California congressmen introduce bills to address physician shortage Two important bills have been introduced in Congress to address our state’s serious physician shortage and improve access to care in California. The first bill, the Training the Next Generation of Primary Care Doctors Act of 2017 (HR 3394), would reauthorize for an additional three years the Teaching Health Center Graduate Medical Education (GME) program that was established by the Affordable Care Act (ACA). The Teaching Health Center program is a community-based primary care physician training program that has been extremely successful in expanding the physician workforce in underserved areas. This bill would also expand the number of residency positions available within existing teaching health centers and establish sustainable funding. This bill has bipartisan cosponsorship by California Congressmen Raul Ruiz, M.D. (D-Palm Springs), Jeff Denham (R-Modesto) and David Valadao (R-Fresno). The second bill, the Comprehensive Additional Residency Expansion Act (HR 3451), introduced by Congressman Jeff Denham (R-Modesto) and sponsored by the California Medical Association (CMA), would build on HR 3394. The Teaching Health Center GME program currently supports 742 residents at 59 teaching health centers. This bill would add an additional 240 residency slots to train new physicians and authorize 10 new teaching health centers. It would also require the new teaching health centers be located in areas with a disproportionate share of Medicaid patients to help alleviate physician shortages and access to care in underserved regions. These bills are critically important because California is experiencing a severe shortage of primary care physicians, particularly in the rural and Central Valley regions of the state. Our state has one of the lowest primary care physician to patient ratios in the nation. Only 10 percent of physicians practice in rural areas nationwide, although 25 percent of the population resides in these regions. Training more physicians to meet the growing demands of an aging population with multiple chronic conditions is a CMA priority. We support efforts to encourage more physicians to practice in underserved areas to improve access to care. The underserved Central Valley region of California in particular has experienced difficulty attracting and retaining physicians. Data shows that most physicians set down roots in the areas where they train and remain there after their training to care for their communities. These two bills will help to create a new generation of rural physicians and ensure that patients in those areas have access to essential preventive and primary care to diagnose and treat health problems early. These are important bills that represent a practical approach to improving the physician shortage crisis and access to care challenges in California’s underserved areas. August 9, 2017 General Federal Legislation, Federal Legislative Advocacy , Graduate Medical Education, Physician Workforce, Primary Care, Rural Health, Underserved Communities 0 0 Comment Read More »
AMA introduces tool that allows physicians to pinpoint underserved patient care areas The American Medical Association (AMA) announced today that it was introducing a mapping tool that lets physicians see the distribution of physicians and nonphysician clinicians by specialty, state, county or metropolitan area. Called the Health Workforce Mapper, AMA believes the tool will be useful to physicians so they can identify the best locations to establish or expand a medical practice based on regional needs for access to care and the existing health care workforce. The tool can identify and prioritize underserved areas; create and display ratios of physicians and nonphysician clinicians to population in any given region; map the practice locations of physicians and other clinicians in specific states or regions; select and compare across multiple categories of physician specialty types; identify shortage areas, hospital locations, population indicators and relevant health data; and view geographic features, including highways, mountain ranges and waterways. AMA members have access to the tool for free. A limited view of the tool is open to anyone. Sign up for a live webinar demonstration of the AMA Workforce Mapper at 1 p.m. Eastern time on Nov. 14. November 5, 2014 General American Medical Association, Rural Health, Underserved Communities, AMA 0 0 Comment Read More »
