Fees and OGME

Follow-up from the Annual Meeting...

My read on the discussion was a concern more with the magnitude of the fee change than with the change to a flat rate fee structure based on FILLED positions.  The flat rate also includes inspections.  In addition, I think that it is critical that we have beyond anecdotal (show of hands) data the impact of changes to DMEs.

Some givens with opinion (my view - you may disagree that these are givens):

• The funding of OGME is convoluted at best.  It is a conglomeration of the AOA, Specialty Colleges, OPTIs, COMs, hospitals and BOS member board certified osteopathic physicians.
• Transparency is a concern in the current system.  It is difficult to "follow the money."  I am not suggesting that anyone is hiding anything.  The lack of transparency is primarily related to the first bullet.
• The multitude of stakeholders results in as many (and likely more) opinions on the topic.  A Specialty College may have one opinion based on their direct role in sponsoring an evaluating committee and another opinion based on their advocacy for their programs.
• The AOA "raised" fees two years ago (2009) as a result of the $25 per trainee fee that goes to specialty colleges to support the work of Specialty College evaluating committees (SPEC).
• The previous fee increase was in June in 2001 for AY 2002 ($300 per program, $120 per trainee).
• Comparing ACGME fees and AOA fees is comparing apples and oranges.
• It is more efficient in total to operate an AOA-accredited program than ACGME-accredited program.  We can argue the definition of efficiency.  I would argue that the total costs (accreditation fees, faculty, administration, etc.) are much lower for osteopathic programs if for no other reason than paid faculty/program directors are not mandated.  I would also argue that there are no data to suggest that outcomes are disparate for graduates of AOA and ACGME accredited programs.  But…
• In almost all cases, dually accredited programs originated from gaining AOA accreditation for established ACGME accredited programs.  Therefore, AOA accreditation fees and other added costs (dues, required courses and attendance) are additive.

At the EPPRC collaborative in October of 2010, there was general agreement from stakeholders in OGME that spending more money to promote quality training was appropriate.  While that seems laudable, this cannot be adjudicated until we have an accurate accounting of the current system – the entire system.  I believe that a simplified fee structure can help this happen.