Here's the complete version of the article that appeared in today's Albuquerque Journal ( May 4, 20100) which I wrote along with Dr. Dan Derksen, of the UNM Medical School. He's a Family Doctor and knows a lot more than I do.
A little
over a month ago, President Obama signed H.R. 3590 the “Patient Protection and
Affordable Health Care Act” and H.R. 4872 the “Health Care and Education
Reconciliation Act” into law.
By 2014, it is estimated that 240,000 New Mexicans will be eligible for
private insurance through insurance exchanges and another 125,000 through
Medicaid expansion in our state. That’s the good news.
But will we have enough health providers to care
for an additional 365,000 (out of our estimated total of 450,000) uninsured
that will have health insurance? By 2025, there will be a shortage of 40,000
primary care physicians in the United States and up to a million nurses. New Mexico’s current primary care
physician shortage is 400 and will grow to 950 in 10 years. A recent study by the Commonwealth
Foundation ranked New Mexico last in access to health care of all states, and last
in access to preventive services. That’s the bad news.
While opponents of the bill have said that this
shortage dooms health care reform, they overlook some important elements of the
new law that have not received the media attention they deserve.
Provisions
in the federal legislation that begin this
year will help states build the health professional workforce over the next
four years to prepare for insurance coverage provisions that begin in
2014.
Many of these provisions were inserted by our
own Senator Jeff Bingaman who is familiar with our
shortages—and successful pilot projects-- here.
First, the bills allocate $125 million over 3
years in grants, and another $230 million over 5 years in direct and indirect
graduate medical education funding for “teaching health centers” based on
models pioneered in New Mexico (La Familia and St. Vincent’s in Santa Fe,
Roswell, Albuquerque’s South Valley Health Commons, and in Hidalgo County) in
partnership with UNM. Training in these community-based centers increases the
retention of UNM medical school graduates who practice in New Mexico two- to
threefold. Retention of UNM graduates has been a problem in the past-- currently
approximately 25 percent remain in the state. This new funding could help start
new primary care residency programs in community health centers and rural
hospitals in places like Silver City and Farmington.
Second, the bill creates a National Health
Workforce Commission to design funding and incentives, and to evaluate the implementation
and revision of federally funded programs, grants, and regulations related to
the nation’s health workforce including nursing, dental, and medical
professionals. We need it. What we are doing now is not enough.
Another very important
provision will increase Medicare, Medicaid and Children's Health Insurance
Program payments for primary care services by 10%. Commercial insurance payers
follow Medicare’s lead in paying for primary care so this is an important
change and it will actually save money in the long run, since regular, routine
care through a family physician, nurse practioner or other primary care
provider prevents illness, manages chronic disease and curtails costly health
catastrophes.
The new payment schedule will also encourage
medical students to go into primary care, instead of more lucrative specialties
to which many are drawn to pay off medical school debt.
Other
provisions of the law will spur models that reward coordination of care – such
as the Patient Centered Medical Home. These more-coordinated,
multi-disciplinary “homes” are beginning to spring up in New Mexico after the
passage of state legislation sponsored by Rep. Danice Picraux and supported by
the NM Medical Society in 2009. They are popular with patients who get more
wrap-around, appropriate care that fits their lifestyle and pocketbook. Although these homes are sprouting in
other states, New Mexico is very well positioned to take advantage of the new law’s
provisions.
Another
provision creates a Primary Care Extension Program, links with academic
institutions, creates hubs in communities, and uses health extension agents, to
expand primary care training and services.
Professional
health training is expensive for the New Mexicans who wish to become nurses,
physicians, dentists, physician assistants, dental assistants, or pursue other
health professions careers. The new
law expands loans, scholarships and grants to encourage health professionals to
practice in health professions shortage areas.
At the state level, we currently have a law on
the books which subsidizes tuition for medical students who commit to working
in primary care in New Mexico’s rural areas. But, with the current budget crisis, there is no state
funding. The federal law could
fund this and other student programs and help fill the pipeline with much
needed health providers.
As an added bonus, the National Center for Rural
Health Works estimates that one primary care physician generates about $1.5
million in revenue, $0.9 million in payroll, and creates 23 jobs. Thus adding the 400 primary care
physicians needed in New Mexico would create over 9,200 jobs and generate much
needed tax revenue for the state.
Four hundred by 2014 – that’s a goal worth shooting for – and now within
reach if we act quickly to take advantage of health workforce provisions in the
health reform legislation.
Senator Dede Feldman is the vice-chair of
the New Mexico Legislative Health and Human Services Committee. Daniel Derksen, M.D. is a family
physician, senior fellow in the Robert Wood Johnson Center for Health Policy
and Professor at the University of New Mexico.
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