Massachusetts
Massachusetts isn’t using a tool that could help tackle its shortage of primary care doctors – The Boston Globe
When Massachusetts is a national outlier in any policy, it’s worth asking why and whether that policy still makes sense.
Massachusetts today is one of only seven states that does not use Medicaid money to fund medical residencies, which provide the clinical training of new doctors after they complete medical school. Among the 10 states with the most teaching hospitals and physician residents, it is the only one that does not use Medicaid money to support graduate medical education, or GME, according to the Association of American Medical Colleges.
The main reason appears to be cost: Massachusetts did have a program, but policy makers cut it in 2010, according to the Executive Office of Health and Human Services, amid budget shortfalls due to the 2008 recession and as state officials prioritized implementing universal health insurance coverage.
Today, cost remains a barrier to reinstating the program. Yet given the shortage of primary care physicians, lawmakers should consider reinstating Medicaid GME in a targeted way that shores up needed services like primary care, behavioral health care, and community health centers.
Without the Medicaid money, residencies are mostly paid for by Medicare, which gave $16.2 billion in fiscal 2020 to GME programs nationwide.
Although it may seem like an arcane distinction, there are two good reasons to use Medicaid money to fund residencies beyond those funded by Medicare. One is that the federal government would match the state contribution, drawing new federal money. The second is that the state can narrowly tailor a Medicaid program to decide how much money to spend — and how to spend it.
This flexibility means state lawmakers could target money for residencies in specific specialties that Massachusetts needs more of.
There is a dire need to train more primary care physicians and keep them in Massachusetts. People are struggling to find doctors. Wait times at community health centers, which see many Medicaid patients, have recently been as long as 80 days for a new patient and up to 40 days for an existing patient, according to Michael Curry, president and CEO of the Massachusetts League of Community Health Centers.
According to the Milbank Memorial Fund’s primary care scorecard, 16.7 percent of adults in Massachusetts and 5.4 percent of children in 2021 lacked a usual source of health care, numbers that had grown since 2011. According to survey data from Massachusetts Health Quality Partners and the Center for Health Information and Analysis, adults were having a harder time accessing primary care in 2022 than in 2019. Massachusetts has a higher rate of doctors leaving primary care than the nation overall. One-third of Massachusetts doctors in 2020 were over 60 and fewer than one-quarter of Massachusetts medical school graduates are entering primary care, according to MHQP.
When someone cannot get an appointment with a primary care physician, they are more likely to become seriously ill and go to the emergency department, at a time when hospitals are experiencing capacity crunches.
Funding more residency training slots through Medicaid would not magically solve the problem. Seriously addressing the primary care shortage will require paying primary care doctors more and addressing the administrative burden that makes primary care such a hard job. Massachusetts officials are taking other steps to address the problem, like establishing student loan repayment programs.
But reestablishing Medicaid GME could allow hospitals and community health centers to train more doctors to work in badly needed fields. Because specialty care is more lucrative, without the added Medicaid incentive, hospitals are more likely to create residencies in specialty fields than primary care.
Multiple bills to reestablish Medicaid GME payments are pending in legislative committees, with advocacy by the League of Community Health Centers and the Massachusetts Health and Hospital Association. The details differ, but the basic idea is to pay for residencies in fields with shortages, including primary care and behavioral health care, in hospitals and community health centers. (Like primary care, behavioral health care is a field where worker shortages are severely impacting people’s ability to get timely care.) A program could also potentially fund training for non-physician clinicians, like nursing students.
The League of Community Health Centers is asking for $50 million in Medicaid funding over three years, half of which would be reimbursed by the federal government. According to the organization, that level of funding would pay to graduate 23 new family medicine doctors annually (with funding for three years of residency) and to fund 69 residency slots each year for nurse practitioners, assuming a cost of $185,000 per physician resident and $120,000 per nursing resident.
Most states use general fund money to pay for Medicaid GME, though some rely on municipal tax money or taxes on hospitals. Lawmakers will have to determine the best funding source.
But the money is likely to be a smart investment, and it will draw in federal money that the state is leaving on the table now. And if increased funding for residencies means more doctors go into primary or behavioral health care in Massachusetts, patients will be seen sooner and will get the care they need to remain healthy, lowering costs in the long term.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
Massachusetts
Deadline nears for Massachusetts Health Connector enrollment
SPRINGFIELD — With just days left before the Dec. 23 deadline, state and local leaders are urging uninsured residents to enroll in health coverage through the Massachusetts Health Connector to ensure they’re protected in the new year. The cutoff applies to anyone who wants coverage starting Jan. 1.
The Health Connector — the state’s official health insurance marketplace — is the only place residents can access financial assistance and avoid misleading “junk” policies that often appear in online searches, according to a statement from the agency.
Officials say the enrollment period is especially critical for people without job-based insurance, gig workers, newcomers to the state and anyone seeking affordable, comprehensive health plans.
At a press conference Wednesday at Caring Health Center’s Tania M. Barber Learning Institute in Springfield, health leaders emphasized that most people who sign up through the Connector qualify for help paying premiums through its ConnectorCare program.
Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, said the state has spent nearly two decades committed to ensuring access to health care and offering the most affordable coverage possible for everyone.
”And despite the federal challenges, we continue to do everything we can to offer coverage to everyone who needs it. Now is the time for people who don’t have coverage to come in, apply, and find out what kind of plan for which they qualify,” she said.
Open enrollment also gives current members a chance to review their coverage, compare options and make changes.
Recent changes in federal policy have caused shifts in coverage and higher premiums for many Massachusetts residents, creating uncertainty and concern, said Cristina Huebner Torres, chief executive vice president and strategy and research officer at Caring Health Center.
“During times like these, trusted, local support becomes even more essential, and our Navigators have been on the very front lines, helping residents understand their options, maintain coverage, and navigate a complex and evolving system,” Huebner Torres said.
Massachusetts
Massachusetts woman charged with DUI after Simsbury crash
SIMSBURY, Conn. (WTNH) — A Massachusetts woman was arrested Wednesday and charged with DUI after a crash in Simsbury, according to police.
The crash happened at around 2:15 p.m. on Hartford Avenue and Elm Street. Police responded to reports that one of the operators of the vehicles was unconscious, later becoming conscious.
Upon arrival, police found that operator, who was identified as 39-year-old Allison Beu of Southwick, Massachusetts, outside of her vehicle and interacting with the other involved parties.
The two occupants in the other vehicle were not transported to the hospital.
Beu was charged with DUI and failure to drive in proper lane.
Massachusetts
Massachusetts Governor Healey reacts to Brown University shooting
BOSTON (WWLP) – Following the shooting at Brown University, claiming the lives of two students and injuring nine others, Governor Healey is joining calls for anyone with information to contact authorities.
Police have not yet made any arrests in connection with the shooting, but they have released footage of a person of interest, calling on the public for help.
“At this time, we just have to encourage anyone in the public who may know something, see something, to immediately contact law enforcement,” said Healey.
Governor Healey says the Massachusetts State Police are in Rhode Island to assist with the investigation. The governor also spoke to mounting fear on college campuses, as the number of mass shootings in the United States exceeds the number of days so far in the year.
“In speaking with many of them, I know that they are taking all measures to ensure the safety of students and faculty, and certainly as a state we will do everything that we can to support those efforts,” said Governor Healey.
Local to western Massachusetts, UMass Amherst told 22News about their campus safety plans, which include adding emergency preparedness to student orientation and hosting optional active threat training for students, staff, and faculty.
The FBI is offering an award of up to $50,000 leading to an arrest and conviction. Anyone who thinks they may have information is encouraged to call the Providence Police.
Local News Headlines
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