Proposals Address Primary Care Shortage

By  //  May 12, 2012

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While there’s little debate about a growing primary care physician (PCP) workforce shortage in the United States, it’s less clear whether existing workforce policies, such as educational loan forgiveness, easier access to scholarship money and higher payment rates, can boost the supply of practitioners quickly enough to provide adequate access to needed primary care services for the “baby boomers” as they age, and the more than 30 million U.S. residents expected to gain health coverage through the Patient Protection and Affordable Care Act (PPACA) beginning in 2014.

The Health Resources and Services Administration (HRSA) estimates an additional 17,722 primary care practitioners are already needed in shortage areas across the country to meet a target of one provider for every 2,000 patients. Likewise, other research indicates that another 35,000 to 44,000 adult primary care providers may be needed by 2025 to care for the nation’s aging population.

Recent developments to address the impending PCP supply and demand crisis focus on accelerating medical school curriculum for students willing to commit to a primary care tract, and a Health and Human Services (HHS) proposal to substantially increase Medicaid reimbursement rates for PCPs.

Three Year Medical Degrees

Several medical schools are piloting primary care programs that allow medical students to obtain their degree in just three years.  The programs were initiated in an effort to attract more students to family medicine and help to avoid a major primary care physician (PCP) shortage, American Medical News reports.

Medical students have traditionally spent their fourth year in specialty rotations and undergoing interviews for residency programs, however the medical schools in the three-year pilot programs are condensing the curriculum to three years for students committed to primary care, primarily family medicine, by eliminating breaks and electives and letting students begin clerkship training in their second year.

Dr. Robert Pallay

“Students who know they want to go into family medicine from the start don’t necessarily need that fourth year,” said Robert Pallay, MD, professor and chair of the Dept. of Family Medicine at Mercer University School of Medicine, one of the four schools that have initiated or are developing three-year programs over the last five years.

Many students, burdened with high debt for their medical education, steer clear of a career as a PCP because reimbursement is lower relative to medical or surgical specialties. The 3-year programs are significantly less costly for students, and with the prospect of getting into active practice at least one year earlier, the economic offset is an incentive for some, who may not have considered family medicine, to take the three-year pathway and go into primary care..

A consortium of six schools has asked the Center for Medicare and Medicaid Innovation for $23 million to bring the model to more campuses with the ultimate objective of accelerating the preparation of well trained physicians to more rapidly populate the ranks of PCPs and better meet the existing and future demand of primary care services in this country.

CMS Proposal Would Increase Medicaid Reimbursement by 34%

It has often been said that when trying to influence a physician make sure that consideration of their time and money are primary components of your argument. Fast-tracking PCP preparation with three-year med school training addresses the “time,” and HHS on Wednesday released a proposed rule that would implement a two-year significant increase to Medicaid reimbursements for PCPs.

The PPACA provides for a 34% Medicaid and 10% Medicare reimbursement increase for PCPs.

The proposal, which was included in the PPACA, would increase Medicaid funding to states by more than $11 billion in 2013 and 2014, and bring PCP Medicaid reimbursement rates in line with Medicare rates. The Center for Medicare and Medicaid Services (CMS) estimates that PCP Medicaid reimbursement rates will increase by 34%, and, per the PPACA, the federal government would cover the entire cost of the increase.

The proposed rule applies to primary care physicians defined as those who specialize in family medicine, internal medicine, and pediatrics, as well as subspecialists in certain circumstances when they provide primary care.

Marilyn Tavvener

This provision in the PPACA is one of many, including also a 10% increase in PCP Medicare rates, intended to provide incentives for more physicians to pursue careers in primary care and address the looming PCP shortage, which will have a significant impact on Medicaid beneficiaries. Whether this provision will stand after the U.S. Supreme Court ruling on the disputed elements of the PPACA scheduled to be released at the end of the present term in June remains to be seen.

In a statement related to the proposal, acting CMS administrator Marilyn Tavenner said, “It will help encourage primary care physicians to continue and expand their efforts to provide checkups, preventive screenings, vaccines, and other care to Medicaid beneficiaries.  The funds will be an important tool for states to ensure their primary care networks are prepared for increased enrollment as the health care law is implemented.”


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