Medical board gives priority licensing review to physicians practicing in underserved areas The Medical Board of California will give priority review and processing of license applications to any physician who has received or accepted an offer of employment to work in an area of California designated as underserved. In order to be considered for this process, applicants need to submit the initial application forms, fingerprint cards (out-of-state applicants) or Live Scan (California applicants), application fees, primary source documents and supporting documents. Physicians also need to supply the additional documentation: An original signed and dated letter from the applicant to the medical board confirming acceptance of employment in California to provide medical services to a formally-designated underserved area and /or population. An original signed and dated letter from the prospective employer confirming the offer of employment. Documentation confirming the facility is in an underserved area or serves an underserved population or medical specialty from the California Department of Public Health, California Office of Statewide Health and planning Development, California Health Professions Education Foundation, California Department of Health Care Services or the U.S. Department of Health and Human Services. For more information, click here. Contact: Mark Seidl, (916) 274-6103 or Mark.Seidl@mbc.ca.gov. September 4, 2014 General Medical Board of California, Rural Health, Licensure 0 0 Comment Read More »
Congress passes California Medicare GPCI fix After 10 long years of lobbying efforts by the California Medical Association (CMA), Congress has finally passed a bill to update California's outdated Medicare localities. The long overdue fix will update California’s Medicare physician payment regions to the same Metropolitan Statistical Areas (MSA) used to pay hospitals and raise payment levels for urban counties misclassified as rural, while holding remaining rural counties harmless from cuts. The MSAs used to determine payment rates for hospitals are continuously updated, so that reimbursement accurately reflects local costs to deliver care. The physician payment localities, on the other hand, have not been updated in 15 years. As a result, 14 urban California counties are still designated as rural. This has caused many California physicians to be paid up to 13 percent per year below what Medicare says they should be paid if they were in the correct region. These counties are currently experiencing significant access to care problems. About a third to one half of the physician groups and hospitals in these regions report difficulty recruiting physicians to treat seniors because the cost of living and the cost to practice are high, but the Medicare locality payments have not kept pace with real costs. For instance, San Diego is now the sixth largest city in the United States, yet under the old Medicare localities, it is still designated by as rural. San Diego physicians and patients alone lose $26 million in Medicare funding each year because of the inaccurate rural designation. The locality update (known as the California "GPCI fix") is part of the “Protecting Access to Medicare Act of 2014” bill passed by the House and Senate last week to postpone for one year the 24 percent cut to Medicare physician payments as called for under the fatally flawed sustainable growth rate (SGR). The bill (H.R. 4302) was signed into law by the President on April 1. The California GPCI fix will increase payments to physicians in 14 counties by $50 million annually to over $400 million in the next decade. The rate increase begins in 2017 and will be phased in each year until full implementation in 2022. The counties poised to see reimbursement increases are San Benito, Santa Cruz, Marin, Santa Barbara, San Diego, Monterey, Sonoma, Placer, El Dorado, Yolo, Sacramento, San Luis Obispo, Riverside and San Bernardino. Because private health plans in these areas tie their fee schedules to the Medicare fee schedule, this will help access to care for all California patients, not just Medicare seniors. Locality 3 counties of Napa and Solano and Locality 99’s remaining rural counties will be held harmless from cuts. (In other words, their geographic rates will never be lower than their current rates.) Their rates can increase as costs go up but they will never be cut below the current floor. San Francisco, Santa Clara, San Mateo, Alameda, Contra Costa, Orange, Ventura and Los Angeles counties have always been in their own localities and reimbursed at their local costs to provide care. This will continue under the MSA system. This is a huge win for California patients and physicians. It will maintain and improve access to care in many regions of California. CMA has many California Members of Congress to thank for the herculean bipartisan team effort to finally get the California locality reform through Congress and signed into law. CMA extends its strongest thank you to our long-time Congressional GPCI quarterback, Congressman Sam Farr (D-Santa Cruz, San Benito, Monterey) for his perseverance to see this through. Congressman Farr and Congressman Darrell Issa (R-San Diego) led the Congressional effort and were extremely effective in passing this law. CMA also extends its gratitude to Congressman Henry Waxman (D-LA), ranking Democrat on the Energy and Commerce Committee, who originally included the California provision in the Committee’s bipartisan Medicare SGR bill, setting the stage for its final passage. CMA must also express its deep appreciation to California's