4.10.20
全国各地的学术医疗中心(amc)都处于应对COVID-19的第一线. As the major safety net providers in many areas, amc不仅面临着患者数量激增的问题,还面临着利用本已有限的资源的巨大压力. 在持续的大流行期间,amc的教育使命对这些医院提出了独特的挑战,因为他们要评估如何最好地利用培训生来增加医疗保健人力,同时遵守联邦法规和认证要求.
ECG的GME专家团队拥有丰富的专业知识和经验,可以帮助您度过这个不确定的时期. Please do not hesitate to contact Leah Gassett at [email protected] with questions or concerns.
The Centers for Medicare & Medicaid Services (CMS) recently released an interim final rule on policy revisions in response to the ongoing public health emergency. 政策修订中有几项是专门针对教学医院和bet8网站备用的, including:
- 允许教学bet8网站备用在病人护理bet8娱乐期间通过虚拟手段满足实际存在的要求.
- Allowing teaching physicians to bill for services performed by residents, such as primary care evaluation and management, diagnostic test and imaging interpretation, and psychiatry services, 只要住院bet8网站备用通过虚拟方式直接监督.
- 允许医院报销住院医师在家或在病人家中度过的时间,用于直接的研究生医学教育和间接医学教育(IME)的报销目的.
While the interim rule provides some regulatory relief for AMCs, additional action is needed to support these critical institutions. 以下列出了五个关键的COVID-19医学教育宣传主题,供AMC领导人支持.
1. Impact of Temporary Inpatient Bed Additions on IME Reimbursement
Under current regulations, 住院床位的增加可能会稀释实习生和住院bet8网站备用与床位(IRB)的比例,从而对IME报销产生不利影响. 大纽约医院协会和美国医学院协会(AAMC)主张,在计算IME报销IRB比率的分母中,不应包括为应对新冠肺炎疫情而增加的临时床位 purposes. 因为IME支付公式使用当年IRB比率或上一年IRB比率中较小者, 这不仅会影响本财政年度的报销,还会影响下一财政年度的IME报销. 教学医院需要联系他们的代表,加入这项倡导工作.
2. Prioritizing Distribution of CARES Act Relief Fund
The AAMC is asking the Department of Health & 在确定流程时,人类bet8娱乐部根据一组拟议的标准对设施进行优先排序, methodology, and funding levels for distribution from the CARES Act relief fund. The proposed criteria list includes:
- 管理高度复杂病人护理的历史经验,证明如下:
- Case mix index.
- Patient transfers received.
- Number of intensive care unit beds.
- Care for financially vulnerable patient populations, 如不成比例份额医院患者百分比或可比措施所示.
- Size, as demonstrated by number of beds.
- Number and complexity of COVID-19 patients.
教学医院的领导可以通过倡导额外的标准来更好地定位他们的组织, such as major teaching status, IRB ratio, and/or resident FTE count, to also be included in determining priority for distribution of CARES Act funds.
3. Suspension of Resident FTE Cap-Building Period
全国各地的一些教学医院正在与他们的立法者合作,主张CMS暂时停止目前正在进行上限建设的新教学医院的五年上限建设窗口. bet8网站备用必须评估其临床培训地点,以确定是否有任何地点目前处于上限建设窗口期,并考虑暂时暂停是否会缓解与设定FTE上限有关的时间问题.
4. Emergency Medicare GME-Affiliated Group Arrangements
紧急医疗保险gme附属团体安排允许医院共享因国家紧急情况而流离失所的居民的上限空间. Current regulations, enacted to help address training disruptions in the aftermath of Hurricane Katrina, 只有当家庭医院的住院床位减少20%或更多时,才允许这种急诊附属医院. Given the likely increase in occupancy under the pandemic, 教学医院需要推动CMS修改这一要求,从资格标准中删除占用规定. 这将使医院能够重新安排驻地工作人员,以支持面临病人激增的医院的业务,并转移上限空间,以确保能够报销住院时间.
5. Reimbursement for Early Medical School Graduate Support
许多医学院选择让四年级学生提前毕业,以补充劳动力. 虽然ACGME建议这些早期毕业生在NRMP计划开始日期之前不应该进入PGY-1职位, there is an opportunity to utilize these trainees in a non-GME “medical worker” role. Each state is addressing the licensure of these providers differently. Federal Medicare GME reimbursement is not currently available to help cover the costs associated with employing the recent graduates as part of this special COVID-19 response team; table 1 highlights the reimbursement considerations.
表1:早期医学院毕业生就业时间和报销考虑
April–June 30 | July 1 and Later | |
Role | Special COVID-19 response team | Resident/intern |
Reimbursement | Currently not reimbursable | Eligible for Medicare GME reimbursement |
教学医院需要在州和/或联邦层面倡导报销与雇用这些刚毕业的bet8网站备用相关的费用,作为应对COVID-19的一部分.
医学教育和AMC的领导者必须与他们的政府关系办公室和地方协调, state, 和联邦代表建议修改现行规则,使这些关键机构能够领导国家应对COVID-19大流行.
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