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Tuesday Apr 14, 2015

Connecting Family Physicians to Communities in Need

A quick update: As reported in my previous post, the House of Representatives approved the Medicare Access and Children’s Health Insurance Program Reauthorization Act (H.R. 2) on March 26 by a vote of 392-37. The U.S. Senate is expected to consider the legislation this week. We continue to urge members to contact their Senators and urge them to support this important legislation.

In a world with good and bad government programs, the National Health Service Corps(nhsc.hrsa.gov) (NHSC) has to rank near the top of the good list.

Established in 1970 as part of the Emergency Health Personnel Act, the NHSC was designed to address growing physician shortages in primary care specialties and the decreasing numbers of primary care physicians practicing in underserved communities. Its mission was simple, “improve the delivery of health services to persons living in communities and areas of the United States where health personnel and services are inadequate.”

The AAFP has long viewed the NHSC as a central component of the nation’s primary care workforce strategy. We adopted our first policy regarding the NHSC in 1974, and it has been consistently reaffirmed by the AAFP Congress of Delegates since its initial adoption. That policy states clearly that the AAFP “supports the objectives of the National Health Service Corps” and that we will “assist the Corps in making information available to family medicine residents regarding practice opportunities and benefits in the Corps.”  

The Academy continues to honor this directive through our advocacy and education activities. We are especially pleased that the NHSC, through the Medicare Access and Children’s Health Insurance Program Reauthorization Act (H.R. 2), would be funded for an additional two years. The funding extension is strongly supported by the AAFP and would allow the Corps to continue its mission of placing family physicians in underserved communities. Without such an extension, funding for this vital program is scheduled to stop on Sept. 30.

In 1972, the NHSC placed an initial 180 volunteer physicians in 100 communities. Also in 1972, the Emergency Health Personnel Act Amendments established the NHSC Scholarship Program(nhsc.hrsa.gov). This program awarded a full scholarship -- measured by tuition, fees, and stipends -- based on a commitment on the part of the scholar to serve in an underserved community. The NHSC continued to place volunteers in underserved communities between 1972 and 1977 while the first class of scholars completed their residency training. In 1977, the first class of NHSC scholars began their service.  

In 1987, the NHSC was enhanced though the establishment of the NHSC Loan Repayment Program(nhsc.hrsa.gov). This program afforded primary care physicians incremental annual payments that were applied against their student loans in return for service in an underserved community. The loan repayment program was important to the growth and reach of the NHSC because it allowed communities to immediately meet their health care needs, as opposed to waiting for a physician to complete his or her training through the NHSC scholarship pipeline.

Today, more than 9,000 physicians, dentists and other primary care professionals are participating in the program. Collectively, they provide care to more than 9.5 million people. All told, more than 45,000 primary care physicians, dentists and others have participated in the program, delivering health care services to millions of patients in our nation’s most vulnerable communities.  

From early pioneers, like David Cutsforth, M.D., and David Grube, M.D.(nhsc.hrsa.gov), to the current generation of NHSC participants, like Brian Freeman, M.D.(nhsc.hrsa.gov) and Christin Donnelly, M.D.(nhsc.hrsa.gov), thousands of family physicians have participated in the NHSC program during the past 45 years. Through their service, millions of patients had access to health care they otherwise might not have had.

Future generations of family physicians will continue this proud tradition of service and will impact positively the lives of millions of people who reside in our nation’s health professions shortage areas (HPSAs) through participation in the NHSC program. For the thousands of family physicians who have participated in this program, we thank you for your service. For the current generation of medical students and family medicine residents, we urge you to consider the NHSC as a means of assisting with the financing of your education, but more importantly as a practice opportunity that will impact individuals who otherwise may not have access to your skills and compassion.

The AAFP values our relationship with the NHSC and is committed to securing adequate and stable funding for the program so that it may continue to improve the lives of people living in our most vulnerable communities.

Wonk Hard
In a 5-4 decision, the U.S. Supreme Court ruled in the Armstrong v Exceptional Child Centers Inc.(www.supremecourt.gov) that physicians and other health care providers could not sue states for higher payments under the equal access provisions of the Medicaid Act. The decision by the Supreme Court overturns a ruling issued by the 9th Circuit Court of Appeals.(sblog.s3.amazonaws.com) The equal access provisions of the Medicaid Act requires that states accepting federal Medicaid funding establish payment rates at levels that ensure access to care for beneficiaries.

The AAFP joined other physician organizations in submitting an amicus brief(www.americanbar.org) to the Supreme Court in support of the 9th Circuit decision. The majority opinion noted that physicians have administrative remedies for low payment rates. The opinion went on to suggest that “plaintiffs must first seek relief through CMS first before instigating legal action.”

Posted at 08:00AM Apr 14, 2015 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.