Tester bill would allow medical residents to work in rural hospitals

Billings Gazette

by Zach Benoit

Montana Sen. Jon Tester introduced a bill in the Senate on Wednesday that would make it easier for physicians in medical residency programs to train and work in rural communities.

Called the “Restoring Rural Residencies Act,” the bill addresses a complaint long held by residency programs that the U.S. Centers for Medicare and Medicaid Services, which helps to pay for medical residency slots across the country, doesn’t allow funding to follow residents to rural, critical access facilities.

If passed, the bill would would allow Medicare to reimburse programs for time residents spend training at such hospitals, Tester said in a news release.

“Folks in rural communities deserve access to quality health care,” he said. “Critical Access Hospitals are often the only place families can turn to for care in remote parts of our state. If we want more doctors to practice in rural areas, we need to train them in rural areas and this bill will get more doctors practicing in rural hospitals across Montana.”

A critical access hospital is certified by CMS and is a rural area, has no more than 25 beds, must provide 24-hour emergency care, see an average patient stay of 96 hours or fewer for acute care and be a certain distance from other hospitals and critical access facilities.

Montana has 46 critical access hospitals, representing about 70 percent of the hospitals in the state.

Tester, a Democrat and Montana’s senior Senator, said that the bill is designed to bring more doctors into rural communities for training and encourage medical professionals to practice in those same areas.

Billings Clinic’s three-year Internal Medicine Residency Program works with 18 physicians — it’ll expand to 25 in July — and officials at the hospital have been vocal about the need to send those residents on rural rotations, as well as regarding the difficulty in doing so without the CMS payments.

“Current policy is very unfair to rural America and this legislation will help us deal with our severe physician shortage in Montana’s rural communities,” said Dr. Nicholas Wolter, the clinic’s chief executive.

The clinic recently announced it has received a $4.3 million grant from the Leona M. and Harry B. Helmsley Charitable Trust’s Rural Healthcare Program to fund four-week rotations at Livingston HealthCare in Livingston and at Sheridan Memorial Hospital in Wyoming for its resident physicians. The money also established a program to fund seven residents during three years to study rural health care and present their findings.

It wasn’t immediately clear how the bill would effect those efforts.

There are three residency programs in Montana. In addition the clinic, RiverStone Health in Billings runs the Montana Family Medicine Residency and the University of Montana in Missoula sponsors the Family Medicine Residency of Western Montana.

Other health care professionals from the region shared support for the bill as well.

“The Restoring Rural Residencies Act is key to allowing our small rural critical access hospitals in Montana to help train the next generation of Montana rural physician,” said Dr. Jay Erickson, assistant dean of the Montana WWAMI Clinical Office. “This act will be important to help solve the rural physician workforce problems in Montana and throughout the U.S.”

Dick Brown, president and CEO of the Montana Hospital Association, described the need for the bill as “a public health issue” and said that in expanding the opportunities for trained medical professionals, it will also improve the quality of and access to health care.

In the release, Tester also noted that he is sponsoring the PARTS Act to allow rural hospitals to provide outpatient treatment to Medicare patients without having an attending physician present, as well as the Critical Access Hospitals Relief Act, which removes the 96-hour acute care stay rule for such hospitals.