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Federal primary-care program for underserved areas is at risk despite successes

A government program that is providing care for some 500,000 patients and has successfully increased the number of primary-care physicians in underserved areas is in danger of folding.

The federal Teaching Health Center program was created with a $230 million appropriation in Section 5508 of the Affordable Care Act and, as of 2014, it was helping to train 550 residents at 60 centers in 27 states and the District of Columbia in underserved rural areas and urban neighborhoods. The program's money is running low, but some advocates are hoping that an appropriation could be part of the next legislative “patch” Congress passes to postpone decreases in physician Medicare reimbursement set to go in effect April 1 as part of the sustainable-growth rate pay formula.

A new policy research brief by George Washington University's Geiger Gibson/RCHN Community Health Foundation Research Collaborative shows that the program has been working as intended and its findings may provide some momentum to keep it going.

“The key point we hope to make is that this is a promising approach to meet the demands we are facing,” said Leighton Ku, lead author of the policy brief.

The brief cites a survey by the American Association of Teaching Health Centers that includes data on 91 doctors who started their training at 10 of the original 11 programs and finished their residency in the 2013-14 academic year. The survey found that 91% of these doctors were working in primary care, compared with only 23% of their peers. Also, 76% of physicians trained in the program were practicing in underserved areas, compared with 26% of their peers. And 21% were practicing in rural areas, compared with 8% of their peers. (Comparison figures were derived from a 2013 report in the journal Academic Medicine.)

Two-thirds of the program's former residents continue to practice in the state where they trained. A full 87% of the residents who completed their training at Lone Star Community Health Center outside of Houston, for example, are still practicing in Texas.

The authors calculated that the 550 residents enrolled in the program are caring for a total of 500,000 patients and can be expected to take care of almost 1 million after their training is done.

The program is also popular among medical students. Some 11,000 students applied for the 93 residency positions available for the 2014-15 academic year.

The Affordable Care Act initially funded the program as a five-year effort with training institutions receiving $150,000 annually per resident. Ku said some institutions are using only a portion of that amount (usually about $75,000) to partially fund a resident's training in order to stretch the money out and help residents currently in the program to finish their training.

“Programs are saying, 'We won't take in new residents for the academic year that starts July 2015, but we'll continue to support the people we have now,' ” said Ku, a George Washington University professor of health policy and management.

The concept of teaching health centers had been “kicked around for a while” long before the ACA was drafted, but it needed attachment to a “must-pass” legislative vehicle to get approved, Ku said. The ACA provided that vehicle, but now may prove to also be its downfall as anything associated with that controversial legislation faces difficulty getting renewed.

Sen. Patty Murray (D-Wash.) introduced a bill (PDF) last July that called for providing an additional $420 million to extend the program through fiscal 2019. But no one co-sponsored the bill and it died without action in the Finance Committee.

Supporters are looking for another “must-pass” vehicle to attach an appropriation to. The most-promising bills would either be the latest bill postponing SGR-driven Medicare physician pay cuts or measures to extend the Children's Health Insurance Program (CHIP), which is scheduled to expire Sept. 30.

Members of the American Association of Teaching Health Centers have been pushing for attaching an extension onto an SGR bill.

The group laid out its strategy in a recent THC Graduate Medical Education Legislative Update. Members were encouraged to schedule visits with legislators during the Feb. 13-23 Congressional recess.

The update cited the proposed Hospital Improvements for Payments (HIP) Act and noted that “there is some likelihood that HIP provisions may be attached to the SGR legislation.”

One emerging strategy would be to connect an extension of the teaching health center program onto that legislation, which in turn would be attached to the expected SGR fix.

Follow Andis Robeznieks on Twitter: @MHARobeznieks


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