The U.S. House of Representatives’ Committee on Energy and Commerce (the Committee) issued an open letter to the public on December 6, 2014, soliciting input on ways to improve graduate medical education (GME) “financing [and] federal program governance and structure.”  The request comes as Congress is considering the Institute of Medicine’s (IOM) recent report recommending “sweeping changes” to the GME system.  Among the specific proposal the Committee requests comment upon is whether there should be separate payments for indirect medical education (IME) costs and direct graduate medical education (DGME) costs, whether the per-resident amount should “follow[] the resident and not the institution,” and “whether the current system of residency slots appropriately” meets the nation’s healthcare needs.  The deadline to submit comments is January 16, 2015. 

In particular, the Committee requests input on the following seven questions:

  1. What changes to the current GME financing system might be leveraged to improve its efficiency, effectiveness, and stability?
  2. Of the “numerous proposals put forward to reform the funding of the GME System,” are there “any proposals or provisions” you support and why?
  3. Should federal funding for GME programs ensure training opportunities are available in both rural and urban areas?  If so, what sorts of reforms are needed?
  4. Is the current financing structure for GME appropriate to meet current and future healthcare workforce needs?
  1. Should it account for direct and indirect costs as separate payments?
  1. If not, how should it be restructured?  Should a per-resident amount be used that follows the resident and not the institution?
  2. If so, are there improvements to the current formulas or structure that would increase the availability of additional training slots and be responsive to current and future workforce needs?
  1. Does the financing structure impact the availability of specialty and primary care designations currently?  Should it moving forward?
  1.  Does the current system incentivize high-quality training programs?  lf not, what reforms should Congress consider to improve program training, accountability, and quality?
  2. Is the current system of residency slots appropriately meeting the nation’s healthcare needs?  If not, please describe any problems and potential solutions necessary to address these problems?
  3. Is there a role for states to play in defining our nation’s healthcare workforce?

The open letter is available here