On April 10, Centers for Medicare & Medicaid Services published the 2025 IPPS Proposed Rules. There are several new proposed rules which can impact the ability of hospitals to create new programs.
Specifically, there are five areas CMS has proposed changing that will impact eligibility for CMS funding for new programs:
Newness of Residents
Newness of Program Director and Faculty
Number of Residents to Constitute a “Small” Program for Rural Sites
One Hospital Sponsoring Two Programs in Same Specialty
Commingling of New and Existing Residents
Please note that CMS has only issued proposed rules regarding the Newness of Residents criteria, meaning CMS could finalize their position on this issue in the final rules, which have historically been published in early August. However, CMS is issuing a Request for Information (RFI) regarding the other criteria listed, allowing CMS to study these issues further before proposing rules.
Regardless, CMS’s comments in the proposed 2025 IPPS rules reflect CMS’s current stance on these issues. The healthcare industry would benefit from paying close attention and providing guidance to CMS, ensuring that any final rules reflect industry concerns and do not inadvertently diminish the ability of the development of new GME programs, nor create rules that severely restrict new GME program’s ability to create a quality GME program.
While we will investigate and provide insights into each of these focus areas, it is imperative your hospital or health system provide input and feedback to CMS on these rules if you are planning on building new programs in the future or your ability to fund new programs may be at risk.
The comment period closes June 10 at 5 pm EST.
Select from the dropdown list – Academic OT005
Historically, CMS has not provided concrete parameters for what constitutes a “new” program. While the elements CMS evaluates include the accreditation status of the program, “newness” of Program Director, “newness” of faculty, and “newness” of residents, there are many permutations and combinations of these factors that impact if a program is truly “new” and its ability to create new federal funding. Most importantly, some of these rulings contradict the ACGME’s requirements for new programs.
Newness of Residents
As a benchmark, Germane Solutions has historically recommended programs to only fill their first class of residents and to not match additional PGY levels with transfer residents (due to the lack of clarity from CMS). With these proposed rules, CMS strives to clarify insights into this area. While this proposed rule indicates that 90% of the newly matched program’s residents over the 5-year cap development period need to be new, the feedback from individuals across the country will impact that final percentage.
We are personally excited to have some clarification, rather than leaving the determination up to the MAC and their review multiple years after the program has been operational. Overall, we are not against this new rule and believe new programs should truly be “new”. The 90% also gives some flexibility for programs to bring in a few PGY 2 or 3s to help with integration and improve the program's quality.
Furthermore, the mere presence of residents from existing programs in reality has very little to do with whether that program is new. Rather, we believe CMS should focus primarily on how they fund residents from existing programs— not use the presence of residents from existing programs as a reason to decide whether the program is new; especially considering that CMS can easily determine if the program is new by confirming that all PGY 1 slots are filled by new residents for all 5-years of the FTE cap development period.
CMS needs to grasp that when a program admits an existing program resident into a PGY 2 or PGY 3 slot, this decision has no effect on the newness of the program. A program’s decision to admit a PGY 2 or PGY 3 resident is generally done for one of two reasons. First, experienced residents enrich the learning experience for new residents, thus enhancing the program's quality. Second, the program is typically being a good community steward by agreeing to train PGY 2 or PGY 3 residents (likely due to extenuating circumstances specific to that resident).
It may make sense for CMS to limit their participation in funding existing program residents as new program residents, but it is not appropriate for CMS to use the presence of existing program residents as justification for deciding whether the program is new. Additionally, when CMS decides a program specialty is not new, CMS does not provide any funding for the program specialty as a new GME program, forever solidifying the fact there is no FTE cap nor long-term funding for that specialty program.
Newness of Program Director
Newness of Faculty
Definition of a “Small” GME Program
One Hospital Sponsoring Two Programs in Same Specialty and Commingling of Residents
While there are normally impacts to GME in the CMS rules, this is the first time in many years that multiple areas are up for discussion and feedback. We encourage all teaching hospitals to reach out and provide your feedback to help shape future legislation. If these changes create negative consequences and limit funding for new program development in the future, the existing physician shortage will be exacerbated even more.
Lastly, Germane Solutions will publish two additional blogs that are pertinent to GME institutions: one that reviews the distribution of cap, similar to Section 126, and one that concentrates on cap redistribution opportunities for closed hospitals.
If you have any questions regarding these recently proposed changes and how they may impact your organization, please contact us. We will be happy to meet and discuss how these proposed rulings apply to your current environment and strategy.
Link to 2025 IPPS Proposed Rules: https://public-inspection.federalregister.gov/2024-07567.pdf