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Cap Flexibility

Providing New Teaching Hospitals in Areas of Need with Additional Time to Establish Medicare Funded GME Caps


The Centers for Medicare & Medicaid Services (CMS) has both the opportunity and the obligation to leverage its existing authority to establish GME caps in order to strategically target additional support to areas with the greatest need across the country.

Specifically, CMS should allow new GME teaching hospitals located in areas of need, to extend their cap-building window for up to an additional five years beyond the current window (for a total of up to ten years).  This would include GME programs currently in their cap-building window. 

Injecting flexibility into the cap-building process provides CMS with the ability to supplement the current broad-based cap-building window with a tailored policy designed to target federal funding (while keeping control over incremental costs) to the areas of highest need.    

Benefits of Cap Flexibility


Lifesaving Opportunities for New Teaching Hospitals

Cap flexibility provides lifesaving opportunities for new teaching hospitals to further develop residency programs and secure the resources necessary to launch and/or scale-up training capabilities.  Additional time is vital to     ensuring that teaching institutions in under-resourced areas will be able to build-up to a level necessary to meet regional needs.


Address Physician Shortages

Cap flexibility can help alleviate regional physician shortages by providing time for institutions to add primary care and/or specialty and sub-specialty residencies in shortage.

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Boost Return on Investment for GME Programs

Cap flexibility can help boost the return on investment for Medicare, local communities, states, medical schools, and the hosting teaching hospital.  By expanding training opportunities, the likelihood of physicians remaining in the underserved area to practice increases.

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Address Maldistribution of Physicians and GME Programs Nationwide

Cap flexibility can help address the maldistribution of physicians and GME resources across the country.  Cap flexibility incentivizes the establishment of GME programs in areas of high need, without taking away resources away from other areas.  As residents tend to practice where they train, adding, developing, and incentivizing the establishment of programs at teaching institutions located in underserved, under-resourced, and rural areas will help address the current maldistribution of physicians across the country.  Over time, a well-tailored cap-flexibility policy will better align the supply of physicians with demand by creating a more diverse and equal distribution of GME training resources and programs, as well as physicians across the U.S.

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