Medicaid drawdown will help UVM foot bill for graduate medical education

University of Vermont College of Medicine. Photo courtesy of UVM.

University of Vermont College of Medicine. Photo courtesy of UVM.

One big ticket item for the state’s 2012 budget adjustment act is $30 million for graduate medical education for funding residencies and fellowships for medical students at the University of Vermont.

UVM will cover the state’s $12.76 million share of the Medicaid match, according to the Department of Vermont Health Access budget adjustment request. Federal funds will cover the rest of the $30 million total.

Because of UVM’s relationship with the state, the federal government matches the money as if it came from the state. This is the first time UVM has footed the bill for payments of this type, although it is becoming a common practice in numerous other states.

According to officials from Fletcher Allen Health Care, the drawdown of federal funds will help increase Medicaid’s chronic underpayments to the hospital. In addition to services for Medicaid patients, the funding will help fund residencies at Fletcher Allen.

The funding mechanism will open up funding for safety-net programs for low-income people without dipping into state coffers. As the state’s only academic medical center, Fletcher Allen Health Care, the University of Vermont and the UVM Medical Group provide a safety net for low-income and uninsured Vermonters.

As part of an agreement with the Department of Vermont Health Access, UVM agreed to provide a quality assurance report to the state to make sure the program provides benefits to Medicaid beneficiaries. DVHA Commissioner Mark Larson said part of this is ensuring people on Medicaid have access to care.

Dr. John Brumsted, interim president and CEO for Fletcher Allen Health Care, presented the proposal to the House Committee on Health Care earlier this week.

While Brumsted noted the matching federal funding will cover some of the costs where the hospital falls short, it will not make up for the consistent Medicaid underpayments.

In addition to providing services to low-income residents on Medicaid, the funding is part of an overall effort to make sure the state has enough trained physicians, said Rep. Michael Fisher, D-Lincoln, who chairs the House health care committee. Fisher said he hopes this means more residencies for primary care physicians.

Uninsured and underinsured residents do not go to the doctor enough, Fisher said, and generally this means they do not seek treatment until health problems become more dire.

“We know we need more primary care,” he said.

Currently, about 39 percent of residency programs at Fletcher Allen are in primary care specialties like family medicine, while the rest are in other specialties like anesthesiology or orthopaedics, according to Brumsted’s presentation.

Shifting to more primary care is not as simple as going out and adding residencies, Brumsted noted in committee. Rep. George Till, D-Jericho, a physician and member of the health care committee, added that it requires attracting candidates but most medical students choose residencies in more lucrative specialties.

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