Virginia Establishes a Center for Primary Care and Rural Health to Address Needs
The Commonwealth of Virginia created a Center for Primary Care and Rural Health in the Virginia Department of Health as a central entity to coordinate public and private recruitment and retention activities.
A $4.2-million loan fund, catalyzed by a Robert Wood Johnson Foundation (RWJF) program-related investment (PRI), provided capital for practices and health care facilities in underserved areas.
The project was part of the RWJF Practice Sights: State Primary Care Development Strategies national program.
- Virginia created a Center for Primary Care and Rural Health in the Virginia Department of Health as a central entity to coordinate public and private recruitment and retention activities.
Initial activities included identifying and evaluating access problems in target zones and providing technical assistance and education in underserved areas.
- A $4.2-million loan fund, catalyzed by the RWJF program-related investment (PRI), provided capital for practices and health care facilities in underserved areas. Sixteen loans totaling $1.62 million have closed so far.
- Scholarships and a loan repayment program were funded by the state, and Medicaid reimbursement rates were increased in underserved areas.
RWJF supported this project through two grants from May 1993 to May 1999 totaling $897,994 to the Commonwealth of Virginia Joint Commission on Health Care. In addition, RWJF provided a $700,000 grant from December 1995 to December 2005 to the Virginia Health Care Foundation to cover the program-related investment.
As of 1994, the Medical College of Virginia Department of Family Practice estimated that Virginia would have to recruit 500 primary care physicians to the state's underserved areas to reach what it defines as the minimum ratio of one doctor per 2,000 population. Moreover, according to the department's database, 24 percent of primary care physicians in the state's non-metropolitan areas were over the age of 60. The department projected that 400 of them would retire by the year 2000. Based on career decisions of past Virginia medical school graduates, the department projected that new graduates would replace only 130 of those 400 retirees. Among mid-level practitioners, only 11 percent of nurse practitioners and 8 percent of physician assistants practiced in underserved areas. Rural practitioners in the state face professional isolation, heavier workloads, and inadequate income.
During the planning phase (ID# 022282), the state legislature expanded and increased the flexibility of a number of scholarship programs to better target resources to meet the needs of underserved communities. Programs now give preference to disadvantaged applicants, residents of state-designated underserved areas, and students who agree to practice in those areas. The state also began upgrading its needs assessment and management information systems. The project also received $1.1 million in matching support from the state's Department of Health, the Virginia Health Care Foundation, Blue Cross and Blue Shield of Virginia, and the Area Health Education Centers Program.
The grantee set five major objectives for the implementation phase of the project (ID# 024629):
- Establish a central entity to coordinate public and private recruitment and retention activities.
- Develop a statewide management information system and database to support needs assessment and recruitment and retention efforts.
- Develop private sector financial and programmatic incentives, including a loan fund, to encourage and support recruitment and retention efforts in underserved areas.
- Determine the feasibility of integrated delivery systems in underserved areas and the impact of those models on an area's ability to attract and retain primary care providers.
- Implement regulatory and reimbursement policies that create incentives for primary care providers to practice in underserved areas.
The commonwealth now has a Center for Primary Care and Rural Health with one half-time provider placement specialist. The center uses a variety of techniques to identify practice opportunities in underserved areas and publicizes those opportunities to prospective practitioners. Among the center's accomplishments:
- Practice Sights highlighted the problem of primary care shortages, thereby enabling the center to leverage $325,000 annually in general fund appropriations from the General Assembly. The project director thinks this is its key achievement. The appropriation is being used for a number of initiatives addressing access to care.
- Practice Sights has stimulated the center to integrate its primary care and rural health initiatives, scholarship and loan repayment programs and its research component to continue the Practice Sights efforts. The center's study of Virginia safety-net providers (SJR 112) has led to many initiatives supported by the Joint Commission on Health Care, and enacted by the General Assembly.
