Letter to the Hon. Alex Azar, Secretary of the US Department of Health and Human Services - Gardner, Bennet Make Bipartisan Push to Support Physician Training Programs in Rural Communities

Letter

Dear Secretary Azar:

As you continue to address the provision of health care during the COVID-19 public health emergency, we ask that the Department of Health and Human Services (HHS) resolve COVID-related rural physician training issues.

While HHS has taken important steps to shore up the health care system, rural physician training is at risk. Rural hospitals have been significantly impacted by revenue losses due to the COVID19 pandemic, and without federal action, we are concerned that some may be forced to discontinue their physician training programs to remain open. In an effort to address this concern, we ask that you support these important physician training programs by releasing approximately $100 million in targeted funding from the Provider Relief Fund established in the CARES Act to fund rural hospitals that train physicians and commit to maintaining training programs for at least three years.

The Government Accountability Office has reported that "rural training sites may incur higher costs because their training may have to utilize multiple training sites--such as community hospitals or rural health clinics--in order to meet accreditation requirements for resident rotations and patient case-mix. The added administrative work of coordinating with other sites to provide these resources can be a challenge." Additionally, the data show that training in rural areas increases the likelihood of practice in rural areas, and is associated with a two- to threefold increased likelihood of rural practice. For example, graduates of Family Medicine Rural Training Tracks practicing in rural areas average approximately 35%, which compares very favorably to the current 9% of all physicians currently in rural practice.

We are concerned about the impact of COVID-19 on the physician training infrastructure in rural America. Given the economics of rural residency training, as rural hospitals face financial difficulties, a residency program is convenient ballast -- easily jettisoned to help the financial bottom line. Even hospitals that do not close may choose to decrease or eliminate their residency program due to its added costs. It is critical that we maintain these programs in order to ensure our rural communities have a sustained health care workforce for the future.

We urge you to commit immediate resources from the Provider Relief Fund to rural hospitals that maintain their current residency training programs. This will help rural hospitals currently training residents who are likely to go into rural practice, often near their training site, and who supply a significant portion of the future workforce serving those hospitals. The proposed, targeted payment is not a substitute GME payment, but rather an incentive payment to a rural hospital that commits to maintaining its current training program. The payment would be determined by the number of resident positions; however, it is not a payment for residency education. A rural hospital which serves as the primary location of training of greater than 50% of residents' time, would receive the bonus payments upon agreeing to maintain its training program(s) for the next three academic years.

As you continue to address the financial needs of the provider community, we request that you include support for the physician training pipeline in rural America. This action will help provide needed care to patients during this emergency, and help maintain a physician workforce for the future.

We appreciate your attention to this important matter.