primary care

[washamericom]

no one liked my idea, which i put forth as the health care debate began. i said "take a half a trillion dollars, open up as many low cost or free clinics as you can. take the other half to hire doctors out of residency, pay them 100,000/year. if they stay for a given period of time, pay off their student loans, a portion percentage/ year diminishing. it ecourages, young people to want to be doctors, and it eliminates the insurance companies and it create real jobs. not government made up ones."

 

[Greenbeard]

Well, the numbers aren't quite the same but the spirit is similar. From the new law:

On community health centers:

Sec. 4101. School-based health centers. Authorizes a grant program for the operation and development of School-Based Health Clinics, which will provide comprehensive and accessible preventive and primary health care services to medically underserved children and families. Appropriates $50 million each year for fiscal years 2010 through 2013 for expenditures for facilities and equipment. Section 10402 adds vision services to the list of health services for which a School Based Health Center should provide referrals.

Sec. 5313. Grants to promote the community health workforce. Authorizes the Secretary to award grants to States, public health departments, clinics, hospitals, Federally qualified health centers, and other nonprofits to promote positive health behaviors and outcomes in medically underserved areas through the use of community health workers. Community health workers offer interpretation and translation services, provide culturally appropriate health education and information, offer informal counseling and guidance on health behaviors, advocate for individual and community health needs, and can provide some direct primary care services and screenings. Section 10501 clarifies the definition and activities of community health workers.

Sec. 5502. Medicare Federally qualified health center improvements. Directs the Secretary of Health and Human Services to develop and implement a prospective payment system (PPS) for Medicare-covered services furnished by Federally Qualified Health Centers (FQHCs). Additionally, adds remaining Medicare-covered preventive services to the list of services eligible for reimbursement when furnished by an FQHC. Section 10501 clarifies that the Secretary of HHS shall vary payments to FQHCs based on the type, duration, and intensity of services they deliver and establishes an annual FQHC market basket update.

Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs). Authorizes the following appropriations: FY2010 - $2.98B; FY2011 - $3.86B; FY2012 - $4.99B; FY 2013 - $6.44B; FY2014 - $7.33B; FY2015 - $8.33B.

Sec. 10503. Community Health Centers and National Health Service Corps Fund. Establishes a Community Health Centers and National Health Service Corps Fund. The fund will create an expanded and sustained national investment in community health centers under section 330 of the Public Health Service Act and the National Health Service Corps. As amended by Section 2303 of the Reconciliation Act, increases mandatory funding for community health centers to $11 billion over five years (FY 2011 – FY 2015).

On primary care workforce development:

Sec. 5102. State health care workforce development grants. Competitive grants are created for the purpose of enabling State partnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels. Grants will support innovative approaches to increase the number of skilled health care workers such as health care career pathways for young people and adults.

Sec. 5201. Federally supported student loan funds. Eases current criteria for schools and students to qualify for loans, shorten payback periods, and decreases the non-compliance provision to make the primary care student loan program more attractive to medical students.

Sec. 5301. Training in family medicine, general internal medicine, general pediatrics, and physician assistantship. Provides grants to develop and operate training programs, provide financial assistance to trainees and faculty, enhance faculty development in primary care and physician assistant programs, and to establish, maintain, and improve academic units in primary care. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home.

Sec. 5508. Increasing teaching capacity. Directs the Secretary to establish a grant program to support new or expanded primary care residency programs at teaching health centers and authorizes $25 million for FY2010, $50 million for FY2011 and FY2012 and such sums as may be necessary for each fiscal year thereafter to carry out such program. Also provides $230 million in funding under the Public Health Service Act to cover the indirect and direct expenses of qualifying teaching health centers related to training primary care residents in certain expanded or new programs.

Sec. 5402. Health professions training for diversity. Provides scholarships for disadvantaged students who commit to work in medically underserved areas as primary care providers, and expands loan repayments for individuals who will serve as faculty in eligible institutions. Funding is increased from $37 to $51 million for 2009 through 2013.

Sec. 5501. Expanding access to primary care services and general surgery services. Beginning in 2011, provides primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a 10 percent Medicare payment bonus for five years. Section 10501 removes the budget-neutrality adjustment that would have offset half of the cost of the primary care and general surgery bonuses.

Sec. 5503. Distribution of additional residency positions. Beginning July 1, 2011, directs the Secretary to redistribute residency positions that have been unfilled for the prior three cost reports and directs those slots for training of primary care physicians. In distributing the residency slots under this section, special preference will be given to programs located in States with a low physician resident to general population ratio and to programs located in States with the highest ratio of population living in a health professional shortage area (HPSA) relative to the general population.

Sec. 5508. Increasing teaching capacity. Directs the Secretary to establish a grant program to support new or expanded primary care residency programs at teaching health centers and authorizes $25 million for FY2010, $50 million for FY2011 and FY2012 and such sums as may be necessary for each fiscal year thereafter to carry out such program. Also provides $230 million in funding under the Public Health Service Act to cover the indirect and direct expenses of qualifying teaching health centers related to training primary care residents in certain expanded or new programs.

In addition, some decisions from HHS to use part of the prevention and public health fund for this purpose:

In an attempt to address a national shortage of health-care workers, Health and Human Services Secretary Kathleen Sebelius said Wednesday that the federal government will spend $250 million in programs to increase the number of doctors, nurses and other care providers. The money ... includes $168 million to train 500 new primary-care physicians over the next five years, $30 million to encourage 600 nursing students to attend school full-time and complete their education, and $32 million to create 600 new physician assistants.​