AAFP Scores Win on Payment to Support Rural Residencies

CMS Rule Enacts Long-sought Change to Medicare GME Payment

September 05, 2019 03:37 pm News Staff – After strong AAFP messaging to regulators and sustained collaboration with lawmakers, CMS has issued a final rule that benefits primary care physicians and their patients in underserved areas.

Starting Oct. 1, training time for residents at critical-access hospitals will be eligible for Medicare reimbursement -- a long-sought win for the Academy that also provides an early boost to the AAFP's new Rural Health Matters initiative.

The rule achieves this by updating Medicare's hospital inpatient prospective payment systems to allow residents training in CAHs to be included in full-time equivalent counts for purposes of direct and indirect graduate medical education payments.

It's a change the Academy asked for most recently in a June 19 letter to CMS Administrator Seema Verma, M.P.H.

"The AAFP applauds and strongly supports the section of the proposed rule regarding graduate medical education related to critical-access hospitals," said that correspondence. "The proposed change will help better meet the health care needs provided in CAHs in rural America."

The final rule's IPPS element also echoes language in the Rural Physician Workforce Production Act of 2019 (S. 289) and the Restoring Rural Residencies Act of 2019 (S. 1240), legislation crafted with the Academy's input and support.(2 page PDF)

The Academy's suggestions for increasing production of primary care physicians -- particularly family physicians in underserved rural areas -- that were laid out in the June letter to CMS were not limited to IPPS policy. But that aspect of the final rule clears a key bureaucratic barrier to revitalizing rural health care.

Supporting the recruitment of family physicians to rural areas -- including by increasing student choice, the number of residency positions and support for residency programs -- is among the key goals of the AAFP's Rural Health Matters initiative.

Related AAFP News Coverage
HHS Designates $20 Million for New Rural Residency Programs
(8/5/2019)

Focus on Rural Health
Full-scope Family Medicine Flourishes in Southwestern Kansas
(7/8/2019)

Policy Brief Makes Case for Funding Teaching Health Centers
(5/8/2019)

Additional Resource
HealthLandscape Rural Health Explorer