1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?

What is the return on Medicaid investment in physician workforce training? Annually, an estimated $1 billion is paid to hospitals, clinics, and physician faculty groups to teach and graduate young physicians. The exact amount invested is unknown. The heterogeneity among states is speculated and yet to be determined. How the variety of graduating physician specialties matches to the health needs of Medicaid population is undefined. To what extent GME investments relate to graduate retention in the state is unknown. Whether the Medicaid-supported trainees work in health profession shortage areas (HPSAs) or Medically Underserved Area (MUA) has yet to be defined. To what extent the graduates accept Medicaid patients in their practice is unknown.

2. Why are you struggling with this issue?

There is increasing scrutiny on using Medicaid as a pass-through for funding hospitals, especially safety net hospitals. There is also increased accountability and transparency at the state government level on where tax-payer money is going.

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

If state Medicaid ROI in GME is high, then there would be higher confidence in the practice of using IME payments in State Plan Amendments and 438.6(c) funding through statewide Medicaid Managed Care payments.

If state Medicaid ROI is GME is low, then there would be need to be a reckoning. Corrective actions would be informed by the details of where the ROI worked best and least.

4. When do you need the evidence report?

Thu, 06/13/2024

5. What will you do with the evidence report?

The MMDN would devise recommendations to CMS and state Medicaid programs on how to increase ROI in physician workforce development that better addresses the needs of Medicaid recipients.

Also, to provide more context for the date above, it would be ideal to have a report within 12 to 24 months.

Optional Information About You

What is your role or perspective? Clinician administrator

If you are you making a suggestion on behalf of an organization, please state the name of the organization - Florida Medicaid

May we contact you if we have questions about your nomination? Yes