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Other
Health Professions Programs
Children’s Hospitals Graduate Medical Education
Payment Program
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FY
2007
Actual |
FY
2008
Enacted |
FY
2009
Estimate |
FY
2009 +/-
FY 2008 |
BA |
$297,009,000 |
$301,646,000 |
--- |
($301,646,000) |
FTE |
8 |
9 |
-- |
-9 |
Authorizing Legislation: Section 340E of the Public
Health Service Act; Public Law 109-307
FY 2009
Authorization |
$330,000,000 |
Allocation
Method |
Formula Based Payment |
Program Description and Accomplishments
The purpose of the CHGME Payment Program
is to support graduate medical education (GME) training
in freestanding children’s teaching hospitals.
Payments are made to these hospitals to enhance their
financial viability and to help them maintain GME
programs. There are about 60 children’s hospitals
nationwide that are considered freestanding teaching
hospitals and are potentially eligible for this program.
In FY 2006, the CHGME Payment Program supported 60
freestanding children’s hospitals and the training
of 5,243 medical residents on and off-site. This is
a slight increase from the actual numbers reported
for the previous year of 5,103. The increase represents
interns and residents training on-site.
HRSA makes monthly payments to these hospitals and
has established a “Resident Assessment Program”
that requires each participating hospital to be subject
to audits during the period of October through March
of each fiscal year. Also, HRSA established a data
system that will compute CHGME interim and final payments
and help determine if any recoupment and redistribution
of funds is necessary.
The CHGME Payment Program uses a web site to publish
information about the program, application materials,
time lines, upcoming events, and other communications.
Hospitals download the application materials from
the web site and complete the application electronically.
All electronic communications between the hospitals
and program staff are conducted through CHGME Payment
Program electronic media. The program’s web
site also includes the latest published performance
results. The program plans to enhance and integrate
its current use of information technology in its application,
reporting, and financial systems to increase productivity
and efficiencies for FY 2008.
An Office of Management and Budget (OMB) Program
Assessment Rating Tool (PART) assessment of the CHGME
was conducted in 2006 and the program received a rating
of Adequate. The PART review noted that the program
makes timely payments to eligible hospitals, but is
fundamentally duplicative of other Federal, State,
and private efforts. Children's hospitals receive
payments from Medicaid, private insurers, and charitable
donations. The program does not address a specific
need. Children's hospitals are more likely to have
positive profit margins than other hospitals. In 2000,
74 percent of children's hospitals had positive margins,
compared to 67 percent of all hospitals, and 59 percent
of major teaching hospitals. The program is achieving
its long-term performance goal of 100 percent of hospitals
with a verified count of the number of medical residents.
In 2003, 2004, and 2005, the program achieved this
goal.
As part of the program’s reauthorization, Congress
mandated that (1) freestanding children’s hospitals
submit an annual report to describe the status of
GME in their institutions and that (2) the government
prepare a report to Congress that will include recommendations
regarding the CHGME Payment Program. Data are required
to be collected on: 1) the types of training programs
that the hospital provided for residents such as general
pediatrics, internal medicine/pediatrics, and pediatric
subspecialties including both medical subspecialties
certified and non-medical subspecialties; 2) the number
of training positions for residents, the number of
such positions recruited to fill, and the number of
positions filled; 3) the types of training that the
hospital provided for residents related to the health
care needs of different populations such as children
who are underserved for reasons of family income or
geographic location, including rural and urban areas;
4) changes in residency training including changes
in curricula, training experiences, and types of training
programs, and benefits that have resulted from such
changes, and changes for purposes of training residents
in the measurement and improvement of the quality
and safety of patient care; and, 5) the numbers of
residents (disaggregated by specialty and subspecialty)
who completed training in the academic year and care
for children within the borders of the service area
of the hospital or within the borders of the State
in which the hospital is located.
The program complied by developing a comprehensive
data collection instrument that required data on each
of the educational and workforce areas required by
law. The instrument was pilot tested and modified
to incorporate changes and enhancements suggested
by the GME community. The Department of Health and
Human Services submitted and received OMB clearance
for the data collection and posted the data collection
instrument on the website. The first submission of
data from participating children’s hospitals
is expected by February of 2008.
There are currently four performance measures for
this program, one of them an efficiency measure. The
program exceeded its target for the first program
measure, “Maintain the number of FTE residents
in training in eligible children’s teaching
hospitals,” by 601 residents. The target was
4,828 residents in 2006 and the actual count was 5,243.
The second measure, “Percent of hospitals with
verified FTE resident counts and caps,” met
the target of 100 percent in 2007.
The third measure, “Actions to assess the feasibility
and cost effectiveness of verifying all hospitals’
bed counts, case-mix indices, and number of discharges,”
was not addressed in FY 2007 as the program is awaiting
OMB guidance on the results of the pilot test showing
the feasibility of further endeavors in this area.
The efficiency measure for CHGME Payment Program is
to make 100 percent of direct medical education and
indirect medical education payments to children’s
hospitals on time. For FY 2007, HRSA made 100 percent
of all payments on time as it also did in previous
years.
Funding includes costs associated with grant reviews,
processing of grants through the Grants Administration
Tracking and Evaluation System (GATES) and HRSA’s
electronic handbook, and follow-up performance reviews.
Funding History
FY
2004 |
$303,169,000
|
FY 2005
|
$300,730,000 |
FY 2006
|
$296,795,000 |
FY
2007 |
$297,009,000 |
FY 2008
|
$301,646,000
|
Budget Request
No funds are requested for this program in
FY 2009. The FY 2009 budget focuses on activities
that fund the placement of more doctors, nurses, and
other health care professions in regions of the country
that face shortages. An Office of Management and Budget
(OMB) Program Assessment Rating Tool (PART) assessment
of the CHGME was conducted in 2006 and the program
received a rating of Adequate. The PART review noted
that the program makes timely payments to eligible
hospitals, but is fundamentally duplicative of other
Federal, State, and private efforts.
# |
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target |
FY
2009 Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective 1: Improve access to health care |
7.I.A.1 |
Maintain the number of FTE residents
in training in eligible children’s teaching hospitals. |
4,693
(1)
199 (2) |
4,911(1)
192 (2) |
4,450(1)
378 (2) |
5,051(1)
192(2) |
4,450 (1)
378 (2) |
Jul-08
100% |
5,051(1)
192 (2) |
NA (3) |
NA |
7.VII.C.1 |
Percent of hospitals with verified
FTE residents counts and caps. |
100% |
100% |
100% |
100% |
100% |
100% |
100% |
NA (3) |
NA |
Efficiency
Measure |
7 E. |
Percents of payments made on
time |
100% |
100% |
100% |
100% |
100% |
100% |
100% |
NA |
NA |
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Appropriated Amount
($ Million)
|
$303.169 |
$300.730 |
|
|
$296.795 |
N/A |
$297.009 |
$301.646 |
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Notes:
(1) |
Total trained on-site. |
(2) |
Total trained off-site. |
(3) |
NA for FY 2009 and out year targets = Not Applicable
because no funding is requested. |
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