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Colleagues in Hallway

GME Industry Trends

Germane Solutions' CEO, Susan Hearn-Stiffler, is laser-focused on the evolving trends and shifting priorities of the greater GME ecosystem and brings valuable insights that directly address the most prevalent challenges within the industry. With over 35 years of experience, Susan strives to create a higher-functioning environment for all Academic Medicine stakeholders, and each quarter, Susan will highlight emerging strategies and provide you with insights to excel in the ever-evolving GME climate.

Hospital Lobby

Rural Designation

If your hospital is designated as urban and you have not considered electing rural, you may be missing out on several benefits, including additional GME reimbursement, the ability to develop newly funded GME programs, and 340B funding. This designation does not mean that you need to be in a rural area. In fact, hospitals across the country in areas such as New York City, Miami, and Los Angeles have made this election. 


Historically, hospitals that chose to elect rural designation experienced losses in the first few years due to the requirement to be paid at rural rates for the first year. CMS has recently released the FY 2024 IPPS rulings that can reduce the initial loss and make the strategy more valuable to hospitals. See our blog FY 2024 IPPS GME Update for more information on how the rulings will affect Capital DSH payments. To understand the proposed changes in the rural floor see FY 2024 IPPS Update Regarding Rural Floor Implications.


Germane Solutions has helped many hospitals reclassify as rural under § 412.103 and through wage index reclassifications with the MGCRB. To find out if your hospital would financially benefit from the implementation of these strategies, please contact us for assistance in that evaluation.

Doctor Taking Notes

The ABS EPA Project

Entrustable professional activities (EPAs) are utilized in the educational process of nursing, allied health, and medical students and residents. EPAs are defined as units of professional practice that can be fully entrusted to a trainee as soon as they demonstrated the necessary competence to execute the activity unsupervised.


The American Board of Surgery (ABS) is taking a step forward in modernizing how surgical training is assessed and evaluated. The ABS recently announced its Entrustable Professional Activities (EPA) Project, which will launch in July 2023 for general surgery residency programs. This project aims to develop a competency-based assessment for general surgery trainees and represents a significant change from traditional time-based residency training models. This new assessment paradigm has the potential to create a habit of workplace-based micro-assessment and improvement-oriented performance feedback linked to core competencies and milestones, ultimately improving the quality of clinical training experiences for general surgery trainees.

Supportive Doctor

Interprofessional Learning & Learner Integration

According to the World Health Organization, by implementing interprofessional collaboration and encouraging learners to work together and respect differing perspectives within healthcare, multiple disciplines can work more effectively as a team to provide highly effective patient and population-centered care. Research has shown this improves quality and safety outcomes and improves the satisfaction of both patients and learners/caregivers. 


There is increasing interest in the industry to organize learners in this way, which not only improves outcomes but also to retains learners after graduation. Training and retaining are becoming strategic imperative to enable hospitals and health systems have the adequate caregivers needed for their patient populations.


Germane Solutions has been working closely with organizations to develop effective learner strategies, integrate interprofessional education into an organization's strategic vision, and develop comprehensive learner strategies that meet cultural, quality, and workforce needs.

Friendly Young Doctor

NRMP Match

One of the biggest GME events of the year is The Match. Germane Solutions looks to The Match as an indicator of the supply and demand of upcoming physicians and training positions. To date, this year’s match had the largest pool of applicants and available positions. This year’s results were not surprising, as there has been ongoing growth in the number of medical schools and the creation of new GME programs. However, there still is an imbalance within the industry, as there are more applicants in The Match than there are GME training positions resulting in many medical graduates being left unmatched. See our blog, Germane Solutions' Contribution to the 2023 Match, for more detailed insights and a look into how Germane Solutions contributed to the development of over 7,000 training positions annually.


How did your programs do in the match this year?  Germane Solutions can help you review your recruitment process and strategy for whom you are targeting, ensuring you fill your slots and continue to build your physician pipeline.

Man Signing


The deadline is nearing for hospitals and health systems to file Medicare GME Affiliation Agreements (MGMEAAs.) These agreements, which must be filed by June 30th, provide flexibility within hospital partnerships for Medicare reimbursement and cap sharing. MGEAAs are leveraged between two or more teaching hospitals to optimize Medicare reimbursement from GME activity and provide additional experiences to residents/fellows through a variety of clinical learning environments. These affiliations also give hospitals the ability to temporarily transfer cap from one hospital to another. See our blog, Medicare GME Affiliation Agreements: Criteria, Optimization, and Benefits to the Learning Environment, for more detailed insights. 


If you have shared rotational agreements, multiple hospital sites, non-hospital rotations, or unused cap, you should consider the benefits of an MGMEAA to help optimize funding. Please reach out to Germane Solutions, as there is still time to develop your MGMEAA for the 2023-2024 academic year.

Supportive Doctor

Learner Integration

The practice of medicine is becoming increasingly dependent on teams of professionals caring for complex patients and patients with multiple chronic conditions. Multidisciplinary, collaborative teams can provide comprehensive care for the entire patient and have found that this approach results in better patient outcomes, improved satisfaction, and a lower cost of care. 


However, achieving this level of coordination and the mutual respect required for success can be challenging due to the historical silos that typically exist in training, the strong cultures of each profession, the dominance of the physician role, and the lack of urgency to change the healthcare delivery system.   


The ongoing physician shortage, COVID, financial concerns, and other factors have pushed many hospitals and health systems across the country to consider how they handle learners in their organization; determine what model of care will improve quality, satisfaction, and costs; and assess their readiness for the implementation of multidisciplinary care teams. 


Starting with learners is key if an organization wants to successfully implement highly functioning care teams. Interprofessional education has been successful in helping students understand their own professional identity while gaining an understanding of others’ professional roles. This knowledge paired with a focus on communication and respect between different healthcare disciplines has been successful in breaking down silos and developing learners that want to practice collaboratively.


Germane Solutions has been working with organizations on their learner model and has found that many hospitals and health systems don’t know the exact number of learners within their organization at any given time. Additionally, there is often no strategy for the learners or strategic relationships with the educational institutions sending learners. Without a clearly defined learner strategy, a process to bring in and track learners, and communication between disciplines, success in interprofessional learning is unlikely.  


Look for more information in an upcoming blog this spring on how to develop your own interprofessional learning strategy and process and how this can contribute to high-functioning and collaborative care teams.

Your GME Partner

Susan Hearn-Stiffler, RN, BSN, MBA 

Ms. Hearn brings over 35 years of experience in clinical and administrative healthcare. Her substantial experience as a registered nurse and healthcare consultant brings to bear all the knowledge and experience of a clinician along with a broad-based understanding of the healthcare industry. Prior to assuming the CEO role, Ms. Hearn oversaw all operations for Germane’s National Academic Medicine Consulting Group. Ms. Hearn also served as a Senior Manager and leader in the healthcare practice at Deloitte Consulting. Ms. Hearn holds a Bachelor of Science in Nursing from the College of Mt. Saint Joseph and an MBA from the University of Cincinnati.

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