Vanderbilt’s Karen Dolan, recently diagnosed with ALS, tears up after receiving a standing ovation at this week’s kickoff of the 2005 Community Giving Campaign.
photo by Dana Johnson
Feds to fund additional resident slots at Vanderbilt, Meharry
Under new federal legislation, Vanderbilt and Nashville General Hospital at Meharry will soon receive additional resident slots funded by Medicare. The extra slots raise the totals at the two institutions by 25 and 23, respectively.
The legislation, the Medicare Prescription Drug, Improvement and Modernization Act of 2003, went into effect July 1 and is aimed at helping hospitals make up for the costs of shouldering total financial responsibility for resident compensation after a cap was placed on Medicare-funded slots in 1997.
“We are very happy that we have received approval for the additional 25 slots,” said Warren Beck, director of Finance for the Vanderbilt hospitals and clinics. “We already had the money invested in those slots and had not been reimbursed for several years. This will help offset our operating losses on the training program.”
That's a feeling shared by the administrators at Nashville General.
“It's a coup for us because it relieves Nashville General Hospital and the city of Nashville from the financial burden of funding these slots and it permits the stabilization and expansion of the medical training programs in institutions that serve an underserved population,” said Jim O'Neill, M.D., director of clinical program development and education for the Meharry-Vanderbilt Alliance.
The additions bring the total number of Medicare-funded resident slots to 59 at Meharry and 470 at Vanderbilt.
A piece of the 2003 legislation stipulated that unused Medicare-funded residency slots be redistributed. Essentially, the extra slots were placed in a general pool and assigned to those hospitals meeting designated criteria.
The additional slots will help offset effects of the Balanced Budget Act of 1997, which froze the number of Medicare-funded resident slots allotted to each hospital.
Public hospitals were among the hardest hit.
When Hubbard Hospital, located on the campus of Meharry Medical College, closed its doors it lost its number of resident slots. Despite the relocation of Nashville's public hospital, Metro General, to the Hubbard location in 1999, the cap required by the Balanced Budget Act allowed only 36 resident slots to transfer along with the hospital.
“The cap is hospital-to-hospital,” said Mel Bass, director of Federal Affairs and associate vice chancellor of Health Affairs at VUMC. “Although one facility shut down and another moved into its place, the hospitals were not allowed to combine slots. Metro General had to open on the Meharry campus with the number of residents it brought with it.
“Meharry, as a medical school, needed more slots in order to offer training programs as well as take care of the larger patient pool that included a growing population of underserved Nashvillians.”
Bass was asked to help resolve the issue in 2000 with little luck. Since it was a Medicare-related bill, the rules require that any changes be attached to a piece of legislation pertaining to Medicare.
Meanwhile, Vanderbilt University Medical Center and Meharry Medical College formed a partnership, the Meharry-Vanderbilt Alliance, in 1999 to enhance the educational, scientific and clinical programs at and between both institutions as well as to assist with collaborative efforts in the areas of medical education.
The Alliance held a planning retreat with 90 faculty members from both campuses and developed a list of issues demanding attention.
High on that list was securing additional funds to help support the residents critical to running both training programs.
“No. 1 on this list was the need to increase the number of funded residency slots at Nashville General Hospital at Meharry,” said Clifton Meador, M.D., executive director of the Alliance. He said it took an “act of Congress” and credits Vanderbilt and Meharry, U.S. Sen. Bill Frist, and U.S. Rep. Jim Cooper with assisting in the passing of the new legislation to help accommodate Meharry's needs.
O'Neill said the new act is a perfect match for Vanderbilt and Nashville General. Typically, physicians working with underserved populations come from institutions that have an interest in health-related issues concerning minorities and the disparities that exist in health care for minorities and underserved populations, he said.
“Both hospitals and institutions agree that this is a national problem and have begun addressing disparities in health care and education as well as engaging in research targeted to fix the problems.”