American Healthcare Prospects of Medical Education

The graduate medical education field has sensed the impact of the Patient Protection and Affordable Care Act, amended by the Health Care and Education Reconciliation Act. These pieces of legislation, known as ACA, were meant to take care by new provisions of the doctors' activity in less populated regions, such as the rural areas.

To determine the full-time equivalency (FTE) status for residents, the standards were changed by the ACA. For accumulation of FTE status, there are new reimbursement rules, as the residents' type of work has been diversified. For example, residents involved in non-patient care activities, like didactic jobs, are now eligible for reimbursement, which was not possible before the ACA. Besides seminars, conferences are also included in this category. Hospitals can count these activities for the FTE – therefore, the setting in which the resident carries out the activity has to be patient-care related. If the setting is a conference center or a hotel, then it is not counted for the FTE.

Considering the IME purposes, the activities must be the diagnosis or treatment of a patient. The approved settings and activities have also expanded for the IME reimbursements. In the domain of vacation and sick leave, the time spent away counts as long as it is not extending the residents' participation in their assigned graduate medical education program. When more than one institution claims reimbursement for the resident, the eligible one for the FTE status count is considered the institution to which the resident is assigned when the leave period occurs.

Prior to the ACA, the Medicare-reimbursed positions available for resident were at the same level since 1996. The number has not increased nation-wide, but the existent positions are being redistributed based on the usage rates. As some teaching institutions and hospitals have been unable to fill the resident positions, will suffer reductions. Institutions will have to demonstrate the need of additional funding in order to have new resident positions reassigned. The CMS is responsible with the redistribution.