Modifying the Primary Care Exception Rule to Require Competency-Based Assessment.

Area of Science:

• Medical Education
• Healthcare Policy
• Graduate Medical Education

Background:

• Graduate medical education (GME) aims to prepare residents for independent practice.
• Centers for Medicare and Medicaid Services (CMS) billing rules require direct physician supervision, with exceptions.
• The Primary Care Exception Rule (PCER) allows indirect supervision after six months of training.

Purpose of the Study:

• To review the history and limitations of the PCER.
• To propose modifications to CMS billing requirements for resident supervision.
• To advocate for mandatory competence assessment of residents before independent practice.

Main Methods:

• Review of current CMS billing rules and the PCER.
• Analysis of the implications of the six-month probationary period.
• Exploration of the milestones framework for competence assessment.

Main Results:

• The PCER does not mandate resident competence assessment before indirect supervision.
• Current GME lacks standardized methods for evaluating readiness for unsupervised practice.
• Varied resident skill development may not align with the six-month timeframe.

Conclusions:

• Mandatory evaluation of resident competence is crucial for safe, independent practice.
• Integrating the milestones framework can standardize assessment.
• Developing benchmarks across training programs is recommended.