Wealthy hospitals should be last in line for the new residency slots

TThe US $ 1.9 trillion bailout plan signed by President Biden in March provides funding to create an additional 1,000 doctor offices in hospitals across the country. The provision is one of many in the bill that aims to help health systems deliver basic care to their patients and communities.

While this important ramp-up is long overdue, an unjust distribution of these residences will fail to serve its purpose. In order to fairly expand the delivery of necessary health services, a significant proportion of new specialist practices in basic areas – including internal medicine, family medicine, pediatrics, obstetrics and gynecology, general surgery, diagnostic radiology, psychiatry, and emergency medicine – should be in rural hospitals first , underserved and tribal areas. The remaining residences should then go to wealthy hospitals.

The expansion of the number of residential units, limited by the Budget Act of 1997 and unchanged for almost 25 years, could not have come at a better time. The combination of a growing and aging population, better access to insurance coverage, and retirement of older doctors would result in a dangerous loss of 37,800 to 124,000 U.S. doctors by 2034.

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The new medical residences funded by the American Rescue Plan will help avert this crisis – if their allocation is based on where in the country new doctors are most needed. Unfortunately, the unjustified allocation of billions under the CARES Act last year shows that the distribution of federal aid to hospitals often favors large, affluent and well-connected facilities at the expense of smaller facilities that mainly treat low-income groups.

According to a 2020 study by the Kaiser Family Foundation, hospitals that care primarily for financially secure patients received twice as much CARES Act relief as hospitals that care for more needy patients with Medicare, Medicaid, or no coverage. The guidelines that determined the distribution of CARES Act funds were developed by the Department of Health and Human Services with the participation of influential lobby groups representing prominent hospitals. HHS funding formulas have overwhelmingly benefited large and wealthy institutions located in major metropolitan markets – such as the Cleveland Clinic, New York Presbyterian Hospital, and HCA Healthcare, to name a few.

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To give an idea of ​​how comfortable these affluent hospitals are, most have billions in cash on hand, receive millions more from affluent donors, run their own venture capital funds, and work with private equity firms to generate billions in additional investments Profits. Did they need eight or nine digit CARES Act Emergency Aid IV fluids to keep the lights on? No – and they certainly don’t need the money as much as vulnerable hospitals, which mainly care for disadvantaged population groups and only have enough funds to cover operating costs for just a few weeks.

Although quite financially sound, wealthy hospitals will undoubtedly use their enormous leverage and influence to claim the greatest number of the new residences. Why this aggressive approach? The amount of long-term profit that each residence slot offers is too great to pass up.

Up to half of a resident’s salary is paid by the federal government as a direct payment for medical training. The federal government also grants the hospitals an indirect medical training allowance, which provides an additional allowance of up to 12% to 15% of the invoiced amounts for the medical services of their residents. Add to this the total fees that hospitals charge patients in addition to the professional services provided by their residents (rooms, meals, supplies, lab work, tests, procedures, and the like), and it shows just how valuable the American Rescue Plan’s new residences are will be in all hospitals now and in the future.

For wealthy hospitals, the benefit of a bonus crop of new residents is even greater: the majority of patients at these hospitals are privately insured, which means their hospital bills are worth almost double what they would if they were paid for Medicare or Medicaid.

Without a framework to ensure that the new residents of the American Rescue Plan are assigned to the hospitals where they do the most good, we could see a repeat of last year’s funding skew of the CARES Act by powerful health organizations versus smaller, less so favored preferred.

To achieve a fairer arrangement, two benchmarking methods can be used: Hospitals can be graded according to a doctor-patient ratio (hospitals with the highest average number of patients under medical supervision would come first). Another approach is to use a relationship between private and public insurance (hospitals that pay more patient bills with Medicare and Medicaid than with private insurance would be high on the list).

Monetary incentives could also be built into the designation of the new residency places that would support young doctors wishing to start their careers in low-income, underserved, and tribal regions, with tax-free grants to offset their substantial medical school debts. In addition, they could receive scholarships to pay for their moving, utilities, and housing costs.

The American Rescue Plan aims to improve the health of disadvantaged groups over the long term by improving access to medical care, investing in community health, and making social contributions to health. Giving the lion’s share of the plan’s new medical residency places to wealthy hospitals will undo that goal. Prioritizing the establishment of vital services in low-income urban areas, medically underserved rural areas, and tribal areas across the country will accomplish this.

David Lenihan is the CEO of Ponce Health Sciences University and Tiber Health, a St. Louis-based medical education company.

source https://dailyhealthynews.ca/wealthy-hospitals-should-be-last-in-line-for-the-new-residency-slots/