CMS - Graduate Medical Education (GME)

[cornstein]

Recently, the Institute of Medicine called for greater transparency about GME (graduate medical education) funding--http://www.iom.edu/Reports/2014/Graduate-Medical-Education-That-Meets-the-Nations-Health-Needs.aspx. CMS has information about GME payments by program and institution. These would be worthwhile figures to release.

[dportnoy]

Created page for full use case specifications and solution: http://hhs.ddod.us/wiki/Use_Case_9

[betshsu]

@cornstein Is this data still of interest? If so, could you articulate the value and use of the data so that it can be structured as a use case? Thanks.

[cornstein]

Hi @betshsu This information is still of use. Currently, the public has no way to know how much CMS pays particular institutions for residency and fellowship programs. It would be helpful to know, for each institution and program, the number of residents/fellows, the amount of money paid by CMS and other variables that CMS collects on each program.

[betshsu]

Okay, thanks. I'll start looking into this and see what I can dig up.

[betshsu]

@cornstein Sorry for the delay in updates. We have been working on internal processes with CMS in an effort to avoid duplicate requests to CMS program staff on the same issues; we are doing some internal checking with CMS on the GME question.

[betshsu]

@cornstein I apologize for the delay, it's taken a while for CMS to get back to us how on how they would prefer to handle this request. Unfortunately, CMS would prefer for this request to be submitted through FOIA. We need to respect the boundaries of how our agencies would prefer to handle data inquiries, and apologize that it has taken this long to get a response that results in a FOIA submission.

You may already be aware of this, but 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
• Graduate Medical Education: What are We Paying for? https://aspe.hhs.gov/sites/default/files/pdf/74821/report.pdf

In the first report, on page 34, ASPE details their methodology for estimating Medicare DGME and IME spend using CMS Cost Reports.

• The Cost Reports can be obtained here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/index.html
• The instructions for obtaining the DGME and IME data are here: http://www.resdac.org/resconnect/articles/162

After downloading the zip file for the calendar years of interest (for example, the 2010 and on files can be found on this page: https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/Hospital-2010-form.html), there will be folder titlde "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, I am unsure of how reliable that data is since I think it may be populated from the Intern and Resident Information System.

The second 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:

• ACGME data
• National GME census from AAMC and AMA
• Medicare inpatient PPS impact file
• AHA hospital survey

Of course, they do not correlate their descriptive analysis with the funding estimates.

I realize that this is only a subset of the data of interest to you; for more granularity, you'll have to go the FOIA route.