Indirect Medical Education (IME) and Supporting Regulations 42 CFR 412.105

IRIS XML FTE Calculations Overview:

IRIS submissions do not record FTE counts directly. Rather, they record residents and their assignments, from which FTE
counts can be calculated. This document outlines how to calculate the FTE contribution represented by a single IRIS
assignment. The FTE totals represented by an entire IRIS submission can then be obtained by summing the FTEs from all
of its individual assignments.
This document is primarily intended for use by software developers and auditors in order to allow them to replicate
CMS’s FTE calculations. Individual providers are encouraged to use a third-party vendor when preparing their IRIS
submissions.
See accompanying documentation for definitions of the IRIS XML fields referenced in this document: timePercentage,
imePercentage, ipfDpuPercentage, irfDpuPercentage, gmePercentage, initialResidencyPeriodCode, residencyCode,
residencyYearsCompleted, nonProviderSitePercentage, isNewProgramFte, and isDisplacedResidentFte.
A note on rounding and precision: Rounding should only be employed when displaying final results to users. Rounding
should never be employed in any intermediate steps of FTE calculations. This includes aggregates. All sums, such as
summing assignment-level counts in order to get submission-level totals, should be done by summing full-precision
values NOT by summing values that have already been rounded. All FTE calculations are done using high-precision
floating point arithmetic. When displaying FTE counts, the CMS implementation rounds values to six decimal places.

I.

IME FTEs (IPPS, IRF & IPF):

The formula for calculating the IPPS IME FTEs represented by a single IRIS assignment is defined as:
Assignment’s IPPS IME FTE Contribution
=
< number of days in assignment >
timePercentage × imePercentage ×
< number of days in cost reporting period >
IPF (Psych) and IRF (Rehab) FTEs use the same formula, except substituting “imePercentage” with “ipfDpuPercentage”
and “irfDpuPercentage” respectively.
Note that this formula is based on the length of the provider’s cost reporting period, so a single resident is theoretically
able to contribute 1.0 FTEs in a short cost reporting period. This is different from the GME FTE calculation, which is
based on calendar years.

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II.

DGME FTEs

The formula for calculating the DGME FTEs represented by a single IRIS assignment is defined as:
Assignment’s Unweighted GME FTE Contribution
=
timePercentage × gmePercentage × ASSIGNMENT_DURATION
Assignment’s Weighted GME FTE Contribution
=
Unweighted GME FTE Contribution × GME_WEIGHT_FACTOR

1) Exception: International Dental Residents (Medical School Code 99998) always receive zero weighted and
unweighted GME FTEs.
2) ASSIGNMENT_DURATION is defined as the percentage of a full calendar year covered by the assignment. If you
ignore leap years then this is simply /365. See full definition below.
3) GME_WEIGHT_FACTOR is either 1 or 0.5 depending on whether the assignment qualifies for full GME
reimbursement or not. See full definition below.
4) Note: Since the GME calculation is based on calendar years rather than the length of the cost reporting period, for
long cost reporting periods a single resident can contribute more than 1.0 GME FTEs (e.g.: 1.08 FTEs for a 13 month
period).

A. GME Weight Factor
1) For calculating the GME Weight Factor, the resident’s Initial Residency Period (IRP) length is determined by each
resident’s IRP residency code (initialResidencyPeriodCode). A reference table containing the IRP lengths for each
residency type code is included in the accompanying documentation.
2) If the assignment’s residency years completed value (residencyYearsCompleted) is greater than or equal to the
resident’s IRP length, then GME_WEIGHT_FACTOR is 0.5 (unless bonus years apply, see below). Otherwise
GME_WEIGHT_FACTOR is 1.0.
3) Bonus Years: If an assignment’s residency type is geriatric, preventative medicine, or child neurology, the approved
residency length should be increased by 2 years for purposes of weighting that specific assignment. ( 42 CFR 413.79
(a); (2), (3), and (4) )
a) For example, a resident might be weighted for three years before starting geriatrics, at which point they would
receive two “bonus” years of unweighted contribution.
b) Bonus years can cause unweighted reimbursement to exceed the normal 5-year limit.
c) Bonus years may start or end in the middle of an academic year and/or the middle of a cost reporting period, so
the calculation must check whether each individual assignment qualifies for bonus years or not.
d) Calculation:
i) Looking across all assignments for the current resident, including all years/providers that have ever claimed
the resident, find the earliest assignment begin date where the assignment’s residency type code
(residencyCode) qualifies for bonus years. Consider that date the BONUS_YEARS_START_DATE. Consider the
BONUS_YEARS_END_DATE to be that start date plus 2 years.
(1) More specifically, BONUS_YEARS_END_DATE = BONUS_YEARS_START_DATE + 24 months - 1 day.
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ii) If the current assignment has an assignment residency type (residencyCode) that qualifies for bonus years
AND the current assignment’s begin date occurs within the bonus years date range (inclusive of the start
and end dates), then apply a GME_WEIGHT_FACTOR of 1.0.
iii) Notes:
(1) Since the bonus year range calculation looks across all FYEs and Providers, this means that one
submission’s data can affect the FTE counts on a different submission.
(2) The bonus years clock starts even if resident is currently unweighted.
e) A reference table listing which specific residency codes are considered eligible for bonus years is included in the
accompanying documentation

