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AAFP Applauds GME Senate Bill Aimed at Rural Shortages

February 14, 2019 04:25 pm News Staff – Sometimes déjà vu is real -- and welcome.

With last spring's stalled Rural Physician Workforce Production Act of 2018 barely having receded into memory, a 2019 version has been introduced in the early days of the 116th Congress.

The Rural Physician Workforce Production Act of 2019 stands to provide "invaluable new federal support for rural residency training, which will help alleviate physician shortages in rural communities," the Academy told the bill's sponsors in Feb. 4 correspondence.

The AAFP sent identical letters praising the bill to Sen. Cory Gardner (R.-Colo.),(2 page PDF) lead sponsor of the 2018 and 2019 bills, as well as to the bill's original co-sponsors, Sens. Jon Tester (D.-Mont.)(2 page PDF) and Cindy Hyde-Smith (R-Miss.).(2 page PDF) The letters were signed by Board Chair Michael Munger, M.D., of Overland Park, Kan.

"The nationwide shortage and maldistribution of family physicians and other primary care physicians is particularly dire in rural communities," the Academy wrote. "Although evidence indicates that one of the most promising ways to recruit physicians to practice in rural areas is through rural experiences during their residency training, numerous incentives in the Medicare program discourage hospitals from providing such opportunities -- including in communities that desperately need new physicians.

"Your bill would provide new, robust financial incentives for rural hospitals (including critical-access hospitals) to provide the training opportunities that the communities they serve need."

Medicare is the dominant driver of graduate medical education (GME) policy, accounting for two-thirds of public funding for residency training, the AAFP noted in a 2018 document supporting last year's version of the Rural Physician Workforce Production Act.

"The last major revision to Medicare GME policies took place over 20 years ago, in the Balanced Budget Act of 1997 (BBA)," the paper said. The BBA placed caps on institutions sponsoring residency training for the first time. Congress provided incentives for rural training in subsequent legislation, but CMS' Medicare GME policies have "arguably run counter to congressional intent to encourage maximum growth in rural training," the paper added.

Government Accountability Office (GAO) data from 2018 cited in the AAFP's paper indicate that 99 percent of GME funding now goes to recipients in urban areas.

"Rural training sites may incur higher costs because their training may have to utilize multiple training sites -- such as community hospitals or rural health clinics -- in order to meet accreditation requirements for resident rotations and patient case-mix," the GAO reported. "The added administrative work of coordinating with other sites to provide these resources can be a challenge."
Passage of the Rural Physician Workforce Production Act would begin to rebalance GME training policy, the AAFP noted in its Feb. 4 letter, while also extending financial incentives to urban hospitals for use in increasing the number of residents in rural training tracks.