Reps. Cathy McMorris Rodgers, R-Wash., and Mike Thompson, D-Calif., have reintroduced legislation that would establish pilot projects to test and support primary care training models in four community-based settings.
The bipartisan bill, known as the Primary Care Workforce Access Improvement Act of 2013(www.govtrack.us), would establish pilot projects to allow a portion of graduate medical education (GME) payments to go directly to community-based primary care residency programs. Those programs then would collaborate with local hospitals to provide necessary training in inpatient care.
Medicare GME funding currently is funneled solely through hospitals. But that model does not compensate for many of the costs of training in nonhospital settings, which is where most primary care services are provided and where primary care residents need to spend the bulk of their training time, according to AAFP Board Chair Glen Stream, M.D., M.B.I., of Spokane, Wash.
More than 90 percent of care delivered by primary care physicians is provided in the community, and the vast majority of patients receive care in community settings. As a consequence, a significant portion of primary care training should occur in community settings, said Stream.
He also pointed out that funding for physician training directly influences the type of physicians that are produced. The current system, according to Stream, does not foster the production of primary care physicians.
"Discussions about reforming our health system frequently focus on better aligning payment to promote quality and efficiency," said Stream. "GME funding and its effect on our physician workforce is very similar. This bill will align GME funding to promote production of the strong primary care workforce our country needs."
The legislation would establish a five-year pilot to test four models whose principle mission is the education and training of primary care physicians. The models identified for testing are
- a community entity working with two or more hospitals,
- two hospitals working together to develop a primary care program,
- a hospital subsidiary or independent corporation working with the community to further primary care, and
- a medical school or university collaborating with a hospital.
"As we continue to address the disparities in rural health care, one issue stands out: the shortage of primary care physicians," said McMorris Rodgers in a prepared statement(mcmorris.house.gov). "Our legislation encourages residents to train in rural areas, like eastern Washington. Once they complete residency, doctors usually stay in the area where they train, so our legislation is a vital first step to improving access to primary care in rural areas."