Graduate Medical Education Enhancement and the Consolidated Appropriations Act, 2021

• DOI: 10.4300/jgme-d-21-00467.1
• Publication Date: 2021-10-20T17:08:08Z
• Authors: Oliver W. Hayes; Jon Scaglione; C. Powell Hutchinson; Irina Zhorzholiani
• Keywords: Economic shortage; Graduate medical education

On December 27, 2020, the $2.3 trillion Consolidated Appropriations Act of 2021 was enacted, providing for fiscal year funding.1 While may be best remembered $900 billion COVID-19 relief payments, new law included essential provisions graduate medical education (GME). Buried within 5593 pages are a series incremental changes to federal funding GME.2 Although, United States is facing projected shortage physicians, past efforts increase GME have failed.3,4 Recognizing impending Congress created modest expansion federally funded training positions.5 This article describes Sections 126, 127, and 131 offers recommendations. Our first suggestion consider incorporating information from each section into system-level strategy beginning with Section 131, then finally 127.Section provides hospitals that low full-time equivalent (FTE) caps or FTE per resident amount (PRA) funding. Those qualify reset either through 26, 2025.Hospitals an cap if they not trained residents programs before enactment date, will train programs, meet criteria listed in Figure 1. Some qualifying likely those accepted few rotating program but aware their current status. We recommend review cost reports publicly available report data can help determine eligibility.6 For institutions do reset, challenge successfully matriculate (1–3 FTE) partnered self-sponsored program(s) by 2025. Institutions should expect development program, director recruitment first-class matriculation, take minimum 2 years more.Hospitals PRA entered Medicare Affiliation Agreement since existing following 2. Given PRA, there fewer temporal restraints. interested must withdraw abstain Agreements, because entering agreement after date disqualify hospital.Section 126 distribution additional 1000 Medicare-supported positions, maximum 200 positions distributed next 5 years. provision fund over cap. Thus, proportionally expand build fill awarded FTE. The legislation further states favored distribution:Another consideration “demonstrated likelihood hospital filling positions” number approved positions. No less than 10% group captioned above. Therefore, year, 40% such hospitals.The Centers Medicaid Services (CMS) proposes application deadline January 31, 2022, disbursed July 1, 2023. this received national attention, CMS rightly anticipated intense competition, including among teaching prioritized criteria. proposed rules plan limit competition ways. First, reduce award size no more 1.0 individual hospital. Second, place highest priority on geographic HPSA scores specifically allocate applicant score, highest, etc, use prorating only score exceeds residency available.Use greatly competition/interest these urban facilities. mitigates concerns Council Academic Family Medicine secondary unintentionally applicants rural areas disadvantaged situation, as historically all positions.7 met, it accomplished “checkbox” attestation Accreditation Graduate Medical Education (ACGME) submissions, initial accreditation, expanding program. remaining preparatory steps expected fall cycle include:The final most generous piece which aims solve problems prior hub (urban) spoke (rural) partnership known track (RTT) promote opportunities:It our opinion difficult require detailed analysis. Capitalizing opportunity requires coordinated partnerships between redefine physician States. However, funding, generated perpetuity, feasible method addressing redistribution, while increasing facility's evidence RTT positively impact retention areas, excellent news.8–10 see promising medicine address shortage. examine infrastructure what resources advantage section. Rural Health Clinics, Federally Qualified Centers, Critical Access Hospitals, now revised rules, provide many attractive sites at sites.Since inception caps, has been very opportunities materially until now. Appropriation Act, thousands US fellowship major emphasis communities. Over eligible 131. we encourage organizations leadership potential partners find ways utilize limitations removed. In past, functioned bottleneck terms pool—in 2021, government paths substantially supply future well.