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Comment & Response
March 2020

Considerations in Analysis of Medicare Graduate Medical Education Payment Policies

Author Affiliations
  • 1Association of American Medical Colleges, Washington, DC
JAMA Intern Med. 2020;180(3):471. doi:10.1001/jamainternmed.2019.6966

To the Editor We identify several flaws in the approach used by Chen and colleagues1 to analyze Medicare’s graduate medical education (GME) payment policies that led to the unfounded claim of Medicare GME overpayment. The authors questioned the soundness of Medicare GME payments being set “without assessing the association with teaching costs,”1 but the entire study ignores the cost side of the payment equation by applying the $150 000 Teaching Health Center program payment rate cap to estimate Medicare overpayment for GME and assumes that teaching hospitals can support lower payment no matter their training costs. This approach is not sensible because real-world GME programs are subject to many variations, such as additional costs for surgical training programs compared with training primary care physicians at teaching health centers.

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