Addressing VA Physician Shortages: The Link between VA and Medicare GME

Transcription

1 Addressing VA Physician Shortages: The Link between VA and Medicare GME Congressional Staff Briefing Atul Grover, M.D., Ph.D. July 17, 2014

2 What we want to tell you today Medical schools, teaching hospitals = vital partners with VA in care, training, research To address VA doc shortage we need to address US doc shortage Enacting Medicare, VA GME policy changes is critical long term 2014 AAMC. May not be reproduced without permission.

3 The Future Is Already Here: VA Physician Shortage Is Part of Huge US Shortage We Need to Address 2014 AAMC. May not be reproduced without permission.

4 The Future Is Already Here: Everyone agrees: VA has a physician shortage Today, VA has thousands of vacancies for health care providers (A)long with an untold shortage of providers to meet the demand of veterans who want to get care at VA, Sen. Bernard Sanders (D-VT) (T)he (VA) faces a shortage of more than just primary doctors non-va health providers are willing to do their part to serve veterans. Sen. Tom Coburn (R-OK) Health workforce shortages and recruitment and retention of health-care personnel are a key challenge to rural veterans access to VA care and to the quality of that care, Independent Budget "We were told by staff increased demand and shortages of some physician specialties contributed to the wait times, GAO s Debra Draper "We lack sufficient clinicians to meet the current demand for timely, high quality health care, Sloan Gibson, Acting VA Secretary, July 16 4

5 The Future Is Already Here: Many factors likely cause of VA physician shortage VA at a disadvantage competing for physicians VA budget tight, patient population complex US doc shortage worsens due to: Aging population = higher per capita needs Increased insurance coverage Growing population overall Older physicians retiring Medical advances increase utilization Without additional training, decline in physicians per capita 5

6

7 A Growing, Aging Population Matters Physician Utilization per 100,000 People by Age 7 HHS/HRSA The Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand, December 2008 at AAMC. May not be reproduced without permission.

8 What s the US Physician Shortage and What Do We Need to Do About It? 2014 AAMC. May not be reproduced without permission.

9 Projected Shortage: 130,000 in 2025 Half primary care docs Half specialists What s important: Order of magnitude, not precise numbers 130,000 doctors = more than 6 VA physician workforces VA s entire doc workforce = 20,000 9

10 Projected Equal Shortages in Primary Care & Specialties (IM, FM and Peds) 10 Source: The Impact of Health Care Reform on the Future Supply and Demand for Physicians Updated Projections Through 2025 (June 2010), AAMC Center for Workforce Studies.

11 67% of Current VA Physician Vacancies = Specialists Percent of VA Physician Vacancies 5% 28% Prim. Care Specialists Other 67% Other = Non-Care Givers 11 Source: AAMC Analysis of Job Postings from VA Physician Careers Website, July 10,

12 Medical Schools Are Expanding to Meet Shortage 2013 AAMC. May not be reproduced without permission.

13 Matriculants, ,000 19,500 19,000 18,500 18,000 17,500 17,000 16,500 16,000 15,500 15, Source: AAMC Data Book AAMC. May not be reproduced without permission.

14

15 Hundreds of Medical School Grads Unmatched in 2014 Medicare GME cap is the bottleneck Congress capped # of residents for which Medicare pays its share of the costs at 1996 level 2014 AAMC. May not be reproduced without permission.

16 Residency Cap Source: NRMP, Results and Data: 2014 Main Residency Match 16

17 What s Needed to Address Shortage For both US and VA Grow doc workforce lift Medicare GME cap; continue VA investment in GME Grow non-physician workforce Address maldistribution of workforce Change care delivery to be more effective: Multi-disciplinary teams Delivery system research Evidence-based innovations in care All Are Needed AAMC. May not be reproduced without permission.

18 Bills that Increase Medicare Cap on Residents by 15,000 over 5 Years H.R. 1180: Resident Physician Shortage Reduction Act of cosponsors H.R. 1201: Training Tomorrow s Doctors Today Act lifts cap, sets accountability measures cosponsors S. 577: Resident Physician Shortage Reduction Act of 2013 lifts cap cosponsors

19 The Future Is Already Here: Lifting Medicare GME cap will benefit all Americans, including veterans To End VA Doctor Shortage, Medicare Funding Needs Boost -- Forbes Magazine, Bruce Jepsen, June 1,

20 LONG TERM: Can t address VA doc shortage unless we address US shortage H.R. 1180, 1201; S. 577 IN THE SHORT TERM Expedited contracting with non-va providers is important Ensure timely payment for services Medical Schools, Teaching Hospitals stand ready to help 2014 AAMC. May not be reproduced without permission.

21 For More Information from AAMC AAMC Staff: Len Marquez: Tannaz Rasouli: Matt Shick: AAMC Web Page: Atul Grover s Second Opinion Blog: More Info: AAMC. May not be reproduced without permission.

22