Medicaid Change Adds Support For Primary Care Doc Training

Nov. 14--TUPELO -- Mississippi Medicaid is changing the way it supports graduate medical education for new doctors in hopes of building on the success of a Tupelo-based program.

Medicaid is now supplementing medical residency programs based on the number of doctors training with each program, instead of volume of Medicaid patients at its parent institution.

"Ultimately, we think it's a more sustainable model," said Wil Ervin, Mississippi Medicaid director of external affairs.

For the last fiscal year, the supplement provided about $34 million for residency programs. As new primary care residency programs come online in the next few years, the funding will increase about $39 million.

"We think it's an investment and a priority for our state," Ervin said. "Getting residencies into rural communities and (physician) shortage areas is a priority."

Mississippi generally ranks last in physicians per capita. Rural areas feel the shortage of physicians most acutely. While the expansion of University of Mississippi School of Medicine and the creation of the William Carey medical school have helped, Mississippi needs more slots in residency programs, especially for primary care specialties, like family medicine and internal medicine, to effectively address the shortages, said Dr. John Mitchell, director of the Office of Physician Workforce and a former family medicine residency faculty member in Tupelo.

"People stay where they do their residencies," Mitchell said. "We need to build models of training in areas where there's the most need. We've been last long enough."

Opened in 1995, North Mississippi Medical Center Family Medicine Residency Center in Tupelo was the first offered outside of Jackson. Currently 60 of its graduates are practicing in the region.

"It's been extremely successful in educating primary care doctors and getting them to stay in the region," said Dr. C.K. White, North Mississippi Health Services chief medical officer.

Since the family medicine program opened in Tupelo, Forrest General Hospital in Hattiesburg and Mississippi Baptist Medical Center in Jackson have added family medicine residency programs. Baptist Memorial Hospital-Desoto County, Magnolia Regional Health Center in Corinth and Merit Health Wesley in Hattiesburg have internal medicine programs. Merit Health Wesley also hosts an emergency medicine program.

Medicaid started providing a supplement to hospitals hosting residency programs in 2012. It was based on the number of inpatient discharges of Medicaid patients. However, as more care is delivered on an outpatient basis, using the inpatient volume isn't predictable enough, Ervin said.

"It was fine for established programs, but it didn't lend itself to start up programs," Mitchell said.

In the next few years, Mississippi is on track to open a number of primary care residency programs, Mitchell said.

The Mississippi Delta Family Medicine Program in Greenville is expected to open next summer. NMMC is in the process of seeking accreditation for an internal medicine residency program with a target of starting in the summer of 2021. Around the state, hospitals are in the planning stages for family medicine, internal medicine, psychiatry and internal medicine. In all, seven more programs could be running by 2022.

The process of creating new residency programs has been very deliberate. Just having residency programs doesn't ensure success, White cautioned.

"As they start more residency programs, it's incumbent to have quality programs," White said.

However, state officials and medical leaders are optimistic they are building a strong infrastructure.

"I think our future is bright with what we're building on," Mitchell said. "We're beginning to sprout."

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