3. Create one Medicare GME fund with two subsidiary funds:
3a. A GME Operational Fundto distribute ongoing support for residency training positions that are currently approved and funded.
3b. A GME Transformation Fundto finance initiatives to develop and evaluate innovative GME programs, to determine and validate appropriate GME performance measures, to pilot alternative GME payment methods, and to award new Medicare-funded GME training positions in priority disciplines and geographic areas.
4. Modernize Medicare GME payment methodology.
4a. Replace the separate indirect medical education and direct GME funding streams with one payment to organizations sponsoring GME programs, based on a national per-resident amount (PRA) with a geographic adjustment.
4b. Set the PRA to equal the total value of the GME Operational Fund divided by the current number of full-time equivalent Medicare-funded training slots.
4c. Redirect the funding stream so that GME operational funds are distributed directly to GME sponsoring organizations.
4d. Implement performance-based payments using information from Transformation Fund pilot payments.
5. Medicaid GME funding should remain at the state's discretion. However, Congress should mandate the same level of transparency and accountability in Medicaid GME as it will require under the changes in Medicare GME contained in these recommendations.