New rules let Medicare fund rural residencies

A change to Medicare that went into effect Oct. 1 aims to help rural hospitals address shortages of nurses and primary-care physicians.

The new rules allow Medicare to make reimbursements for the time residents spend training at Critical Access hospitals. Previously, Medicare was prevented from funding residents’ training time at these facilities, making it more difficult to recruit and train medical professionals in rural areas.

Montana has 48 Critical Access hospitals, which are hospitals with 25 or fewer acute care inpatient beds located 35 miles from another hospital (with some exceptions) and provide 24/7 emergency-care services. The Critical Access designation helps reduce the financial vulnerability of rural hospitals and helps them maintain essential services.

The call for the change began in 2016, when U.S. Sen. Jon Tester, D-Mont., introduced the Restoring Rural Residencies Act to help address the shortage of nurses and doctors at rural hospitals in Montana and across the country. He reintroduced the bill at the beginning of 2019 and pushed the Center for Medicare and Medicaid Services to adopt his policy change.

“Folks in rural communities deserve access to quality health care,” Tester said in a 2016 press release. “Critical Access hospitals are often the only place families can turn to for care in remote parts of our state. If we want more doctors to practice in rural areas, we need to train them in rural areas and this will get more doctors practicing in rural hospitals across Montana.”

President Donald Trump finalized the Center for Medicare and Medicaid Services proposal in August before it finally went into effect Oct. 1.

“When new doctors are trained in rural communities, they are more likely to stay and build their practices in those areas,” Tester said at the Billings Clinic on Aug. 27 as he was recognized for his efforts.

The Montana map of Health Professional Shortage Areas, produced by the Montana Department of Public Health and Human Services, shows a deficit of primary-care nursing across the state. Most Eastern Montana counties face a shortage for their entire populations. But all counties in Northwest Montana earned a shortage designation for low-income populations, meaning low-income residents face a shortage of primary-care services.

Lewis and Clark and Richland counties are the only counties in the state without a primary-care shortage designation.

Bruce Whitfield, chief executive officer of Cabinet Peaks Hospital in Libby, supports the rule change. He said the new incentive will help bring students to Libby, and he hopes the attractiveness of the area will “hook” them and keep them around.

Libby’s location and geography gives it an advantage over some other Critical Access hospitals.

“We’re lucky … it’s a beautiful area,” Whitfield said. “It’s definitely more difficult in Eastern Montana.”

The rule change fails to address what Whitfield identified as Libby’s greatest need – specialty care. The population is aging and demanding more specialty services, while Cabinet Peaks has just one surgeon and no one who specializes in orthopedic surgery.

But Whitfield expects the new rules to help when Cabinet Peaks is inevitably short on primary-care nurses. Even though Cabinet Peaks currently has a solid staff of nurses, the staffing situation is always volatile at a rural hospital.

“They could move on and a year from now it could be different, you never know,” he said. “Experienced nurses are hard to come by.”

Steve Todd, CEO of Saint Luke Community Health Care in Ronan, also welcomes the change.

“We were pretty active with efforts to try and get changes to legislation so residency programs wouldn’t be punished for residents coming out to rural sites,” he said.

Todd said the rule will help alleviate the potential deficit of primary-care doctors in rural Montana. But St. Luke’s participation in the Family Medicine Residency of Western Montana, a three-year program sponsored by the University of Montana, leaves it in better shape than other rural hospitals.

“We’ve been very fortunate to be one of the main rural sites these residents rotate to,” Todd said.

Todd said the Medicare rule change could prove vital as a substantial number of older physicians go into retirement. Similar to Cabinet Peaks, St. Luke and its clinics in Polson and St. Ignatius cannot take their current primary-care situation for granted.

This is why St. Luke has young residents participate in clinical education in local communities and throughout Western Montana.

“Years of study have demonstrated that residents and doctors practice where they’ve trained more often than not,” Todd said.

And with this new incentive for medical students to hone their craft in rural areas, Critical Access hospitals in Montana are hoping an influx of young doctors and nurses keeps the primary-care shortage from getting worse.

Reporter Colin Gaiser can be reached at cgaiser@dailyinterlake.com or 758-4439.