Fraher Erin P, Rains Jacob A, Bacon Thomas J, Spero Julie, Hawes Emily
E.P. Fraher is professor, Department of Family Medicine, University of North Carolina at Chapel Hill, and deputy director for policy, Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina.
J.A. Rains was a graduate research assistant at the time of this writing and is now a research affiliate, Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina.
Acad Med. 2024 Feb 27. doi: 10.1097/ACM.0000000000005678.
Total Medicaid funds invested in graduate medical education (GME) increased from $3.78 billion in 2009 to $7.39 billion in 2022. States have flexibility in designing Medicaid GME payments to address population health needs. This study assessed states' impetus for using Medicaid funds for GME, structure of state Medicaid payments, composition and charge of advisory bodies that guide these investments, and degree of transparency and accountability to track whether Medicaid GME investments achieved desired workforce outcomes.
Structured interviews were conducted in 2015 to 2016 and 2020 to 2021 with subject matter experts representing 10 states. Interview transcripts were analyzed and coded in 6 thematic areas: impetus for using Medicaid funds, the structure of state Medicaid payments, the composition of advisory bodies, the degree of transparency of Medicaid investments, accountability of Medicaid investments, and challenges and changes.
States used Medicaid GME funding to address maldistribution of physicians by geography, setting, and specialty, respond to population growth and undergraduate medical education expansion, offset potential loss of teaching health center program funds, and launch new programs and sustain existing ones. States leveraged Medicaid funding by modifying state plan amendments and redesigning funding formulas to meet specific health workforce needs. Many states had advisory bodies to educate legislators, reach consensus on workforce needs, recommend how to disburse funds, and navigate competing stakeholder interests. States identified a need for improved data and analytic systems to understand workforce needs and monitor the outcomes of GME investments. Determining which accountability measures to use and implementing metrics were challenges.
States have much to learn from each other about strategies to best leverage Medicaid funds to develop and sustain residency programs to meet population health needs. Learning collaboratives should be developed to provide a forum for states to share best practices and strategies for overcoming challenges.
投资于毕业后医学教育（GME）的医疗补助总资金从2009年的37.8亿美元增至2022年的73.9亿美元。各州在设计医疗补助GME支付方式以满足人群健康需求方面具有灵活性。本研究评估了各州将医疗补助资金用于GME的动机、州医疗补助支付结构、指导这些投资的咨询机构的组成和职责，以及透明度和问责程度，以追踪医疗补助GME投资是否实现了预期的劳动力成果。
在2015年至2016年以及2020年至2021年期间，对代表10个州的主题专家进行了结构化访谈。对访谈记录进行了分析，并编码为6个主题领域：使用医疗补助资金的动机、州医疗补助支付结构、咨询机构的组成、医疗补助投资的透明度、医疗补助投资的问责制以及挑战与变化。
各州利用医疗补助GME资金来解决医生在地理区域、医疗环境和专业方面分布不均的问题，应对人口增长和本科医学教育扩张，抵消教学健康中心项目资金的潜在损失，并启动新项目和维持现有项目。各州通过修改州计划修正案和重新设计资金公式来利用医疗补助资金，以满足特定的卫生人力需求。许多州设有咨询机构，以教育立法者、就劳动力需求达成共识、建议资金分配方式，并协调相互竞争的利益相关者的利益。各州认识到需要改进数据和分析系统，以了解劳动力需求并监测GME投资的结果。确定使用哪些问责措施以及实施指标是挑战。
各州在如何最好地利用医疗补助资金来发展和维持住院医师培训项目以满足人群健康需求的策略方面，有很多可以相互学习的地方。应建立学习协作组织，为各州提供一个分享最佳实践和克服挑战策略的平台。
