A range of legislation may help alleviate the shortages, which sometimes are driven by federal payment policies.


May 22—Senators said this week that they are convinced a healthcare workforce shortage is worsening and federal action is needed to address it.

Researchers and healthcare workforce training leaders testified at the Senate Health, Education, Labor and Pension (HELP) Committee about the extent and concentrations—especially in rural areas—of healthcare workforce shortages. Existing shortages include the need for 13,800 additional primary care physicians in areas—especially rural—that are designated as health professional shortage areas, according to estimates of the Health Resources and Services Administration (HRSA). Signs of a worsening situation include projected shortages of 20,000 primary care physicians by 2025, according to HRSA, and 42,600 to 121,300 physicians by 2030, according to the Association of American Medical Colleges.

“Despite the uncertainty and the variation between these predictions and others, there are no major models which suggest that the supply of physicians at current levels will be adequate,” Kristen Goodell, MD, assistant professor of family medicine at Boston University School of Medicine, testified to the HELP Committee.

The message on healthcare provider shortages got through to senators.

“We know that the shortage of healthcare professionals, which includes doctors, nurses, paramedics, and X-ray technicians, is a problem that has the potential to keep getting worse,” said Sen. Lamar Alexander (R-Tenn.), chairman of the HELP Committee.

The shortage also comes amid an ongoing healthcare hiring spree, with the industry’s share of total U.S. jobs reaching 10.76 percent—the highest ever—according to a recent Altarum analysis

Congressional Action

Among the legislative responses to the healthcare workforce shortages was this week’s introduction of a bill, the Geriatrics Workforce Improvement Act, which would make permanent and fund the Geriatrics Workforce Enhancement Program (GWEP). The program provides training for healthcare professionals on the care of elderly patients.

HRSA launched GWEP in 2015 with 44 three-year grants. The new bill would permanently authorize GWEP and provide it with $45 million annually through 2023.

“Because most older adults will continue to receive primary care from frontline providers from the fields of family medicine, general internal medicine, and nurse practitioners—not geriatricians—we must support the training of providers in those disciplines to make good care a reality,” said Elizabeth Phelan, MD, associate professor of medicine, gerontology, and geriatric medicine at the schools of medicine and public health for the University of Washington.

Sen. Susan Collins (R-Maine), the bill’s sponsor, said its need was demonstrated by the fact that less than 1 percent of physicians or nurses have a board certification in geriatrics, even though that segment of the population is growing fastest.

“The way it is referenced around the state is, ‘When you hit 65 you’re given a bus ticket, but there’s never a bus that will show up because we don’t have sufficient providers,” said Sen. Lisa Murkowski (R-Alaska).

The bill echoes bipartisan legislation that was introduced in 2017 in the U.S. House of Representatives.

Similarly, the Title VIII Nursing Workforce Reauthorization Act would authorize the continuation of four nursing training programs that supported 10,537 nursing students in the 2016 to 2017 academic years.

The nursing funding is targeted to HRSA teaching programs that are based in rural and medically underserved areas, including subsidizing 75 percent of the Advanced Nursing Education Program and 61 percent of the Nurse Anesthetist Traineeship program. More than half of the graduating students in those two programs planned to pursue employment in medically underserved areas, according to the latest HRSA budget.

The reality that providers tend to stay in areas where they train drew the focus of many legislators.

Among possible additional legislative steps are changes to federally funded academic residency slots to focus those slots on areas with especially acute shortages, Goodell said when Sen. Bill Cassidy (R-La.) asked for policy change ideas. She noted that such slots are concentrated in states with the least shortages, such as Massachusetts and New York.

“We need to think of graduate medical education as a national issue,” Goodell said.

Murkowski, who noted that Alaska funds 20 residency slots in a Washington state facility without assurance that those physicians would eventually practice in Alaska, also suggested increasing the total number of slots nationwide.

Other ways to help address the provider shortage, especially in rural areas, include greater use of telemedicine, said Julie Sanford, DNS, RN, FAAN, director and professor of the School of Nursing at James Madison University in Virginia.

A House committee recently considered legislation to waive Medicare telehealth requirements to allow treatment for opioid use disorder or co-occurring mental illnesses. 

Health and Human Services (HHS) Secretary Alex Azar II also recently indicated support for a provision of the bipartisan CONNECT for Care Act that would give the HHS secretary authority to waive Medicare barriers to payment for telehealth, according to published reports. That legislation has the backing of some hospital advocates but has not begun to advance in either chamber of Congress.

Administrative Steps

Ongoing steps by the Trump administration also may help address provider shortages, according to the testimony.

For instance, Goodell said physician burnout driven by growing administrative burdens is contributing to the shortage. Specifically, physicians are practicing a fewer number of hours each week, on average, because they are worn down by emerging requirements, such as electronic health record data entry. Fewer working hours increases the need for more physicians.

The administration has taken steps to address the EHR burden, including in the recently issued Inpatient Prospective Payment System proposed rule, which recommended that EHR performance be reported for a 90-day period—instead of a full year—in both 2019 and 2020, as well as allowing hospitals to report only four electronic clinical quality measures and reducing the number of such measures.

Earlier in May, the Centers for Medicare & Medicaid Services (CMS) also released a rural health strategy, which includes promises to reduce regulatory barriers to telehealth, among other steps.

“This builds on our longstanding collaboration with CMS and will highlight key issues for rural safety net providers like rural hospitals and community health centers for CMS and HHS,” George Sigounas, PhD, administrator of HRSA, said in a written statement.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Tuesday, May 22, 2018