Billings Gazette: Medicare rule change aimed at helping rural hospitals attract and retain doctors, nurses

by Mari Hall

Rural Montanans could see more physicians training to work in their communities under a federal program rule change that incorporates an act proposed by Montana Sen. Jon Tester.

The Trump Administration earlier in August adopted Tester’s Restoring Rural Residencies Act, which aims to address doctor shortages in rural America.

The Centers for Medicare and Medicaid Services, or CMS, finalized the rule change incorporating the act that allows Medicare to reimburse for the time medical residents spend training at critical access hospitals, facilities in rural places with fewer than 25 inpatient beds. Montana has 48 critical access hospitals, and before the rule change, their recruitment and training were limited because Medicare did not fund residents’ training there.

Now that CMS will authorize payment for rotations of physicians in Montana and nationwide, hospitals in Lewistown and Sheridan, Wyoming, have hired residents through the Billings Clinic Internal Medicine Residency Program to practice in their facilities.

The Leona M. and Harry B. Helmsley Charitable Trust funds the rural rotations.

Overall, 60% of Montana physicians tend to stay and practice in the rural areas where they train. The residency program started in 2013.

“Coming from a town the size of Big Sandy, I look at everything through a rural lens and I see the challenges that are out there in health care,” Tester said Tuesday during a press conference at Billings Clinic.

“Billings Clinic does a great job in helping support those rural clinics around the region and around Montana. But something happens in rural America,” Tester said. “If you want someone to live there, you’ve got to have health care, and if you’re going to have health care, you’ve got to have docs and nurses and the folks who help staff those facilities.”

Walter Panzirer, a trustee with the Helmsley Charitable Trust, said the organization funded about $9 million to the Billings Clinic Internal Medicine Residency program and the new University of Washington Psychiatry Residency Training Program in Billings Clinic’s new psychiatry center.

“I’m a firm believer. It doesn’t matter if you live on a farm, or you live in the heart of Billings, or you live in the heart of New York City, your access to health care needs to be equal, and should be equal,” Panzirer said during the press conference.

Dr. Amy Consson, a third-year resident with Billings Clinic, has worked in Lewistown and in Sheridan, Wyoming. She graduates in May 2020. Providers who go through the program learn more all-inclusive care, so that people in rural areas don’t have to travel to specialists.

“I was born in Billings and raised in Colstrip, so I grew up in kind of this experience of realizing the limitations to rural medicine. We had a physician’s assistant that would rotate through our community but we didn’t have any full-time providers,” Consson said Tuesday. “Certainly, a lot of our doctoring was done in Billings and Miles City, so it’s really challenging for people in rural parts of the state to get to access for provider care.”

The new Billings Clinic Psychiatric Center just approved applications for its first cohort of students for state-wide rotations.

Students spend four years in the University of Washington Psychiatry Residency Training Program. After medical school, they study for two years in Seattle, and then at the Billings facility, which focuses on integrated care in rural areas. Three new residents should arrive in Billings in 2021.

Eventually the residency will train 12 students at a time across all four years of the curriculum. The program is the only one of its kind in Montana, according to Dr. Julie Kelso, director for the University of Washington Psychiatry Residency Training Program at Billings Clinic. Rural assistance may include in-person care or telepsychiatry.

“What’s not so important is that there’s a psychiatrist in every small town, but that everybody who needs psychiatric care is able to get it in a reasonable way,” Kelso said.

Tester said he’s excited about the new rule change.

“Anytime you can do good things for the state of Montana and rural America in general, it’s a good thing,” Tester said.