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News Article Explaining how GME is funded.

Teaching hospitals diagnose cuts

The U.S. Congress is considering snipping away funding meant for teaching hospitals and the consequences could be dire for the professional medical community, according to the Healthcare Association of Southern California.

“It’s the lifeline for the physicians and the medical professional,” said Mark Gamble, vice president with the association’s Inland Area office in Grand Terrace.

Hospitals that host the area’s doctor training programs that rely on federal
educational funding include:

• Loma Linda University Medical Center.
• Jerry L. Pettis Memorial Veterans Affairs Medical Center in Loma Linda.
• Arrowhead Regional Medical Center in Colton.
• Riverside County Regional Medical Center in Moreno Valley.
• Kaiser Permanente medical centers in Fontana and Riverside
• Casa Colina Centers for Rehabilitation in Pomona.
Congress funds most teaching hospitals through the U.S. Centers for Medicare and Medicaid in Maryland.

Training costs

The Centers for Medicare and Medicaid pay two types of reimbursements to teaching hospitals: Graduate medical education payments fund the cost of training residents. Indirect medical education, or IME payments, pay for treating more seriously ill and injured patients which teaching hospitals, rich with research activity, tend to treat in greater number than do non-teaching hospitals.

Under existing law, Congress is expected to lower indirect payments this year from 6.5% to 5.5%, according to the Association of American Medical Colleges based in Washington D.C. On its Web site, the medical colleges association estimates indirect medical education payments to more than 1,100 teaching hospitals totaled $5.9 billion in 2001.

The association supports the American Hospital Preservation Act, embodied in S. 839 and H.R. 1556, which would maintain the 6.5% payment level. The proposed bipartisan legislation is under consideration in Congress.

“Health care seems to be the popular target for government [to cut funding],” said Mark Uffer, chief executive officer at 289-bed Arrowhead Regional Medical Center in Colton. “They’re flirting with disaster if they continue to cut.” Arrowhead is the public hospital for San Bernardino County and required to treat low income and uninsured populations.

The hospital receives $3.5 million annually from the U.S. Centers for Medicare and Medicaid to help pay for the residency program, and another $3.5 million to pay for costs to treat critically ill and injured requiring special care.

Arrowhead this year will spend $9.5 million total to train residents, with about $6 million coming from the hospital operating budget and the remainder from the federal government. The hospital will spend $4.1 million on residents’ salaries and benefits and $4.4 million to physicians groups for teaching services, according to hospital officials.

In light of threats to government funding and the cost of providing services, the hospital has at times considered ending or scaling back its residency program, Uffer said.

“The reality is we’re a big training program and we need the residents to provide care,” at the hospital and its clinics, he said.“And we need a supply of young physicians in the community.”

Arrowhead pays 82 residents $32,000 to $47,000 a year depending on specialty and year of study.

Of the 82 residents, 54 study family practice medicine, which requires three years of residency training. Family practice residents earn $32,000 the first year, $37,000 the second and $42,000 the third year.

Other specialties, obstetrics and gynecology for example, pay residents $47,000 and require a fourth year in the program, said Andre Blaylock, family medicine residency program director at Arrowhead Regional Medical Center.

Arrowhead Regional draws five to 10 medical students a year from Loma Linda University, the University of California, Irvine and the Western University of Health Sciences in Pomona.

The students, usually in their third and fourth years of medical school, shadow doctors as the doctors treat patients.

Hospitals incur some administrative costs for training medical students, but the greatest expense for teaching hospitals lies with residency programs.

“This is where the big costs lie,” said Blaylock.

Doctor’s choice
Amber Figueroa of Yucaipa, a third-year family practice resident at Arrowhead Regional, chose the Colton medical center’s residency program because of the variety of cases the hospital handles. Uninsured patients who have received cursory treatment for major problems at hospitals that wanted to avoid treatment expenses, often end up at Arrowhead,
Figueroa said.

“I wanted to train in a hospital where I would see a lot of crazy stuff, which I would see at a county hospital,” she said.

She chose Arrowhead because it often allows family practice residents to treat patients while learning other specialties, she said.