U.S. Congressmen Michael C. Burgess, M.D. (TX-26) introduced legislation to bring a halt to the impending physician workforce crisis. In recent years, the number of students going into medicine has dwindled as high insurance costs and poor reimbursement for services have increased. Of those who become physicians, fewer are in locations of necessity or in high-need specialties.
In a recent conversation with Alan Greenspan, former Chairman of the Federal Reserve, he said he was less concerned about the feasibility of paying for entitlement programs than whether an adequate physician labor supply would be available to meet the demand for medical services in the future.
"Every town hall meeting brings the inevitable question from a senior, 'Why do I have to change doctors now that I am on Medicare,' said Congressman Michael C. Burgess. "The answer is simple - doctors are not reimbursed at a level that covers the cost of treatment. Doctors want to heal patients, but they cannot sustain giving assistance without adequate reimbursement."
In fact, physicians have been "saved" during the last minutes of Congress from a negative update to their Medicare reimbursement.
"In short, we keep putting a band-aide on a cut instead of curing the patient," said Rep. Burgess. "In fact, it was my mother who reminded me that I told me that I must take Medicare patients even if I wasn't paid fairly. It was always a financial crisis, and for too many doctors it puts their business and livelihoods at risk."
The Physician Workforce Improvement and Incentives Package is a three-fold solution to the physician crisis: reform Medicare payment; increase growth in the number of physicians; and encourage physicians to go into needed specialties. This combination should ensure a workforce is in place as we move into a particularly difficult period of time as baby boomers age and more and more Americans become more reliant on a steady supply of health care services.
Specifically the bills would accomplish the following:
Ensuring the Future Physician Workforce Act of 2007
1) Eliminate Sustainable Growth Rate (SGR) beginning in 2010. Replace it with Medical Economic Index (MEI).
2) SGR expenditure target reset at 2007 level
3) 3 percent bonus payments beginning in 2008 for quality reporting; making important changes to Medicare quality reporting program by focusing on gaps in care and high-cost services.
4) 3 percent bonus payments beginning in 2008 for Health Information Technology (HIT) implementation.
5) Safe-harbor from anti-kickback laws when implementing HIT.
6) Confidential reports for physicians on Medicare billing.
7) Reports to Medicare beneficiaries on utilization.
8) Collect data on Medicare savings gained by diverting hospital stays with out-patient care.
9) Create an on-going examination of Medicare funding.
10) Study the Relative Value Scale Update Committee (RUC) process.
11) Study healthcare disparities.
12) Accelerate nationwide implementation of the Recovery Audit Contractor program to 2008.
Physician Workforce and Graduate Medical Education Enhancement Act of 2007
1) Establish an interest-free loan program for eligible hospitals in rural and small, urban areas to establish residency training programs in one of the following specialties: family medicine, internal medicine, pediatrics, emergency medicine, OB/GYN, or general surgery.
*Authorization of $25 million over 10 years, 2008-2018.
2) Report to Congress on the efficacy of the program in achieving its stated goals.
"Thirty-four percent of physicians practicing medicine in the United States are within 10 years of retirement age," said John Strosnider, D.O., president of the American Osteopathic Association. "The time it takes to educate and train a physician is, at minimum, seven years. A student accepted in the class of 2007 will not enter the physician workforce until at least 2014. This bill creates a new program that will assist in the establishment of new graduate medical education programs focusing on primary care, general surgery, and obstetrics and gynecology, which is critical to training a larger cadre of physicians."
The High-Need Physician Workforce Incentives Act of 2007
1) Establish a scholarship program for generalist physicians in high-need areas to alleviate shortages of physicians in the fields of family practice, internal medicine, pediatrics, emergency medicine, general surgery, and OB/GYN (henceforth referred to as generalist physicians).
*Authorization: $5 million for each of 5 years, FY2008-FY2015. $25 million total.
2) Establish a loan repayment program for generalist physicians who agree to serve in a critical shortage area.
*Authorization: $5 million for each of 5 years, FY2008-FY2015. $25 million total.
3) Make grants to the States to provide financial aid to physicians in medically underserved areas to support patient-centered, coordinated care in a qualified medical home.
*Authorization: $10 million per year, 2008-2012. $50 million total.
4) Make grants to board-certified entities to establish or expand geriatric fellowship programs in rural, suburban, or medically underserved communities.
*Authorization: $1 million per year, 2008-2012. $5 million total.
5) Report to Congress on grants/loans provided and results achieved.
6) Amend the Internal Revenue Code so that gross income does not include compensation received by a physician from a local government for qualified medical service that is performed (1) in a medically underserved community, and (2) under contract with the local government for no less than 4 years. Compensation will be taken into account as wages and must still be reported - it just won't be counted as gross income.
"ACP is delighted Rep. Burgess is continuing his interest and help in improving America's healthcare system," continued David C. Dale, MD, FACP, president of the American College of Physicians. "He and Rep. Cuellar are to be commended for addressing the critical need to have a strong foundation of primary care and generalist physicians to meet the needs of an aging population with more chronic diseases and to support a new model of delivering care-the patient-centered medical home-that will result in better outcomes for patients and more efficient use of resources."
house/burgess