Other Health Professions Programs

Children’s Hospitals Graduate Medical Education Payment Program

Authorizing Legislation: Section 340E of the Public Health Service Act; Public Law 109-307

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

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.