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Tens of billions of dollars in cuts to some Medicare reimbursements and hospital payments are now on the table as part of the deficit-reduction talks between the White House and Congressional Republicans, and cuts in at least one area would affect the $9.5 billion Medicare pays to teaching hospitals each year, the New York Times reported Tuesday. Whether the cuts will become law depends on the outcome of the negotiations, but the American Council on Graduate Medical Education, as well as a coalition of hospital lobbyists that includes the Association of American Medical Colleges, has raised the alarm.

In an open letter, the Accreditation Council for Graduate Medical Education, which accredits residency programs, laid out its concerns about the changes. Medicare payments comprise the majority of funding for training medical residents and fellows, the council wrote. Losing the Medicare payments would mean that the small, often rural health-care providers that make up about half of group's 681 accredited programs might have to stop offering residencies. Larger providers might turn to industry sponsorship or ask residents to pay tuition. "Abrupt and dramatic reductions in Medicare [graduate medical education] funding will have a significant and adverse impact on both the number of residents educated and trained, and the quality of that education," the group wrote. "This will challenge the profession's responsibility as a public trust to produce the next generation of physicians to serve the needs of the American public through the provision of excellent, innovative, safe and affordable care."