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FUNDING A RESIDENCY PROGRAM
IN
PODIATRIC MEDICINE AND SURGERY
ONE MAN’S PERSPECTIVE
By
Jay
Lieberman, DPM
As we
discussed in our last communication, I recommended that before
you propose the idea of developing a residency program to the
administrator of your hospital, that a person with an intimate
knowledge of GME funding be present.
The Medicare
program makes explicit payments to teaching hospitals for its
share of the direct costs of Graduate Medical Education.
Medicare Direct Graduate Medical Education (DGME) payments
include residents’ stipends, costs for clerical personnel,
medical supplies, membership dues, malpractice insurance,
meeting and seminar fees, library and audiovisual materials.
In the first
year of a residency program, the hospital develops a list of all
direct costs. This is an approximation of their costs. It is
important to identify all of the costs because direct costs are
capped. Each year a cost report is generated so an actual
itemized bill of the costs that have been incurred is submitted
annually. Actual direct reimbursement, although capped, is tied
into Medicare utilization.
In indirect
reimbursement, the hospital either receives a pre determined sum
for sponsoring the program or they can choose to use a formula
based upon their Medicare census. Usually, the later of the two
formulas is more cost effective. Overall compensation ranges
from approximately $75,000.00 to $200,000.00 per resident
depending on the hospital. Overall compensation is dependent on
location, resident to bed ratio, Medicare DRG's and Medicare
admissions and discharges. This is included in a complex
formula that determines potential compensation for the hospital,
and then divided by the number of house staff will give you the
amount of GME per house staff (intern or resident).
The
institution is obliged to inform the Director of Podiatric
Medical Education of the current amounts of direct and indirect
GME funding that is received. Hospitals must provide all of the
educational material needed to run a residency program.
Although the hospital wants to limit its costs, they must
demonstrate a willingness to provide these educational
materials.
Podiatry is
one of the few professions that do not have a cap on the number
of residents that can be funded. The decision to start a
residency program is usually based upon a circumstance that
benefits both the hospital and the podiatry community. While
it exists, it would behoove us to seize this opportunity.
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