New Opportunities for Expanding Rural Graduate Medical Education to Improve Rural Health Outcomes: Implications of the Consolidated Appropriations Act of 2021

Abstract

Evidence shows that those living in rural communities experience consistently worse health outcomes than their urban and suburban counterparts. One proven strategy to address this disparity is to increase the physician supply in rural areas through graduate medical education (GME) training. However, rural hospitals have faced challenges developing training programs in these underserved areas, largely due to inadequate federal funding for rural GME. The Consolidated Appropriations Act of 2021 (CAA) contains multiple provisions that seek to address disparities in Medicare funding for rural GME, including funding for an increase in rural GME positions or "slots" (Section 126), expansion of rural training opportunities (Section 127), and relief for hospitals that have very low resident payments and/or caps (Section 131). In this Invited Commentary, the authors describe historical factors that have impeded the growth of training programs in rural areas, summarize the implications of each CAA provision for rural GME, and provide guidance for institutions seeking to avail themselves of the opportunities presented by the CAA. These policy changes create new opportunities for rural hospitals and partnering urban medical centers to bolster rural GME training, and consequently the physician workforce in underserved communities.

Ten-Year Outcomes: Community Health Center/Academic Medicine Partnership for Rural Family Medicine Training

“…Until the Consolidated Appropriations Act of 2021 (CAA), rural hospitals or partnering urban hospitals could qualify for Medicare GME funding only by participating in separately accredited rural residencies, resulting in financial constraints for lower-resourced facilities. 31 However, the new CAA provision for the definition of Rural Track Program (RTP) to encompass all programs (separately accredited or not) where residents spend time in both urban and rural settings but greater than 50% of training time in rural settings has created new opportunities rural GME expansion. 32 Furthermore, CAA supports cap expansion for urban hospitals with existing RTPs if they develop them in the same specialty at new locations.…”

Characteristics of Hospitals by Graduate Medical Education Expense Category: Implications for Rural Residency Program Expansion

“…Hospital categories were determined using historical data provided by the CMS, 19 as described by Hawes and colleagues 20 . These categories and hospital characteristics were gathered from the March 2022 Medicare Cost Reports released by the HCRIS, 21 which contain financial and operational details for each hospital in the United States.…”

“…Hospital categories were determined using historical data provided by the CMS, 19 as described by Hawes and colleagues. 20 These categories and hospital characteristics were gathered from the March 2022 Medicare Cost Reports released by the HCRIS, 21 which contain financial and operational details for each hospital in the United States. For community characteristics, we used 2022 County Health Rankings & Roadmaps data, 22 which include a variety of county-level health outcomes and health factors for each county in the United States.…”