Medicare is the largest single program providing explicit support for graduate medical education (GME) and every hospital training residents in an approved residency program is eligible to receive Medicare direct graduate medical education (DGME) funding. GME reimbursement data allows you to closely estimate the total “per resident amount (PRA)” your institution receives from Medicare for every one of your podiatric residents.
- DGME payments vary for each institution. The payments are based on the hospital’s per resident amount (PRA) which, by law, was set in the 1980s by CMS for each teaching hospital and updated annually for inflation. Because DGME payments have their basis in historical costs, they are not reflective of the current costs a hospital incurs for resident training. The total amount a hospital receives for DGME is based on the number of residents it is allowed to count, its hospital-specific PRA, and the percentage of its inpatient population that is comprised of Medicare beneficiaries.
- Teaching hospitals also receive an indirect medical education (IME) adjustment from Medicare to their Diagnosis-Related Group (DRG) payments. IME payments are meant to compensate teaching hospitals for the increased patient care costs resulting from treating more complex patients, the standby capacity required in burn and trauma centers, etc. The IME adjustment is an added payment for each Medicare inpatient stay. IME is adjusted based on a hospital’s ratio of residents-to-beds among other factors. If certain conditions are met, residents may be counted for the IME adjustment provided they work in the inpatient or the outpatient department of the hospital or in a non-hospital setting. Medicare pays psychiatric and rehabilitation hospitals differently than acute care hospitals. These hospitals receive “teaching status adjustment” payments instead and the adjustment formula is calculated on the ratio of residents to the hospital’s average daily patient census rather than beds.
- A limit on the number of residents Medicare will pay a specific hospital for was passed by Congress in 1997. Known as the hospital’s resident “cap,” it is based on the number of residents that the hospital trained in 1996. PODIATRY RESIDENTS ARE EXEMPTED FROM THIS CAP.
- Per Resident Amount (PRA) is the reimbursement PER resident received by a hospital and is estimated by dividing “Total DGME and IME Payments for the facility” by “Total FTE residents at the facility.”
- Total DSH Payments are the “Disproportionate Share Hospital” payments are added to the Diagnosis-Related Group (DRG) payment made to institutions that have large volumes of uncompensated care. Theoretically, a podiatric residency program would be involved in clinics serving that population and an appropriate reason to receive some share of those funds as well.
- Additional Allowed FTE Residents is included on this report to capture the Affordable Care Act’s changes to the Medicare DGME reporting, which provides for reallocation of GME slots from teaching programs that have recently closed. Total FTE Residents and Approved DGME Per Resident for the facility already account for these additional residents.
Uncompensated Care Payment is included to reflect additional payments to hospitals reporting after October 1, 2013. This is for reference only and no other calculations with this figure are necessary.