New Opportunities for Expanding Rural Graduate Medical Education to Improve Rural Health Outcomes: Implications of the Consolidated Appropriations Act of 2021.
Journal
Academic medicine : journal of the Association of American Medical Colleges
ISSN: 1938-808X
Titre abrégé: Acad Med
Pays: United States
ID NLM: 8904605
Informations de publication
Date de publication:
01 09 2022
01 09 2022
Historique:
pubmed:
30
6
2022
medline:
16
9
2022
entrez:
29
6
2022
Statut:
ppublish
Résumé
Evidence shows that those living in rural communities experience consistently worse health outcomes than their urban and suburban counterparts. One proven strategy to address this disparity is to increase the physician supply in rural areas through graduate medical education (GME) training. However, rural hospitals have faced challenges developing training programs in these underserved areas, largely due to inadequate federal funding for rural GME. The Consolidated Appropriations Act of 2021 (CAA) contains multiple provisions that seek to address disparities in Medicare funding for rural GME, including funding for an increase in rural GME positions or "slots" (Section 126), expansion of rural training opportunities (Section 127), and relief for hospitals that have very low resident payments and/or caps (Section 131). In this Invited Commentary, the authors describe historical factors that have impeded the growth of training programs in rural areas, summarize the implications of each CAA provision for rural GME, and provide guidance for institutions seeking to avail themselves of the opportunities presented by the CAA. These policy changes create new opportunities for rural hospitals and partnering urban medical centers to bolster rural GME training, and consequently the physician workforce in underserved communities.
Identifiants
pubmed: 35767355
doi: 10.1097/ACM.0000000000004797
pii: 00001888-202209000-00010
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1259-1263Informations de copyright
Copyright © 2022 by the Association of American Medical Colleges.
Références
U.S. Department of Health and Human Services. Rural Action Plan. https://www.hhs.gov/sites/default/files/hhs-rural-action-plan.pdf . Published September 2020. Accessed June 21, 2022.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502.
Amezquita L, George P, Adashi EY. Clogs in the pipeline: How GME funding contributes to the primary care shortage. Am J Med. 2020;133:e455–e456.
Chen C, Petterson S, Phillips RL, Mullan F, Bazemore A, O’Donnell SD. Toward graduate medical education (GME) accountability: Measuring the outcomes of GME institutions. Acad Med. 2013;88:1267–1280.
Mullan F, Chen C, Steinmetz E. The geography of graduate medical education: Imbalances signal need for new distribution policies. Health Aff (Millwood). 2013;32:1914–1921.
He K, Whang E, Kristo G. Graduate medical education funding mechanisms, challenges, and solutions: A narrative review. Am J Surg. 2021;221:65–71.
Consolidated Appropriations Act, 2021, HR 133, 116th Congress (2019-2020). https://www.congress.gov/bill/116th-congress/house-bill/133 . Accessed June 21, 2022.
Centers for Medicare & Medicaid Services. Frequently Asked Questions on Section 126 of the Consolidated Appropriations Act (CAA), 2021. https://www.cms.gov/files/document/frequently-asked-questions-section-126.pdf . Accessed June 21, 2022.
Association of American Medical Colleges. Graduate Medical Education Final Rules Published for FY2022 IPPS. https://www.aamc.org/advocacy-policy/washington-highlights/graduate-medical-education-final-rules-published-fy-2022-ipps . Accessed June 21, 2022.
Centers for Medicare & Medicaid Services. FY 2022 IPPS Final Rule Home Page. https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page . Accessed June 21, 2022.
Accreditation Council for Graduate Medical Education. Rural Track Regulation References. https://www.acgme.org/globalassets/pdfs/rural-track-regulation-references_web.pdf . Accessed June 21, 2021.
Centers for Medicare & Medicaid Services. Direct Graduate Medical Education (DGME). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/DGME . Accessed June 21, 2021.
Centers for Medicare & Medicaid Services. Section 131 of the CAA: Guidance on Teaching Hospitals’ Eligibility for Direct GME Resets. https://www.cms.gov/files/document/guidance-teaching-hospitals-eligibility-direct-gme-resets.pdf . Published March 2022. Accessed June 21, 2021.
Hawes EM, Fraher E, Crane S, et al. Rural residency training as a strategy to address rural health disparities: Barriers to expansion and possible solutions. J Grad Med Educ. 2021;13:461–465.
Pauwels J, Sanner L. Consolidated Appropriations Act, 2021 Graduate Medical Education CMS Rule Interpretations Summary. https://portal.ruralgme.org/toolbox/tools#%3A~%3Atext%3DGME%20CMS%20Rule%20Interpretations%20Summary%20from%20CAA%202020 (login required). Published February 2022. Accessed May 24, 2022.
Pauwels J, Longenecker R, Sanner L. The impact of CMS rule changes on rural GME. https://portal.ruralgme.org/toolbox/download/212 (login required). Published February 2022. Accessed May 24, 2022.
Accrediting Council for Graduate Medical Education. Rural track program designation. https://www.acgme.org/what-we-do/accreditation/medically-underserved-areas-and-populations/rural-tracks/#%3A~%3Atext%3DAn%20ACGME%20Rural%20Track%20Program%2Curban%20Core%2DBased%20Statistical%20Area . Accessed June 21, 2022.
Centers for Medicare & Medicaid Services: Review Contractor Directory—Interactive Map. https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Contractor-Directory-Interactive-Map . Published December 2021. Accessed June 21, 2022.
Holmes M. Rural GME HCRIS Data Tool. https://portal.ruralgme.org/toolbox/tools/7 (login required). Published 2022. Accessed May 30, 2022.
Sanner L, Holmes M, Pauwels J. Rural GME Webinar: A deeper dive into Section 131. https://portal.ruralgme.org/toolbox/tools/7 (login required). Published April 2022. Accessed May 30, 2022.