B. GME FTEs: ASSIGNMENT_DURATION - Dealing with Leap Years
Since GME FTEs are based on the length of a calendar year rather than the length of the cost reporting period,
the formula needs to account for leap years. IRIS uses a simple approach for this:
If the provider’s Medicare cost reporting period contains the leap day (February 29th) then:
ASSIGNMENT_DURATION = / 366
Else, if the cost reporting period does NOT contain the leap day:
ASSIGNMENT_DURATION = / 365

III.

FTE Subcategory Breakdowns

The FTEs represented by an IRIS assignment may be broken down into more granular categories, based on additional
fields that are captured for each assignment, in order to determine their contribution to specific lines in the cost report.
Examples of subcategory breakdowns include: Displaced Residents, New Programs, Non-Provider Site Settings, Primary
Care, etc.
The table below presents the formulas for calculating the FTEs that a single assignment contributes to each subcategory.
The formulas in this table use the following variables:
For the following variables, refer to IME and GME FTE formulas presented above:
IRIS_ASGN_FTE_IME = Assignment's Total IME FTE Contribution (IPPS+IPF+IRF)
IRIS_ASGN_FTE_IME_IPPS = Assignment’s IME IPPS Contribution
IRIS_ASGN_FTE_IME_IPF = Assignment’s IME IPF Contribution
IRIS_ASGN_FTE_IME_IRF = Assignment’s IME IRF Contribution
IRIS_ASGN_FTE_UNWEIGHTED_GME = Assignment’s Unweighted GME FTE Contribution
IRIS_ASGN_FTE_WEIGHTED_GME = Assignment’s Weighted GME FTE contribution
For the following true/false variables, refer to the residency type codes reference table in the accompanying
documentation:
IRIS_ASGN_FTE_ALLOPATHIC = True if the assignment residency type qualifies as Allopathic.
IRIS_ASGN_FTE_OSTEOPATHIC = True if the assignment residency type qualifies as Osteopathic.
IRIS_ASGN_FTE_PODIATRIC = True if the assignment residency type qualifies as Podiatric.
IRIS_ASGN_FTE_DENTAL = True if the assignment residency type qualifies as Dental.
IRIS_ASGN_FTE_OB_GYN = True if the assignment residency type qualifies as OB/GYN.
IRIS_ASGN_FTE_PRIMARY_CARE = True if the assignment residency type qualifies as Primary Care.
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ID

FTE Subcategory

Formula

1

IME IPPS Allopathic and Osteopathic

If ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC
Then ASGN_FTE_IME_IPPS
Else 0

2

IME IPPS Dental and Podiatry

If ASGN_FTE_PODIATRIC OR ASGN_FTE_DENTAL
Then ASGN_FTE_IME_IPPS
Else 0

3

IME IPPS New Program

If isNewProgramFte = true
Then ASGN_FTE_IME_IPPS
Else 0

4

IME IPPS New Program - Allopathic and
Osteopathic

5

IME IPPS Displaced Residents

If isNewProgramFte = true
AND (IRIS_ASGN_FTE_ALLOPATHIC OR
IRIS_ASGN_FTE_OSTEOPATHIC)
Then ASGN_FTE_IME_IPPS
Else 0
If isDisplacedResidentFte = true
Then ASGN_FTE_IME_IPPS
Else 0

6

IME IPF Contribution for New Programs

If isNewProgramFte = true
Then ASGN_FTE_IME_IPF
Else 0

7

IME IPF Displaced Residents

If isDisplacedResidentFte = true
Then ASGN_FTE_IME_IPF
Else 0

8

IME IRF Contribution for New Programs

If isNewProgramFte = true
Then ASGN_FTE_IME_IRF
Else 0

9

IME IRF Displaced Residents

If isDisplacedResidentFte = true
Then ASGN_FTE_IME_IRF
Else 0

10

Unweighted GME FTE Contribution at
Nonprovider Site
(ASGN_FTE_UW_GME_NON_PROV_SITE)

nonProviderSitePercentage x ASGN_FTE_UNWEIGHTED_GME

11

Unweighted GME FTE Contribution at Provider
Site
(ASGN_FTE_UW_GME_PROV_SITE)