- With a General Assembly appropriation of $75,000, the center is funding a prospective study of the telemedicine sites in the commonwealth.
- The Practice Sights grant enabled the center to fund a study of hospital admissions that could have been handled through ambulatory care, and admissions for chronic illness such as hypertension, diabetes, and asthma, which should be preventable with access to primary care. The center is continuing to fund this study with a 1999 appropriation from the General Assembly.
- The center received a $200,000 grant from the Federal Office of Rural Health Policy to research the role of the small rural hospital within a primary care system. This is part of the transition to critical access hospitals defined by the Medicare rural hospital flexibility program.
- The center's work was linked to the RWJF Generalist Physician Initiative in the commonwealth's three medical schools. The program's emphasis on training primary care physicians enhanced the center's ability to promote the recruitment and retention program to the graduates, and recruit primary care practitioners to underserved areas.
- By developing a practice-opportunities database, the center was able to market a wide range of practice sites, thus broadening the selection options for health care professionals.
- The center established network partnerships important organizations in the state: Virginia Department of Corrections; Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services; Virginia Primary Care Association; Virginia Association of Family Physicians; Free Clinics; hospitals; and private practices.
- The center expanded placement of National Health Service Corps (NHSC) and Virginia (VA) scholars, who made a commitment to practice in health professional and medically underserved areas.
- The center established and received funding for the Virginia Physician Loan Repayment Program.
- The center provided technical assistance to areas of the state wishing to maintain or become a Health Professional Shortage Area. This designation is necessary for the placement of NHSC and VA scholars and federal and state loan repayment recipients.
- The center and the Virginia Department of Health Professions are collaborating to develop an ongoing process for collecting physician data that includes practice site information.
- The center established a partnership with the Blue Ridge Area Health Education Center (AHEC) to develop the Virginia Recruitment and Retention Network.
Other accomplishments include:
- Sixteen practitioners and other entities have secured loans totaling $1.62 million from the Healthy Communities Loan Fund, which is a $4.2-million loan fund managed by First Virginia Bank. The fund provides loans for equipment purchases, working capital, renovation and expansion of facilities, and practitioner recruitment packages in underserved areas. The RWJF program-related investment of $700,000 is invested in bank certificates of deposit to catalyze the loan fund.
- Legislative changes during the program period include increasing Medicaid reimbursement in underserved areas.
- In 1998, the legislature approved budget language allowing unused and repaid scholarship money to revert to a previously unfunded physician loan repayment program. It also funded two $10,000 scholarships for osteopathic students agreeing to work in Southwest Virginia.
AFTER THE GRANT
Recruitment and retention efforts, database development, and the loan fund continue. In addition, the Center for Primary Care and Rural Health has contracted with state universities and some of the AHECs for the development of the Virginia Health Access Network, which includes a recruitment Web page, a newsletter, and several other projects addressing minority and multi-cultural health issues. The center also is funding the services of a certified public accountant to assist practitioners in rural and Health Professional Shortage Areas with practice management issues. This initiative was funded to improve retention of practitioners in rural areas.
The Joint Commission on Health Care (JCHC) will introduce legislation during the 2000 General Assembly Session to strengthen the center's role in coordinating Virginia's efforts to recruit and retain providers in underserved areas. The JCHC also will be requesting additional positions and funding for the center to continue and expand its activities.
GRANT DETAILS & CONTACT INFORMATION
Virginia Practice Sights
Commonwealth of Virginia Joint Commission on Health Care (Richmond, VA)
Amount: $ 99,994
Dates: May 1993 to October 1994
Amount: $ 798,000
Dates: August 1994 to May 1999
Patrick W. Finnerty
Virginia Health Care Foundation
Amount: $ 700,000
Dates: December 1995 to December 2005
Patrick W. Finnerty
Report prepared by: Robert Narus
Reviewed by: Molly McKaughan
Reviewed by: Marian Bass
Program Officer: Michael Beachler