One of the Senate's health policy leaders is preparing legislation to address a primary-care physician shortage that could balloon next year as millions of uninsured Americans get coverage under the healthcare reform law.
Sen. Bernie Sanders (I-Vt.) told reporters after a Tuesday hearing that he would soon introduce a bill and push for it to be enacted before the launch of the law's individual insurance mandate, Medicaid expansion and insurance exchanges in 2014.
“There has been a crisis, but that crisis has been accentuated by the ACA and 30 million more people getting insurance, so we just got to make sure there is a place for them to go,” Sanders said.
Sanders said his legislation will fund “a significant expansion” of community health centers and the National Health Service Corps; require membership changes in the American Medical Association advisory panel on Medicare payment rates; and require teaching hospitals to focus on training more primary-care physicians.
Sanders' plans to fund further growth of community health centers followed the Obama administration's decision last year to slow down the distribution of $11 billion designated for them in the Affordable Care Act. The administration proposed holding back for future use $280 million of a $300 million boost those facilities were set to receive in 2012.
“We've got to spend the money we have and fight for more in the future, so I am not sympathetic with what the administration is doing,” Sanders said.
The legislation would target some of the main drivers of an ongoing shortage of primary-care physicians highlighted by witnesses at Tuesday's hearing by the Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging.
Several senators blamed the AMA's Relative Value Scale Update Committee for leading Medicare to pay primary-care physicians at lower rates than the program pays other physicians. The CMS generally uses the committee's recommendations to set Medicare reimbursement rates for different medical services, and a majority of its members are non-primary-care specialists.
Dr. Andrew Wilper. acting chief of medicine at the VA Medical Center, Boise, Idaho, described the RUC as “a secretive group of physicians that wield tremendous influence on Medicare.”
Uwe Reinhardt, economics professor at Princeton University, said in addition to adding primary-care physicians to the RUC, that panel needs a third party to perform outside audits of the AMA panel's recommendations.
Medical schools and teaching hospitals also drew the ire of hearing witnesses for discouraging a primary-care focus by their participants in favor of more prestigious specialties. Several participants said primary-care educational requirements need to be attached to the $10 billion in annual graduate medical education funds provided through Medicare.
“The primary-care culture is often put in the back of the bus” by medical school officials, said Dr. Fitzhugh Mullan, a professor of pediatrics at the George Washington University Medical School.