CMS' missed opportunity to mitigate the anesthesiologist shortage

CMS' rural pass-through program was created to incentivize certified registered nurse anesthetists and anesthesiologist assistants to work for small rural hospitals — but some leaders feel physicians should be included, too. 

The program allows eligible hospitals to use reasonable-costs based Part A payments instead of Part B payments, according to the American Society of Anesthesiologists. 

Mark Thoma, MD, chair of anesthesia with San Francisco-based The Permanente Medical Group, joined Becker's to discuss how the rural pass-through could help mitigate provider shortages. 

Question: What are the downsides of the rural pass-through not applying to physicians?

Dr. Thoma: We really need coverage everywhere. Everybody should have access to top quality. That's just my opinion, and I don't think I'm alone in this. It's very difficult in rural areas, because much of medicine is fee-for-service, so a lot of times the hospital is paying a stipend to keep full-time coverage available, because you're not making it up in your billables. So the rural hospitals are really in a jam. hen you're looking at facilities that are doing less than 800 cases a year or counties that have less than 500,000 people, you're just not going to have that volume. 

Additionally, attracting people to those places can be very difficult. I certainly applaud the opportunities. I think the idea of modifying the laws to make it a little bit easier to get some coverage out there is important. But I do feel sometimes there's a side effect where, as much as they are intended for rural hospitals, it ends up where there are people using that independence to still live in urban and suburban areas. The other side of it is there's plenty of people that come from those communities that want to return to those communities. I went to UC Davis for med school, and they have this idea where they provide the physicians for California, they attract from California and they expect them to want to return to California. With this current policy, I think they're sort of missing out on that opportunity to get physicians from the communities out to those areas.

Q: How does this tie into the physician shortages in rural areas? Do you think this could be a way to mitigate those shortages? 

MT:  I know a physician who goes to Chico, Calif., which is known for Cal State Chico, at least once a year and contracts with dentists from across the northern part of the state to bring their sick dental kids in on one day or one weekend and completes as many cases as possible. And these kids have been on antibiotics for dental abscesses for a year. So he goes to knock out as many cases as possible over that time period, because there's no other access. 

With that in mind, I do personally think that extending the rural pass-through could help physician shortages in rural areas, because it will make it more attractive. Like if you think about other incentive programs that have been done — whether it's loan forgiveness or stipend signing bonuses to get people to spend part of their time in other rural areas — they end up working. It's just one more thing that we can do to make it more attractive to be a physician. We'll still have a shortage, but it could help.

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