OAFP Legislative Proposals

There are 2 parts to our Legislative Package: Primary Care Workforce Recruitment and the Initiative for the Transformation of Primary Care

Primary Care Workforce Recruitment Package

BACKGROUND
Research shows that better access to primary health care results in lower health care costs and better outcomes. Each of these programs will help communities, clinics and hospitals recruit more primary care providers to Oregon.
The quickest way to attract new primary care providers is to offer to repay medical school or health care training loans.
Graduate Medical Education is the biggest bottleneck in the supply line for new primary care physicians. In 2009, there were more than 800 applicants for the 27 family medicine residency slots in Oregon.
One of the best ways to ensure a rural health care workforce is for rural communities to grow their own. Unfortunately, the daunting expense of tuition, and the uncertainty of loan repayment, prevents many rural youth from even considering a career as a health care professional. The prospect of loan forgiveness helps address that problem. Loan forgiveness differs from loan repayment in that the commitment by the medical student and the state is made much earlier in the medical student’s studies.

LOAN REPAYMENT
· Appropriate $6 million funding to the Primary Care Services Program, found in ORS 442.555, the loan repayment program for primary health care providers.
· The purpose of this appropriation is to help rural and medically underserved communities recruit more primary health care providers.

GRADUATE MEDICAL EDUCATION
· A new Oregon Family Medicine Residency Network is created at the Area Health Education Center
· The purpose of this network is to facilitate an increase in the number of family medicine residency slots in Oregon.
· This residency network will help hospital systems develop new family medicine programs throughout the state. Similar programs in Washington, Utah, Minnesota and Wisconsin help organize the distribution of residents and lower costs through common administration.
· Once the new residency programs are established, the Network will help family medicine residencies share resources through a common faculty development center, joint regulatory monitoring, and, possibly, grant writers for outside funding.
· The state appropriates $1 million in 2011-13 to the Family Medicine Residency Network to help create the network. Additional funds for the Network may come from hospital systems and foundations.

LOAN FORGIVENESS
· Create a primary health care loan forgiveness program administered by the Office of Rural Health at OHSU.
· The program is open to students in medical school, and nurse practitioner and physician assistant programs who are enrolled in the Oregon Rural Scholars Program. These students receive increased training in rural settings.
· The purpose of this program is to provide the loan forgiveness commitment early in a student’s medical school or health care program training.
· Students who meet the above criteria and who are willing to commit to working in a rural setting in Oregon are eligible for loan forgiveness. Preference will be given to students sponsored by a rural Oregon community that provides some matching funds.
· The Rural Scholars Loan Forgiveness Program will provide loans of up to $35,000 per year for those accepted. Those accepted must agree to work in a rural setting in Oregon upon completion of their residency or training program.
· One year of the Oregon Rural Scholars Loan will be forgiven for each year worked in a qualified rural setting.
· If a Loan Forgiveness recipient fails to fulfill the terms of the agreement, they are liable for the full amount of the outstanding loan plus interest. Any amounts determined to be due under this section shall be collected by the Collections Unit in the Department of Revenue under ORS 293.250. (Language from HB 3639, page 3, Section 3(3).
· The first recipients of the Oregon Rural Scholars Loan will be named in Spring 2012.
· Fund the program with $175,000 in the 2011-13 biennium.

Initiative for the Transformation of Primary Care

BACKGROUND

While Oregon needs more primary care providers, it also needs to provide primary care differently. A new Initiative for the Transformation of Primary Care will help urban and rural primary care practices innovate ahead of the curve, improve health outcomes, and lower costs by promoting effective interdisciplinary education and collaboration while aiding the transition to patient-centered primary care home care models throughout Oregon.
The locum tenens program, modeled after a successful program in New Mexico, provides fill-in services for heavily burdened rural physicians, physician assistants and nurse practitioners.
The Continuing Medical Education program — primarily directed at change/improvement strategies and procedural training needs — would take CME to interdisciplinary groups of health care professionals at a community/practice level.
Research is needed so that as primary care practices make the transition to the primary care home model, they know what works and what doesn’t, so each clinic isn’t trying to “reinvent the wheel.”

1. Locum Tenens
· The Area Health Education Center (AHEC) at OHSU will administer the program.
· Oregon’s Locum Tenens Service will provide below market-rate services for rural physicians who need time away from their practice.
· In addition to covering office hours and seeing patients, these locum tenens will:
Ø Serve as transformation specialists or “extension agents” bringing information about best practices in practice transformation, evaluating and planning with clinics and providers for the transformation of their practices to a primary care home model.
Ø Encourage and support participation in learning collaboratives to spread successful transformation strategies that improve delivery of health care access and outcomes.
· Medical practices will pay for the cost of the locum tenens program. State funding will pay for administration, marketing and promotion, travel and housing, training and the remainder of the cost of the additional time needed to evaluate/support practice transformation.
· $300,000 is appropriated for this program.

2. Interdisciplinary Continuing Medical Education (CME) at the community level
· The Area Health Education Center (AHEC) at OHSU will administer the program.
· CME provided by this program would focus on strategies to transform practices to a primary care home model.
· The purpose of this program is to provide CME across medical disciplines and to provide it at the clinic or medical practice level.
· $700,000 is appropriated for this program.

3. Primary care home training and research
· A Primary Care Transformation Research and Training Center will be developed within the Family Medicine Department at OHSU.
· The purpose of this center is to facilitate implementation of the patient-centered primary care home at the medical practice level.
· The center will:
o Evaluate the effectiveness of implementing delivery system and practice changes.
o Provide ongoing training for those serving as locum tenens “extension agents” to optimize their effectiveness in initiating practice transformation throughout Oregon.
o Set up and facilitate community-based learning collaborations for primary care providers.
· Appropriate $400,000 to support the Primary Care Transformation Research and Training Center.

Contacts:
Doug Barber, Oregon Academy of Family Physicians, doug@lobbyoregon.com, 541-221-3072