2009 WISCONSIN ACT 190(Assembly Bill 770)

The Rural Physician Residency Assistance Program

-William Schwab, MD

Department of Family Medicine University of Wisconsin School of Medicine and Public Health

Rural Physician Residency Assistance Program

Section 20.285 Allocates $750,000 for FY 2010-11 Funding comes from the critical access hospital

assessment fund Section 36.63

Designates the UW Department of Family Medicine to administer the program

Provides definitions Outlines program characteristics Requires an annual report to RWHC, WHA, and

WMS and to the Legislature

Rural Physician Residency Assistance Program

Scope of Program “. . . establish and support physician

residency positions” in rural areas Rural training track Rural rotation at least 8 weeks duration

Includes family medicine, general surgery, internal medicine, obstetrics, pediatrics, psychiatry

“Rural” = population less than 20,000 and at least 15 miles away from a community larger than 20,000

Rural Physician Residency Assistance Program

Expectations Preference to residency programs that

“actively recruit” graduates of Wisconsin medical schools

Cannot “supplant existing funding” Report by December 1 to RWHC, WHA, and

WMS with a plan and a budget Report by December 1 to the legislature’s Joint

Committee on Finance with demographic information regarding residency positions in rural areas filled through this program

Rural Physician Residency Assistance Program

Questions for interpretation What expenses are acceptable to

“establish and support physician residency positions”?

Resident salaries only? Expenses for lodging, food,

transportation? Payment of supervisors? Administrative overhead costs?

Rural Physician Residency Assistance Program

Questions for interpretation What is meant by “a rural rotation

begun after June 30, 2010 which consists of at least 8 weeks of training experience”?

Does this mean a rotation that didn’t exist prior to 6/30/10, or does it mean that the resident began her/his experience after 6/30/10

Must the “8 weeks” be continuous?, single content area? single location?

What percentage of time during the rotation must be in a rural area?

Rural Physician Residency Assistance Program

Questions for interpretation What does it mean to “not supplant

existing funding”? Does this exclusively mean that RPRAP

funding cannot be used if CMS pass-through dollars for medical education are received?

What if resident time is claimed by an institution that is over its CMS cap?

Can current experiences and programs that do not have direct revenue support so are cross-supported by other resources receive RPRAP funding?

Rural Physician Residency Assistance Program

Challenges to Implementation for 2010-2011 Residency recruitment/selection ended in

March, 2010 Addition of residency positions or

establishment of new rural training tracks requires accreditation approval from ACGME (6-24+ month process)

Curriculum for this academic year is already set for residency programs; flexibility is limited due to educational expectations and coverage needs

Uncertainty regarding future funding