Thread: SCOTUS Rules O'care legal in the form of a tax.

Ok, to start with, yes, I know that using the term O'care connotates that I am not for it. Actually, I am if for only the fact that it now expands medicaid to 130% above the poverty line for all states that choose to accept the money.

But most notably absent here (from a physician's POV) is that there was no mention of expanding the Medicare funding due to the need of more residents, AND no tort reform for malpractice.

How exactly do they expect to treat all of these new patients on an (semi-) annualized basis?
nurses?
PA's?

Seems to be a boon for hospitals, a bust for the in-debt-to-the-eyeballs physicians!

Thoughts???

is O'care irish?

Subtitle D—Enhancing Health Care
Workforce Education and Training
SEC. 5301. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE,
GENERAL PEDIATRICS, AND PHYSICIAN
ASSISTANTSHIP.
Part C of title VII (42 U.S.C. 293k et seq.) is amended by striking
section 747 and inserting the following:
‘‘SEC. 747 ø42 U.S.C. 293k¿. PRIMARY CARE TRAINING AND ENHANCEMENT.
‘‘(a) SUPPORT AND DEVELOPMENT OF PRIMARY CARE TRAINING
PROGRAMS.—
‘‘(1) IN GENERAL.—The Secretary may make grants to, or
enter into contracts with, an accredited public or nonprofit private
hospital, school of medicine or osteopathic medicine, academically
affiliated physician assistant training program, or a
public or private nonprofit entity which the Secretary has determined
is capable of carrying out such grant or contract—
‘‘(A) to plan, develop, operate, or participate in an accredited
professional training program, including an accredited
residency or internship program in the field of
family medicine, general internal medicine, or general pediatrics
for medical students, interns, residents, or practicing
physicians as defined by the Secretary;
‘‘(B) to provide need-based financial assistance in the
form of traineeships and fellowships to medical students,
interns, residents, practicing physicians, or other medical
personnel, who are participants in any such program, and
who plan to specialize or work in the practice of the fields
defined in subparagraph (A);
‘‘(C) to plan, develop, and operate a program for the
training of physicians who plan to teach in family medicine,
general internal medicine, or general pediatrics training
programs;
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June 9, 2010
545 PPACA (Consolidated) Sec. 5301\747 PHSA
‘‘(D) to plan, develop, and operate a program for the
training of physicians teaching in community-based settings;
‘‘(E) to provide financial assistance in the form of
traineeships and fellowships to physicians who are participants
in any such programs and who plan to teach or conduct
research in a family medicine, general internal medicine,
or general pediatrics training program;
‘‘(F) to plan, develop, and operate a physician assistant
education program, and for the training of individuals who
will teach in programs to provide such training;
‘‘(G) to plan, develop, and operate a demonstration
program that provides training in new competencies, as
recommended by the Advisory Committee on Training in
Primary Care Medicine and Dentistry and the National
Health Care Workforce Commission established in section
5101 of the Patient Protection and Affordable Care Act,
which may include—
‘‘(i) providing training to primary care physicians
relevant to providing care through patient-centered
medical homes (as defined by the Secretary for purposes
of this section);
‘‘(ii) developing tools and curricula relevant to patient-
centered medical homes; and
‘‘(iii) providing continuing education to primary
care physicians relevant to patient-centered medical
homes; and
‘‘(H) to plan, develop, and operate joint degree programs
to provide interdisciplinary and interprofessional
graduate training in public health and other health professions
to provide training in environmental health, infectious
disease control, disease prevention and health promotion,
epidemiological studies and injury control.
‘‘(2) DURATION OF AWARDS.—The period during which payments
are made to an entity from an award of a grant or contract
under this subsection shall be 5 years.
‘‘(b) CAPACITY BUILDING IN PRIMARY CARE.—
‘‘(1) IN GENERAL.—The Secretary may make grants to or
enter into contracts with accredited schools of medicine or osteopathic
medicine to establish, maintain, or improve—
‘‘(A) academic units or programs that improve clinical
teaching and research in fields defined in subsection
(a)(1)(A); or
‘‘(B) programs that integrate academic administrative