Senators Dianne Feinstein and Barbara Boxer who, for the first time in six years, were able to convince the Senate leaders to include the California reform in the Senate Medicare SGR legislation. Senator Feinstein’s leadership on the Senate side was key. And sincere thanks to House Majority Whip, Congressman Kevin McCarthy (R-Bakersfield), for his willingness to protect California’s rural physicians and include the California reform in the final SGR patch legislation. California Energy Commerce Committee members, Anna Eshoo (D-Santa Clara), Lois Capps (D-Santa Barbara) and Doris Matsui (D-Sacramento), Ways and Means Committee members Mike Thompson (D-Napa, Sonoma, Solano) and Devin Nunes (R-Tulare), and House Leader Nancy Pelosi made this issue a priority and were instrumental in moving it through their committees and the House. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. April 4, 2014 Medicare Rural Health, Geographic Practice Cost Index, GPCI, Medicare 0 0 Comment Read More »
Governor signs bill for Steve M. Thompson loan repayment program Governor Jerry Brown has signed a California Medical Association (CMA)-sponsored bill that will refine the eligibility criteria for a successful physician retention program, the Steven M. Thompson Physician Corps Loan Repayment Program. The program provides grants of up to $105,000 to physicians who agree to practice in medically-underserved areas of the state for at least three years. The program was created in 2002 under a bill sponsored by CMA. Since its inception, the program has awarded more than $17 million to over 220 individuals. Unfortunately, high demand for this program means less than one third of applicants have been awarded funding. This bill (AB 565) will modify eligibility to require applicants have three years of experience providing health care services to medically underserved populations as designed by the federal government. This change will ensure that individuals providing health care services, such as working in a clinic or other patient care settings, are prioritized over other types of services. AB 565 will also give preference to applicants who commit to serving an underserved population that is located in a federally designed shortage area, ensuring the most dire shortages are given priority. Additionally, as an acknowledgement of the severe shortage areas in the Central Valley, Inland Empire and other rural areas of California, AB 565 also gives preference to applicants who agree to practice as safety net providers in rural communities. “The CMA is proud to be a sponsor of this bill,” said Paul R. Phinney, M.D., CMA president. “Expanding access to care in rural and underserved populations of California will help ensure patients get quality, timely care that they need. With millions of new patients entering the health care system in the coming year, we must do all we can to incentivize providers to practice where they are most needed." October 1, 2013 General Advocacy, Medical School Loans, Rural Health, Underserved Communities, Steven M. Thompson Loan Program, Young Physician 0 0 Comment Read More »
DHCS selects health plans for rural expansion of Medi-Cal managed care The Department of Health Care Services (DHCS) announced last week that it has selected four health plans to provide managed care services to approximately 410,000 Medi-Cal beneficiaries in 28 rural counties. The selections are contingent upon each plan meeting stringent readiness criteria. The California Legislature authorized, as part of last year's budget, the expansion of Medi-Cal managed care into rural fee-for-service counties, expanding Medi-Cal managed care program into all of California’s 58 counties. This expansion is part of the governor's plan to reduce costs in the Medi-Cal program. Under the expansion program, eligible Medi-Cal enrollees will be required to enroll in a Medi-Cal managed care program in order to receive services, effective June 1, 2013. The plans selected by DHCS include Anthem Blue Cross and California Health and Wellness Plan, which received Notices of Intent to Award for the expansion of Medi-Cal managed care to the counties of Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne and Yuba. The state is also planning an exclusive Medi-Cal managed care contract with Partnership HealthPlan of California for expansion in Del Norte, Humboldt, Lassen, Modoc, Shasta, Siskiyou and Trinity counties. In addition, Lake and San Benito counties would become County Organized Health System managed care counties served by Partnership HealthPlan of California and Central California Alliance for Health, respectively. DHCS is currently working with Imperial County on its managed care plan selection process. Click here for more information on Medi-Cal Managed Care Rural Expansion. The California Medical Association will provide members with additional details as they become available March 5, 2013 Medi-Cal California State Budget, Department of Health Care Services, Managed Care, Rural Health, Medi-Cal 0 0 Comment Read More »
