Primary Care Health Workers D.C., whose practice focuses primarily on healthcare policy, federal funding and government relations important to hospitals, community health centers and related non-profit organizations. 2100 M Street, N.W., Suite #200 Washington, D.C. 20037 202.785.4185 Phone 202.466.1286 Fax khatfield@stewartlaw.com www.stewartlaw.com Vermont chaired a subcommittee hearing of the Senate Health, Labor, Education and Pension Committee on the looming primary care worker shortage. He stated, "some 45,000 people unnecessarily die each year because they don't get to a doctor when they should." He declared that lack of access to primary care is a serious national concern especially acute in underserved rural communities and inner cities. Equally alarming is America's projected inability to treat scores of new patients: the American Association of Medical Colleges estimates the shortfall in physicians could reach approximately 91,500 by 2020, and more than 130,000 by 2025. Why the shortage? extend medical coverage to over 30 million more Americans. Second, the U.S. population continues to age and will need more care: it is projected that each day for the next 20 years. Third, while Medicare pays a significant share of the cost of training new doctors, money is tight and new doctors are expensive. Medicare reimburses hospitals for some of their training costs using Gradu- ate Medical Education (GME) payments tied to the level of Medicare services provided by the hospital. (Community Health Centers (CHCs) are also reim- bursed with Medicare funding, and their costs are similarly calculated based on the facility's Medicare share.) Hospitals seek to expand the number of new GME-funded physicians they can train but are hampered by the exist- ing residency "cap" enacted by law as part of the 1997 Budget Act. The cap limits hospitals to a certain number of residents and prevents hospitals from increasing the amount of Medicare GME they can dedicate to training residents. Legislation to expand the cap has been introduced in several past congresses by Senator Bill Nelson (D-FL), but this issue more seriously: upon its introduc- tion this year, cosponsors were Senate Majority Leader Harry Reid (D-NV) and Charles Schumer (D-NY). Additional Senate supporters now include Bob Casey (D-PA), Debbie Stabenow (D-MI), Bob Menendez (D-NJ) and William "Mo" Cowan (D-MA), the first three of whom serve on the Senate Finance Committee to which the bill has been referred. Other congressional champions who seek to enlarge the healthcare workforce believe the nation should also expand the number of Federally Qualified Health Centers (FQHCs), which today provide medical, dental and behavioral health, as well as prescription drugs, to 22 million patients through 1,200 health centers. Other members of Congress have proposed bills to provide Medicare- funded GME to train physicians not only in hospitals, but also in health centers. To this end, Sec. 5508 of the Afford- able Care Act provided $230 million for five years to support the expansion of primary care physician residency training in community-based ambulatory "Teaching Health Centers (THCs)." The funding built on years of evidence which |