GME Study Committee Submits Report to Legislators

(January 3, 2016) The Graduate Medical Education Study Committee, created by the Ohio General Assembly, has completed work and transmitted its recommendations to the legislature on how to fix a flawed formula that results in a wide variation in how teaching hospitals are reimbursed in Ohio.

"It [the current formula] makes no sense at all," said Greg Moody, director of Gov. John Kasich's Office of Health Transformation. who was quoted in a Cleveland Plain Dealer article in November. "A pattern is present throughout the state where hospitals that are essentially providing the same sorts of training programs for medical education receive drastically different amounts."
 
According to OOA Executive Director Jon F. Wills, osteopathic teaching programs, in particular, have been disadvantaged by the current reimbursement formula which was developed in the 1980's based on Medicaid cost reports for direct and indirect graduate medical education expenses.  The more teaching hospitals spent, the higher they were reimbursed, said Wills.  

"The osteopathic profession has traditionally relied on a volunteer faculty to train students in AOA approved residencies," said Wills.  "Allopathic programs, on the other hand, traditionally paid residency program directors and added support staff, which incurred higher costs, particularly in the large academic teaching centers."

Wills went on to say that the current system encourages the training of specialists as opposed to primary care physicians, who are traditionally educated in outpatient settings in community based hospitals.  

"The osteopathic profession is turning out the primary care physicians the Kasich Administration wants," said Wills. "At least this report shines light on the inequities of the current system and starts a discussion on how to bring more equity and incentive the training of primary care physicians at the same time".  

An analysis of hospital payments by the Department of Medicaid shows that Lutheran Hospital, in Cleveland  received $385,000 per trainee in 2014. Meanwhile, Doctors Hospital in Columbus got only $10,616. A chart showing all of the training hospitals in Ohio and what they were reimbursed per residency is included in the report. 

The Graduate Medical Education Study Committee Final Report also contains information on current GME payments to hospitals, explains how the funding formula works, and provides recommendations to update the formula to be more fair and to promote state health policy priorities. The last four pages of the committee’s report describe a consensus, submitted by the Medical School Deans, which will serve as a starting point for future reforms, which Ohio Medicaid has committed to act on in 2016.

The report also includes discussion points suggested by the OOA to incentivize community based programs along with written testimony submitted by other interested parties, including Cynthia Kelley, DO, Vice President of Medical Education for the Summa Hospital System and President of Ohio ACOFP.

Statutory members of the committee included:

• Mchael Anderson, MD, Ohio Children’s Hospital Association (appointed per statute)
• John Carey, Ohio Board of Regents (appointed per statute)
• Charles Cataline, Ohio Hospital Association (appointed per statute)
• Daniel Clinchot, MD, Ohio State University (appointed by House)
• Christopher Cooper, MD, University of Toledo (appointed by Senate)
• Andrew Filak, MD, University of Cincinnati (appointed by Senate)
• Jay Gershen, DDS, PhD,Northeast Ohio Medical University (appointed by House)
• David Hopkins, PhD, Wright State University (appointed by House)
• Kenneth Johnson, DO, Ohio University (appointed by Senate)
• John McCarthy, Ohio Department of Medicaid (appointed per statute)
• Roderick McDavis, PhD, Ohio University (appointed by House)
• Greg Moody (Chair), Office of Health Transformation (appointed per statute)
• Brent Mulgrew, Ohio State Medical Association (appointed per statute)
• Andy Thomas, MD, Ohio State University (appointed by Senate)
• Jon Wills, Ohio Osteopathic Association (appointed per statute)