The House Ways and Means Health Subcommittee held a hearing July 28 on rural health care disparities and Medicare regulations.
Building on a July 22 hearing on hospital payment issues [see Washington Highlights, July 24] Health Subcommittee Chair Kevin Brady (R-Texas) opened the hearing stating, “We are in the midst of a great opportunity to reform how Medicare reimburses hospital and post-acute care providers.” The Chair expressed his desire to focus on rural hospital challenges; specifically physician workforce shortages, which he called “a reality in many parts of this country,” the 96-hour rule on patient status at critical access hospitals (CAHs), and physician supervision.
Ranking Member Jim McDermott, M.D. (D-Wash.) echoed Brady’s support for addressing disparities in rural communities, but urged “we also need to make long-term investments in our health professional workforce. The United States faces a growing shortage of physicians nationally, projected to reach between 46,000 and 91,000 by 2025.”
McDermott then cautioned his colleagues saying, “We should be skeptical that the solution to this problem lies in gutting Medicare support for graduate medical education in urban areas. There is minimal evidence that this will result in more doctors practicing in rural areas. It will simply exacerbate the nationwide doctor shortage and lower the quality of training they receive. There are better ways to train physicians to serve in rural areas, and I encourage my colleagues to look to creative alternatives.”
Testifying before the subcommittee were Tim Joslin, CEO, Community Regional Medical Center (Calif.); Shannon Sorensen, CEO, Brown County Hospital (Neb.); Carrie Saia, CEO, Holton Community Hospital (Kan.); and Daniel Derksen, Director, Arizona Center for Rural Health.
Referencing testimony provided last week by MedPAC Executive Director, Mark Miller, Ph.D., Chairman Brady asked Joslin if he had seen problems in his local community regarding the lack of correlation between expanding rural GME residency slots and the physician retention.
Joslin responded that in his experience, physicians who train in rural areas are more likely to stay. However, he cited that there are still issues, including the need to fund additional residency positions, adding that Congress “needs to respectfully revisit” the caps imposed by the Balanced Budget Act of 1997, which fixed Medicare’s support for GME training slots at 1996 funding levels.
Rep. Danny Davis (D-IL) then asked the panel what existing incentives could be “tweaked” to make a serious impact on the ability to recruit physicians and other medical personnel to rural areas other than destabilizing Medicare reimbursement rates.
Joslin highlighted two components to the problem stating it’s not just, “How you tweak the system, but I think you need to start with the fundamental realization that the system is flawed, because it just doesn’t produce enough.” He further suggested providing “some type of incentive for physicians to want to go and train in these areas, whether it’s financial incentives for educational purposes,” but urged, “The sheer magnitude of the issue is just the lack of enough slots.”
Both Sorensen and Saia agreed that Congress should leverage student loan forgiveness programs to incentivize physicians to stay in rural communities.
Inquiring of the vital partnership between community hospitals and larger medical centers, Rep. McDermott asked Sorensen how Brown County Hospital handles the care of stroke patients. Sorensen stated the hospital utilizes, “some of the stroke care they are doing through the University of Nebraska Medical Center” adding that while they are equipped to provide medication to such patients, the course of treatment “also depends on making sure they are stable before going on that lengthy of a transfer.”
Sorensen further highlighted that the total number of air transfers in the first half of the calendar year to the University of Nebraska Medical Center has exceeded the total number of air transfers of the last calendar year entirely, adding that the increase is likely due to “acuity and timeliness of patients.”