GME: NY Teaching Hospitals Drop Residency-Cutting Program
Fifteen teaching hospitals have quit a Medicare demonstration project that began last year "hailed as a solution to [Graduate Medical Education] funding increases and a pending oversupply of physicians." The current issue of American Medical News reports that "new questions have arisen about the financial and administrative feasibility of an unusual reimbursement scheme that pays hospitals millions of dollars not to train medical doctors." Created under the Balanced Budget Act of 1997, the Health Care Financing Administration initiative aimed to trim medical residency training programs at participating New York hospitals by 20% to 25% over five years in exchange for Medicare subsidies to compensate for the "missing residents." Following congressional approval, government officials planned to take the initiative nationwide in 1999, calling it a "panacea for skyrocketing GME costs and a potential oversupply of physicians." HCFA argues that fewer physicians would decrease health care costs. But hospital officials contend that efforts to reduce residents and replace them with less qualified health care workers "does not make financial or operational sense."
The program sparked a number of complaints from the six New York hospitals that dropped out within the first year, including administrative concerns, budget difficulties and overworked residents. AMNews reports that New York state law prohibits residents from working more than 80 hours per week, but downsizing forced residents into 95-hour weeks. Indeed, the New York Health Department recently "conducted surprise survey visits on 12 hospitals and found all to be violating hourly work restrictions." When New York City's Beth Israel Medical Center dropped the program last month, it "opened a can of worms when it publicly stated" that it was failing to comply with the New York law. Beth Israel CEO Matthew Fink explained, "[T]he residency reduction program 'makes it difficult to reduce resident numbers and still be in compliance with work-hour limitations and on-call schedules.'" As hospitals struggle to make the program a viable option, Wang asserted, "There is no question this is a very hard demo. It is like going on a diet and losing 25% of your body weight. Not a happy thing to do." AMNews reports that more of the 34 teaching hospitals still in the program are expected to drop out in coming months (Greene, Nov. 23/30 issue).