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Washington Highlights

MedPAC Discusses Supply of Primary Care Physicians; Loan Repayment

October 5, 2018—During its Oct. 4 meeting, the Medicare Payment and Access Commission (MedPAC) discussed Medicare’s role in the supply of primary care physicians.

Commission staff introduced the topic by noting the importance of primary care for creating a coordinated health care system and reviewing MedPAC’s previous recommendations on primary care, including bonuses and per beneficiary payments. The presentation also explored the primary care workforce adequacy and added that although the number of primary care physicians has increased annually, the number per 1,000 beneficiaries has decreased. Staff reviewed a variety of factors that may influence specialty choice, including lifestyle preference, student characteristics, administrative burden, and income expectations. Additionally, they pointed out that evidence of the effect of student debt is mixed, with some studies finding that it has modest or no effect and others concluding that students with no debt or high debt are less likely to choose primary care.

Commission staff reviewed two student aid programs for primary care physicians administered by the Health Resources and Services Administration — the National Health Service Corps and Primary Care Loan — but lacked data on funding, participation, and retention.

MedPAC staff proposed a new Medicare loan repayment program for the commission to consider. They discussed its size, whether it should target certain students, which types of specialties should be considered, and a requirement for physicians to treat a minimum number of Medicare beneficiaries.

Following the presentation, AAMC Chief Public Policy Officer Karen Fisher, JD, addressed the commission during the public comment period. She thanked the commission for exploring this issue and for reaching out to work with AAMC at a later date. Fisher noted that the AAMC’s workforce projections show a shortage of both primary care and specialty physicians. She also highlighted data from the AAMC Medical School Graduation Questionnaire, which shows that the role of student debt is not a major influence on specialty choice, as well as data from the National Resident Matching Program that shows that the three major primary care specialties have had high fill rates over the past five years. Fisher urged the commission to address lifting the caps on Medicare support for graduate medical education (GME), which is a barrier to increasing both primary care and other physicians.

The commission will continue this discussion at future meetings, including increasing accountability for Medicare GME payments.

The meeting also included sessions on other topics, including tracking opioid use in the hospital setting, and non-urgent care and upcoding in hospital emergency departments [see related story].


Matthew Shick, JD
Director, Gov't Relations & Regulatory Affairs
Telephone: 202-862-6116


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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