The nation's teaching hospitals could lose billions of federal dollars for physician training, and services to poor and elderly patients could be jeopardized, if Congress approves Medicare cuts that are being considered as part of a sweeping deficit-reduction proposal.
That warning comes from a variety of groups that have descended on the Capitol this week to try to block, or at least minimize, the proposed cuts.
Medicare provides the primary financial support for graduate medical education in the United States.
One proposal by President Obama's bipartisan National Commission on Fiscal Responsibility and Reform would slash about 60 percent, or $3.9-billion, from the estimated $6.4-billion in indirect medical-education payments allocated for 2011, according to an analysis provided to the Association of American Medical Colleges by an independent research group.
Lawmakers are also considering a much more modest deficit-reduction package that would require fewer cuts in Medicare.
The proposed reductions come at a time when the nation's medical schools are increasing enrollments and new schools are opening in order to stave off a predicted shortage of doctors.
Critics of the Medicare indirect medical-education payments say they provide an excessive and unfair subsidy to teaching hospitals.
But administrators at those hospitals say that in addition to helping subsidize the training of doctors and other health-care workers, the Medicare payments help cover the costs of sophisticated medical equipment and treatment, such as trauma and burn care, that their facilities provide.
The cuts would hit hardest in states like New York and Massachusetts because of their large concentrations of teaching hospitals. The Greater New York Hospital Association estimates that, in a worst-case scenario, its hospitals would lose $1.25-billion, or 57 percent, of their Medicare medical-education subsidies, beginning in 2015.
And in Massachusetts, hospitals estimate they could lose about $322-million, or two-thirds of the federal support they receive in indirect medical-education support.
In a letter to President Obama this month, Darrell G. Kirch, president of the Association of American Medical Colleges, acknowledged the need to cut the nation's deficit but warned that the proposed Medicare cuts could have a devastating impact on efforts to increase the physician work force.
He pointed out that Medicare's support for residency training has been effectively frozen since 1997, which has led to fears that the growing number of medical-school graduates will get caught in a bottleneck if there aren't enough residency slots for them to train in. (Newly minted doctors spend three to seven years training under a senior physician's supervision before they can practice independently).
The Accreditation Council for Graduate Medical Education also warned that the proposed cuts could strike a severe blow to the 9,000 residency programs that enroll 114,000 doctors in training. Specifically, it said, residency programs in rural and other underserved locations could be forced to close, while those in Veterans Administration hospitals could be cut back.
To make up the lost revenue, the council added, hospitals might rely more heavily on income from drug and medical-device makers, furthering the potential for conflicts of interest. They might also start charging tuition for residents who are training in certain subspecialties, adding to their already crushing debts.
