Medicare graduate medical education funding unevenly distributed, study finds

The federal government allots more than $10 billion per year through Medicare Graduate Medical Education (GME) payments to fund residency programs at teaching hospitals throughout the country. But the distribution of that funding is severely imbalanced, according to a recent study published in Health Affairs by researchers at George Washington University.

The authors examined the Medicare cost reports that teaching hospitals submitted to the Healthcare Cost Report Information System of the Centers for Medicare and Medicaid Services (CMS) from 2008 through 2010. The population data is based off the 2010 U.S. census.

They found that the current distribution favors programs in Northeast states, such as Massachusetts Rhode Island and Connecticut, which have a high density of residents compared to the population. New York received, $2 billion (20%) of GME funding, while 29 states received less than 1% funding. Wyoming received $1.64 million in GME funding.

In Montana, Medicare GME contributed $1.94 per resident, while the District of Columbia received $172.85 per resident.

The authors say these results are important for two reasons.

“First, it is well established that there is a positive association between the site of training and locale of practice,” the study says. “Second, GME’s dependence on federal support raises legitimate concerns about distributional fairness in this form of public funding.”

The authors suggest updating the GME funding formula to reflect population growth in areas, and they conclude that it is essential the GME system have a central coordinating body that works with policy makers and the GME community to re-evaluate priorities and the distribution of resources.

“These reforms will be essential to transforming our system of graduate medical education to meet the needs of a growing and more fully insured American population,” the study says.