GME Legislation Includes Funding for Child Psychiatric Hospitals

Federal support for graduate medical education (GME) in freestanding children’s teaching hospitals has been reauthorized in legislation that, for the first time, includes a provision that extends the program to freestanding children’s psychiatric hospitals.

The legislation, which received the support of APA and the American Academy of Child and Adolescent Psychiatry (AACAP), authorizes up to $300 million annually for Fiscal 2014 through 2018; however, final funding levels for the program, known as the Children’s Hospitals Graduate Medical Education (CHGME) Payment Program, are determined through annual appropriations bills. The federal fiscal year begins October 1, and a funding measure is expected this month.

The reauthorization bill (Pub.L. 113-98) was approved by the House of Representatives in April and signed by President Obama; the bill had been approved by the Senate in 2013.

The bill authorizes the Secretary of Health and Human Services to use a portion of CHGME funds appropriated above $245 million for “qualified hospitals” that meet the requirements of the program but for technical reasons did not previously qualify. In other words, if funding appropriated for the program exceeds $245 million, children’s psychiatric hospitals will be able to compete for a portion of the funding above that threshold; institutions will complete an applications process in which they demonstrate they possess the capacity and resources necessary to sustain new or additional residency slots under the CHGME program.

“APA is pleased to see this legislation approved and pleased that children’s psychiatric hospitals will be included for the first time,” said APA President Paul Summergrad, M.D. “There is a serious shortage of child psychiatrists, and institutions that are training our future child psychiatrists deserve all the help they can get.”

Child psychiatrist Gregory Fritz, M.D., president-elect of AACAP, said the number of freestanding children’s psychiatric hospitals is tiny—he said he believes there are four in the entire country—and the actual additional dollars involved in funding training at those hospitals is minimal. Including them is a matter of fairness. “It’s a victory for parity,” he told Psychiatric News.

He is academic director at Bradley Hospital in Providence, R.I., a freestanding children’s psychiatric hospital.

“Funding for graduate medical education has for years supported a percentage of educational costs for residents in all medical specialties, except in children’s psychiatric hospitals,” he told Psychiatric News. “This exclusion has meant, de facto, that these institutions have been discriminated against and disincentivized to train a lot of residents because they have never gotten any offset, in spite of the fact that child psychiatry is a shortage specialty.”

In a commentary published in the Providence Journal, Fritz provided some historical background on funding for educational costs of training physicians in children’s hospitals. GME funding was included as part of the initial 1965 Medicare bill, but the original bill excluded children’s hospitals since Medicare pays almost nothing for children’s medical care.

The oversight was corrected with the CHGME Payment Program, which was established in 1999 to support residency education in children’s hospitals in a system modeled after the Medicare GME system. For instance, this year a total of $317.5 million offsets the training expenses of 5,500 residents at 46 children’s hospitals, Fritz wrote in his commentary.

But the 1999 bill did not include children’s psychiatric hospitals. “Only the most cynical observer would conclude that this was a deliberate attempt to exclude children’s psychiatric hospitals and the child psychiatric and pediatric residents they train, especially since no medical specialty represents a greater shortage area than child and adolescent psychiatry,” Fritz wrote. “However steady efforts since 2002 to correct this oversight have thus far been unsuccessful.”

Fritz noted that Rhode Island Sen. Sheldon Whitehouse (D) was a crucial supporter of the reauthorization bill, threatening to hold the legislation up if the children’s psychiatric hospitals were not included.

“We must support medical training programs that teach new health professionals how to treat children’s mental and behavioral health conditions, not just physical ones,” said Whitehouse, a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, in a statement on his website. “[The new provision in the bill] will include children’s psychiatric hospitals in the CHGME program, so these hospitals can build and sustain their residency programs. . . . Bradley Hospital and others may have an opportunity to compete for federal funding, and I look forward to helping them through that process.”

In an October 29, 2013, letter to Whitehouse after Senate passage of the bill, APA CEO and Medical Director Saul Levin, M.D., M.P.A., said that demand for psychiatric physicians will continue to grow in the coming years as insurance coverage expands to include more individuals with mental illness.

“Currently, there are approximately 8,000 practicing child and adolescent psychiatrists in the United States,” Levin wrote. “With the enactment of the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act of 2010, we anticipate the projected need to be 30,000. The modified Children’s Hospital GME Support Reauthorization Act of 2013 constitutes a significant step in meeting this need by appropriately enabling children’s psychiatric teaching hospitals to grow the number of medical students trained in child and adolescent psychiatry.” ■