ASGN_FTE_UNWEIGHTED_GME ASGN_FTE_UW_GME_NON_PROV_SITE

12

Unweighted GME FTE Contribution at
Nonprovider Site - Primary Care

13

Unweighted GME FTE Contribution at
Nonprovider Site - Non-Primary Care

If (IRIS_ASGN_FTE_PRIMARY_CARE OR
IRIS_ASGN_FTE_OB_GYN)
Then ASGN_FTE_UW_GME_NON_PROV_SITE
Else 0
If NOT (IRIS_ASGN_FTE_PRIMARY_CARE OR
IRIS_ASGN_FTE_OB_GYN)
Then ASGN_FTE_UW_GME_NON_PROV_SITE
Else 0
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ID

FTE Subcategory

Formula

14

Unweighted GME FTE Contribution at Provider
Site – Primary Care

15

Unweighted GME FTE Contribution at Provider
Site - Non-Primary Care

16

Unweighted GME Allopathic and Osteopathic
(ASGN_FTE_UW_GME_AO)

If (IRIS_ASGN_FTE_PRIMARY_CARE OR
IRIS_ASGN_FTE_OB_GYN)
Then ASGN_FTE_UW_GME_PROV_SITE
Else 0
If NOT (IRIS_ASGN_FTE_PRIMARY_CARE OR
IRIS_ASGN_FTE_OB_GYN)
Then ASGN_FTE_UW_GME_PROV_SITE
Else 0
If ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC
Then ASGN_FTE_UNWEIGHTED_GME
Else 0

17

Unweighted GME Dental and Podiatry

If ASGN_FTE_PODIATRIC OR ASGN_FTE_DENTAL
Then ASGN_FTE_UNWEIGHTED_GME
Else 0

18

Unweighted GME Non-Displaced Resident
Allopathic and Osteopathic

If (ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC)
AND isDisplacedResidentFte = false
Then ASGN_FTE_UW_GME_AO
Else 0

19

Unweighted GME Displaced Resident Allopathic
and Osteopathic

If (ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC)
AND isDisplacedResidentFte = true
Then ASGN_FTE_UW_GME_AO
Else 0

20

Unweighted GME New Program Allopathic and
Osteopathic

If isNewProgramFte = true
Then IRIS_ASGN_FTE_UW_GME_AO
Else 0

21

Weighted GME A&O Total

If ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC
Then ASGN_FTE_WEIGHTED_GME
Else 0

22

Weighted GME A&O Primary
(Includes OB/GYN)

If (ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC)
AND (ASGN_FTE_PRIMARY_CARE OR ASGN_FTE_OB_GYN)
Then ASGN_FTE_WEIGHTED_GME
Else 0

23

Weighted GME A&O Other

24

Weighted GME Dental and Podiatry

If (ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC)
AND NOT (ASGN_FTE_PRIMARY_CARE OR
ASGN_FTE_OB_GYN)
Then ASGN_FTE_WEIGHTED_GME
Else 0
If ASGN_FTE_PODIATRIC OR ASGN_FTE_DENTAL
Then ASGN_FTE_WEIGHTED_GME
Else 0

25

Weighted GME Dental

If ASGN_FTE_DENTAL
Then ASGN_FTE_WEIGHTED_GME
Else 0
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ID

FTE Subcategory

Formula

26

Weighted GME Podiatry

If ASGN_FTE_PODIATRIC
Then ASGN_FTE_WEIGHTED_GME
Else 0

27

Weighted GME New Program Primary

If (ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC)
AND (ASGN_FTE_PRIMARY_CARE OR ASGN_FTE_OB_GYN)
AND isNewProgramFte = true
Then ASGN_FTE_WEIGHTED_GME
Else 0

28

Weighted GME New Program Other

29

Weighted GME Displaced Resident Primary

If (ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC)
AND NOT (ASGN_FTE_PRIMARY_CARE OR
ASGN_FTE_OB_GYN)
AND isNewProgramFte = true
Then ASGN_FTE_WEIGHTED_GME
Else 0
If (ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC)
AND (ASGN_FTE_PRIMARY_CARE OR ASGN_FTE_OB_GYN)
AND isDisplacedResidentFte = true
Then ASGN_FTE_WEIGHTED_GME
Else 0

30

Weighted GME Displaced Resident Other

If (ASGN_FTE_ALLOPATHIC OR ASGN_FTE_OSTEOPATHIC)
AND NOT (ASGN_FTE_PRIMARY_CARE OR
ASGN_FTE_OB_GYN)
AND isDisplacedResidentFte = true
Then ASGN_FTE_WEIGHTED_GME
Else 0

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