Public comment deadline nears for proposed CMS rule that expands rural health care
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CMS recently proposed a rule that aims to strengthen the U.S. health care workforce.
In addition, to help contain the spread of COVID-19, CMS said the proposed rule would also require hospitals to report COVID-19 vaccination rates among health care personnel.
The deadline for public comment on the proposed rule is June 28, according to the Federal Register.
“Hospitals are often the backbone of rural communities — but the COVID-19 pandemic has hit rural hospitals hard and too many are struggling to stay afloat,” HHS Secretary Xavier Becerra said in a press release. “This rule will give hospitals more relief and additional tools to care for COVID-19 patients and it will also bolster the health care workforce in rural and underserved communities.”
Proposals related to rural health care
Prior to the proposed rule being announced, data from the American Association of Medical Colleges predicted a shortage of up to 139,000 physicians, including 55,200 primary care physicians, by 2033. According to the Robert Graham Center, after graduation, 56% of family medicine residents stay within 100 miles of where they performed their residency.
CMS said it is proposing to allocate 1,000 new Medicare-funded full-time equivalent medical residency positions to certain hospitals, including ones in rural areas and those that help patients in areas that have a scarcity of health care professionals. A CMS spokesperson told Healio Primary Care these positions would be “phased in at a rate of no more than 200 slots per year beginning in fiscal year 2023.”
The agency also said it is proposing to carry out the part of the Consolidated Appropriations Act, Promoting Rural Hospital GME Funding Opportunity that permits rural training hospitals that are taking in an accredited rural training track to acquire an increase in their graduate medical education cap.
"Another provision allows participating hospitals to receive an increase in their [full-time equivalent] slots if they expand an already existing [rural training track] to include a new rural training site," the CMS spokesperson said.
Proposals related to COVID-19
The proposed rule would also require hospitals to provide CMS with data on how many of their health care personnel have been vaccinated against COVID-19.
“This proposed measure is designed to assess whether hospitals are taking steps to limit the spread of COVID-19 among their workforce, reduce the risk of transmission within their facilities, help sustain the ability of hospitals to continue serving their communities through the public health emergency and assess the nation’s long-term recovery and readiness efforts,” CMS said.
In another COVID-19-related proposal, CMS suggested using data gleaned from the beginning of fiscal year 2019 to the start of the COVID-19 public health emergency to estimate inpatient hospital utilization rates for fiscal year 2022. The agency, which said its goal is to use “the best available data overall,” said the decision is based on reports that indicate the pandemic spurred declines in many aspects of health care.
To review the complete proposed rule, visit the Federal Register’s website.
References:
American Academy of Family Physicians. CMS-172-P; Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2022 Rates. Available at: https://www.aafp.org/dam/AAFP/documents/advocacy/workforce/gme/LT-CMS-FY2022IPPSProposedRule-060721.pdf. Accessed June 9, 2021.
Blake Fagan E, et al. American Family Physician. Migration After Family Medicine Residency: 56% of Graduates Practice Within 100 Miles of Training. Available at: https://www.aafp.org/afp/2013/1115/p704.html. Accessed June 9, 2021.
CMS. CMS proposes to enhance the medical workforce in rural and underserved communities to support COVID-19 recovery and beyond. Available at: https://www.cms.gov/newsroom/press-releases/cms-proposes-enhance-medical-workforce-rural-and-underserved-communities-support-covid-19-recovery. Accessed June 9, 2021.
CMS. Fact sheet. Available at: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care. Accessed June 9, 2021.
IHS Markit on behalf of the Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2018 to 2033. Available at: https://www.aamc.org/media/45976/download. Accessed June 9, 2021.
National Archives. Proposed rule by the Centers for Medicare & Medicaid Services on 05/10/2021. Available at: https://www.federalregister.gov/documents/2021/05/10/2021-08888/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the. Accessed June 9, 2021.
Perspective
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The American Academy of Family Physicians recently submitted comments to CMS in response to the FY 2022 Hospital Inpatient Prospective Payment System proposed rule (CMS-1752-P).
This proposal charts a course for allocating 1,000 new graduate medical education residency positions that were enacted by Congress in December 2020. The AAFP urges CMS to apportion these new residency slots in a way that would effectively alleviate ongoing physician shortages in rural and underserved areas and therefore improve equitable access to comprehensive care across the nation.
The academy supported CMS’s proposal to prioritize applications for new residency slots that are submitted by hospitals located in Health Physician Shortage Areas and that care for underserved populations. However, we recommended CMS also prioritize applications from hospitals that produce more trainees who ultimately practice in health professional shortage areas. This would offer a more sustainable approach by investing in physicians who will care for underserved communities well into the future.
We also support CMS’s proposals to establish new rural training track sites, but we strongly urge CMS to allow existing rural training sites to increase the number of physicians they can train. These sites have been successful at training rural physicians and addressing physician shortages — priorities shared by the AAFP and federal policymakers — and we recommend they are expanded.
The AAFP applauds CMS for prioritizing health equity in these proposals and looks forward to partnering to ensuring the Medicare GME program is effectively addressing the maldistribution of physicians and disparate access to care across the country.
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