certification. These are also known as core programs. Subspecialty programs are educational experiences following the completion of prerequisite specialty programs (e.g., pediatric pulmonology). These are also known as fellowships. 4Prior to 2014, in order to participate in the CHGME program, a hospital must have been excluded from the Medicare inpatient prospective payment system (IPPS)-the system Medicare uses to pay most hospitals for inpatient GAO-18-66R Children's Hospital Physician Training Program Page 1

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