IOM calls for education innovation fund

Its report asks Congress to use existing funds to reward new approaches to care, but some say diverting money could hurt institutions.

By Myrle Croasdale, AMNews staff. Aug. 4, 2003.

Congress should take a portion of the Medicare indirect medical education payments it makes to academic medical centers and create a fund that only finances innovative education, according to a new report from the Institute of Medicine.

But, the idea is meeting some resistance among medical educators.

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Jordan Cohen, MD, president of the Assn. of American Medical Colleges, greeted the report with caution.

"The development of an 'education innovation fund' is an admirable concept and one the AAMC supports. However, we strongly disagree with the method the IOM proposes to create this fund," Dr. Cohen said in a prepared statement.

IOM committee members said they intensely debated the funding recommendation, which was one of a raft of proposals aimed at modernizing academic medical centers and improving patient care, knowing it would be controversial.

Payments for indirect medical education are estimated at $2.6 billion for 2003.

"The section on financing is the most unusual, most provocative part of the report," said IOM task force member Nancy-Ann DeParle, a senior adviser for JP Morgan Partners and a former HCFA administrator. "Most reports talk of the struggles of academic health centers and the need for more funding. We say redirect the money we have."

The report, "Academic Health Centers: Leading Change in the 21st Century," proposes that Congress create a competitive grant fund using a portion of the indirect medical education payments it doles out each year. In 2003 those payments were estimated at $2.6 billion. This ongoing fund would support such educational innovations as the use of clinical information systems and testing of new educational approaches in hospital and nonhospital settings.

Dr. Cohen said teaching institutions already have IME funds budgeted for existing educational needs. Segregating a portion for developing new training modes would be crippling for the centers.

"Academic health centers struggle every day to survive in an environment of diminishing resources," he said. "IME payments are already down 30% over the past five years; payments by Medicaid and private insurers have been constrained; and funding for Title VII health professions programs may be cut by 93%. If IME payments are slashed further, the very infrastructure upon which our nation's health care system rests may well begin to falter. For this reason, we hope the IOM will come forward with a more realistic funding alternative."

A sense of urgency

DeParle said it was urgent that academic health centers begin working toward the report's goals and not wait for new funds.

"Academic health centers aren't moving quickly enough, and the country has a strong interest in seeing this happen," she said.

She said financial incentives were needed if the slow response to a 1999 IOM report on medical errors was any indication of hospitals' ability to change.

The report recommended medical centers adopt computerized physician order entry systems. Since the report was released, DeParle said only 2% to 5% of hospitals have made such a change.

Some academic medical centers have taken steps toward the interdisciplinary, team-based patient care the report seeks to support, but this is not widespread.

"We heard anecdotes during this process from doctors who said they'd go on rounds as a resident and have no idea what the nurses knew or didn't know and that they didn't have any real understanding of a team-based process of care," DeParle said.

If the IOM report's recommendations were in place, doctors would start residencies working side by side with nurses, pharmacists and other health care professionals, she said, and have an understanding of the differences in their knowledge bases and expertise.

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