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Community and Population Health Cases

Doctor Talking to Boy in Wheelchair

How Do We Increase Access to Care in Rural Areas?

The Client

Germane Solutions was contacted by a rural critical access hospital that was under the governance of a larger health system within the state. Seeking to address the healthcare needs of the surrounding local community, the hospital was interested in exploring ways to bring more physicians into the area.

The Challenge

The hospital which was located in a primary care, dental health, and mental health Professional Shortage Area (HPSA) and provided care to a Medically Underserved Area/Population (MUA/P). The hospital was dedicated to serving the needs of its community but realize the limitations that the lack of physicians imposed. The client was interested in addressing the physician shortage through the development of GME programs designed to bring providers into the rural area; however, it could not support GME on its own. The client faced barriers including limited resources, limited funding, and a lack of infrastructure. The health system under which it was governed had another hospital with an existing Family Medicine residency program, but this program was based in the urban setting – missing the rural training focus that the client desired and the community needed.

The Solution

Germane Solutions investigated opportunities for bringing physicians into the local area. Driven by the need for and impact of primary care services, the client wanted to focus on increasing the primary care physician availability.

Germane Solutions identified a two-part solution for the client: develop a Family Medicine Rural Training Track (FM RTT) Program with the support of the Health Resources and Services Administration (HRSA) Rural Residency Planning and Development (RRPD) Grant Program. The FM RTT would serve as the vehicle for bringing primary care physicians into the community, year after year. The RRPD Grant would provide the financial support to mitigate program planning and development costs. Germane Solutions brought this recommendation to the client, outlining the process for each step and how it would achieve their overall goal of addressing the physician shortage in their community. Germane Solutions also investigated the client’s eligibility for the grant. Focused analyses were completed to understand how the client could partner with the existing Family Medicine residency program in the urban setting to create an FM RTT. Additionally, Germane Solutions conducted research about the community itself, its unique health needs, and the barriers to care it face. It was confirmed that the client was eligible for the RRPD grant, and an application was started.

With Germane Solutions' expertise of both HRSA and Accreditation Council for Graduate Medical Education (ACGME) rules and requirements, the client was assisted in creating a comprehensive, compliant HRSA RRPD Grant application. This application included a fully planned FM RTT program based at the client’s rural hospital in partnership with the urban FM program. Support strategies were outlined – for land, labor, and capital needs – and resident recruitment and retention plans were detailed. The goal to retain at least 50% of graduates in the surrounding counties to practice autonomously drove each component of the application.

Reading a Braille with Doctor

The Germane Effect

Upon receiving the Notice of Award (NoA), the client was awarded the full requested amount of $750,000 from HRSA, the maximum RRPD award available. This funding was used over a 3-year period for the planning and development of the FM RTT program. With this support, the client was well-positioned to create an FM RTT program that will provide comprehensive clinical training and education to develop residents into independent rural family medicine physicians. The experiences residents received through the FM RTT prepared them to serve the unique needs of the patient population. The format of the FM RTT also provided the opportunity for the urban partner hospital to increase its Medicare FTE cap and receive CMS reimbursement for resident FTE spent at the urban site. Through Germane Solutions' guidance and support, this client was been able to achieve its goal of creating a pipeline of primary care physicians into their service area to address the physician shortage and, ultimately, the community health needs – today and tomorrow.

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