units in fields defined in subsection (a)(1)(A) to enhance
interdisciplinary recruitment, training, and faculty development.
‘‘(2) PREFERENCE IN MAKING AWARDS UNDER THIS SUBSECTION.—
In making awards of grants and contracts under
paragraph (1), the Secretary shall give preference to any qualified
applicant for such an award that agrees to expend the
award for the purpose of—
‘‘(A) establishing academic units or programs in fields
defined in subsection (a)(1)(A); or
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June 9, 2010
Sec. 5301\747 PHSA PPACA (Consolidated) 546
‘‘(B) substantially expanding such units or programs.
‘‘(3) PRIORITIES IN MAKING AWARDS.—In awarding grants or
contracts under paragraph (1), the Secretary shall give priority
to qualified applicants that—
‘‘(A) proposes a collaborative project between academic
administrative units of primary care;
‘‘(B) proposes innovative approaches to clinical teaching
using models of primary care, such as the patient centered
medical home, team management of chronic disease,
and interprofessional integrated models of health care that
incorporate transitions in health care settings and integration
physical and mental health provision;
‘‘(C) have a record of training the greatest percentage
of providers, or that have demonstrated significant improvements
in the percentage of providers trained, who
enter and remain in primary care practice;
‘‘(D) have a record of training individuals who are
from underrepresented minority groups or from a rural or
disadvantaged background;
‘‘(E) provide training in the care of vulnerable populations
such as children, older adults, homeless individuals,
victims of abuse or trauma, individuals with mental
health or substance-related disorders, individuals with
HIV/AIDS, and individuals with disabilities;
‘‘(F) establish formal relationships and submit joint
applications with federally qualified health centers, rural
health clinics, area health education centers, or clinics located
in underserved areas or that serve underserved populations;
‘‘(G) teach trainees the skills to provide interprofessional,
integrated care through collaboration among health
professionals;
‘‘(H) provide training in enhanced communication with
patients, evidence-based practice, chronic disease management,
preventive care, health information technology, or
other competencies as recommended by the Advisory Committee
on Training in Primary Care Medicine and Dentistry
and the National Health Care Workforce Commission
established in section 5101 of the Patient Protection
and Affordable Care Act; or
‘‘(I) provide training in cultural competency and health
literacy.
‘‘(4) DURATION OF AWARDS.—The period during which payments
are made to an entity from an award of a grant or contract
under this subsection shall be 5 years.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—For purposes of carrying out this section
(other than subsection (b)(1)(B)), there are authorized to be appropriated
$125,000,000 for fiscal year 2010, and such sums as
may be necessary for each of fiscal years 2011 through 2014.
‘‘(2) TRAINING PROGRAMS.—Fifteen percent of the amount
appropriated pursuant to paragraph (1) in each such fiscal
year shall be allocated to the physician assistant training pro-
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547 PPACA (Consolidated) Sec. 5302\747A PHSA
grams described in subsection (a)(1)(F), which prepare students
for practice in primary care.
‘‘(3) INTEGRATING ACADEMIC ADMINISTRATIVE UNITS.—For
purposes of carrying out subsection (b)(1)(B), there are authorized
to be appropriated $750,000 for each of fiscal years 2010
through 2014.’’.

Yes, I read this a few years ago too. While these funds have been released beginning in 2010, notice the lack of new residencies. These funds have been going into expanding the infrastructure of existing programs that submit grant proposals targeting the specific subsections (ie, poor patient populations, or HIV pediatric, or interdisciplinary, etc.). So now the same number of residents will also cover more clinics targeting these areas.

Also, of note, did you catch the part where the PA programs would have the same access to these funds? If they also required residencies, I'd say its a level playing field.

AND the biggest takeaway of this whole legislative curtsey to serving the "under-served," this amended budget is 125 million of new money when the capped budget (for over a decade now) for residency education is over 12 Billion. So this is an increase of just over 1%. This doesn't even pretend to keep up with inflation.

just saying...