U.S. medical schools increase 2008 enrollment to meet physician demand
U.S. medical schools continue to expand their enrollment to meet the increasing demand for physicians, according to data released Tuesday by the Association of American Medical Colleges (AAMC).

First-year enrollment at U.S. medical schools this year increased nearly 2 percent from 2007, to more than 18,000 students—the highest enrollment in history.

In a boon to the medical education efforts to increase diversity in medicine, the number of Latino first-year enrollees rose by more than 10 percent this year; Latinos represent 7.9 percent of the 2008-09 entering medical school class. The number of Native American first-year enrollees increased by more than 5 percent, and the number of African American first-year students remained nearly the same as in 2007. Overall, the percentage of women first-year enrollees held steady again this year at about 48 percent.

After a five-year increase in applicants to medical schools, the number of applicants leveled off this year at more than 42,200. While the overall applicant pool is one of the largest in more than a decade, the number of first-time applicants decreased by 3 percent. On average, there were more than two applicants for every available opening at a medical school.

According to AAMC, many medical schools are beginning to take a holistic approach to reviewing applicants, evaluating them on the basis of their academic and personal achievements and within the context of the opportunities and challenges each has encountered. There was an increase in the number of applicants who had community service experience and medical research experience on their premedical resumes.

The applicants to medical school this year were among the most academically qualified in history, according to AAMC; data show an increase in the average undergraduate grade point average (to 3.5) and average MCAT (Medical College Admission Test) scores (to 28.1).

Private FFS Medicare plan overpayments to total $2.5B in 2008

Private fee-for-service (PFFS) Medicare Advantage plans will be paid an average 16.6 percent more in 2008 compared to what the same enrollees would have cost in the traditional Medicare FFS program, according to a report from the Commonwealth Fund.

Although Congress made revisions to policies that affect how PFFS plans operate in 2011 and thereafter, the legislation is expected to slow enrollment in PFFS plans but not stop the overpayment for each enrollee, the report said.

"The legislation passed this year does not adequately address the overpayment problem in private fee-for-service Medicare Advantage plans," said Commonwealth Fund President Karen Davis. "While new requirements will eliminate some of the higher payments to plans and strengthen reporting requirements, we need to determine whether these plans are the best use of limited Medicare dollars."

The study follows an August report which found that private Medicare Advantage (MA) plans were paid 12.4 percent more per enrollee in 2008, compared to what the same enrollee would have cost in the traditional Medicare FFS program, with total extra payments of $8.5 billion in 2008.

In the new report, Brian Biles, professor of health policy at George Washington University in Washington, D.C., and colleagues estimated that extra payments to PFFS plans will amount to $1,248 per beneficiary over traditional Medicare costs for each of about two million Medicare beneficiaries enrolled in PFFS plans, for a total of more than $2.5 billion in 2008.

Since PFFS plans tend to locate in areas where MA payments are high relative to costs in traditional Medicare, extra payments to PFFS plans average five percent more than for other MA plans—equivalent to $310 more per enrollee.

The bulk of the extra payments have resulted from rapid growth in PFFS enrollment—from 220,000 enrollees in December 2005 to nearly two million in February this year. Also, the number of payors offering Medicare PFFS plans grew from four firms in 2004 to 70 in 2008.

Created by the Balanced Budget Act of 1997, PFFS plans currently receive preferential treatment over other MA plans. For example, unlike other MA plans, PFFS plans are not required to have a contract or other network arrangement with physicians, hospitals and other providers. Instead, PFFS plans are allowed to pay providers with which they have no contracts at Medicare FFS rates, called “deeming authority.”

Additionally, PFFS plans are currently exempt from quality reporting and disclosure requirements and they are not subject to bid review or negotiation with Medicare.

The new legislation will eliminate deeming authority and require PFFS plans in certain areas to offer provider networks in 2011. PFFS plans will also have the same reporting requirements as other MA plans, the report said.