GME Payments to Rural Emergency Hospitals

On April 10, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2024 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule.

CMS, in the proposed rule, has provided for the payment of interns and residents for Rural Emergency Hospitals (REHs).  If these changes are finalized, rural hospitals that become REHs would be allowed to serve as training sites for Medicare graduate medical education (GME) payment purposes.

The proposed changes to GME payments for training in the new Medicare provider type, REH, are aimed at addressing the growing concern over closures of rural hospitals. The Consolidated Appropriations Act, 2021 established the REH provider type to help support graduate medical training in rural areas.

This change would also help ensure that there are enough medical professionals trained to provide care in rural areas, where there may be a shortage of healthcare providers.

By supporting graduate medical training in rural areas, these changes could also help to improve the overall quality of care in these underserved communities.

Currently, GME payments are driven by the following factors that do not apply to REHs:

• The ratio of Medicare days to total days;
• The ratio of residents to available beds; and,
• Inpatient payments under IPPS.

In addition to there is also the concern that acute care hospitals have been capped for the number of residents to the amount of residents from a cost reporting period more than 20 years ago.  Acute care hospitals will be concerned that these payments will reduce the amounts they will get for GME.