To date, two major accreditation bodies—the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA)—have accredited the majority of medical residency training programs in the United States. These two organizations are now working toward creating a unified system called the Single GME Accreditation System that will allow graduates of both allopathic and osteopathic medical schools to complete their residency and fellowship education in ACGME-accredited programs and demonstrate achievement of common milestones and competencies. The announcements of the single system came in 2014 when the ACGME, AOA and the American Association of Colleges of Osteopathic Medicine (AACOM) announced their agreement to a Memorandum of Understanding (MOU) outlining the unified system. As part of the agreement, the AOA will cease accreditation activities by June 30, 2020.

Under the current Centers for Medicare & Medicaid Services (CMS) regulations, both ACGME- and AOA-accredited programs are considered "approved" programs for Medicare graduate medical education (GME) funding purposes. The initial residency period (relevant to direct GME funding) may differ between an ACGME-accredited program and an AOA-accredited program of the same specialty, however, as many AOA programs have traditionally required longer training for board eligibility. Also, CMS' regulation prohibiting a hospital that became a teaching hospital after 1996 from sharing funded GME positions through GME affiliation agreements likely has a disproportionate effect on AOA-accredited programs, given that residency training in many of these programs takes place in such teaching hospitals.

As the two accrediting bodies take concrete steps toward creating the new system, teaching institutions have begun to grapple with new Medicare GME funding-related concerns. Some questions that have surfaced include the following:

  • If a new teaching hospital plans to merge its new AOA-accredited program into an existing ACGME-accredited program at another hospital, what will be the impact on its new GME caps?
  • If the transition to the Single GME Accreditation System causes AOA-accredited programs to close, what impact will this have on the nationwide shortage of residency positions?
  • What will the duration of the initial residency period for formerly AOA-accredited programs be under the Single GME Accreditation System?
  • Should CMS provide funding incentives to existing teaching hospitals (that already have Medicare GME caps) to partner with AOA-accredited programs so those programs can meet the more stringent ACGME patient volume requirements?

More questions will undoubtedly emerge over the next five years as the transition to the Single GME Accreditation System occurs, and CMS likely will need to address some of these concerns through guidance and rulemaking.