Use Case 9: Transparency on GME (Graduate Medical Education) funding

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Requirements

Use case summary

Description

Value

  • Value to customer: Currently, the public has no way to know how much CMS pays particular institutions for residency and fellowship programs. Ideally, this data should be made transparent.

Customer

  • ProPublica

Current data and limitation

  • Data source: CMS Cost Reports
    • https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/index.html
    • Instructions for obtaining the direct graduate medical education (DGME) and indirect medical education (IME) data here: direct graduate medical education (DGME) and indirect medical education (IME)
      • The zip files which contain the DGME and IME estimates are split into two groups:
        • "Hospital Form 2552-96": Cost reports with fiscal years between Sept 30, 1996 through April 30, 2010
        • "Hospital Form 2552-10": Cost reports with fiscal years May 1, 2010 and beyond
      • After downloading zip files of the cost reports that include the fiscal years of interest, there will be a folder titled "IME_GME" in the parent folder. In that folder there will be a CSV file for every fiscal year.
        • Each row is a hospital
        • The DGME spend can be estimated by summing the "GME_Part_A" and "GME_Part_B" fields
        • The IME spend can be estimated by summing the three "IME" fields
        • While there is an "Interns_and_Residents" field, this data may not be reliable that data is since it may be populated from the Intern and Resident Information System.
  • Related reports: In 2006, ASPE published two reports around GME.
    • Alternative Ways of Funding Graduate Medical Education https://aspe.hhs.gov/sites/default/files/pdf/74846/report.pdf
      • Estimates Medicare DGME and IME spend using the Cost Reports, as described above (methodology on page 34 of the report)
    • Graduate Medical Education: What are We Paying for?https://aspe.hhs.gov/sites/default/files/pdf/74821/report.pdf
      • This reports mentions hoping to use the CMS Intern and Resident Information System to obtain information to characterize residents and residency programs, but finding data anomalies making it unsuitable for their analysis. Instead, they use a couple of data sources:
        • Accreditation Council for Graduate Medical Education (ACGME) data
        • National GME census from the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA)
        • Medicare inpatient prospective payment system (PPS) impact file
        • American Hospital Association (AHA) hospital survey
  • Limitations
    • The estimated DGME and IME spending from the Cost Reports cannot be correlated with descriptive statistics characterizing residents or residency programs.

Specifications

  • Fields: For each institution and program:
    • number of residents/fellows
    • amount of money paid by CMS
    • other variables CMS collects on each program

Solution

Short term workaround

  • For more granular information than what can be provided by the DGME and IME estimates from the Cost Reports, a FOIA request would be need to be submitted to CMS.

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