Over the next five years, the Health Resources and Services Administration’s (HRSA’s) Teaching Health Center Graduate Medical Education (THCGME) program could yield up to $1.8 billion in public program savings, according to a report released today. Researchers at the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health (GW Milken Institute SPH) conducted the analysis.
The THCGME program, which began in 2011, aims to increase the number of primary care resident physicians training in community-based care sites like community health centers. Currently, 56 Teaching Health Centers (THCs) in 23 states train residents in the primary care specialties of family medicine, internal medicine, pediatrics, psychiatry, ob-gyn and dentistry.
Current federal authorization and funding for the THCGME program expire on Sept. 30, and President Trump’s proposed FY2020 budget includes two years of additional funding for teaching health centers. The new analysis details how the THCGME program has the potential to produce $1.5 billion in Medicaid savings and $284 million in Medicare savings while providing high quality primary care in medically underserved locations.
“Graduate medical education is a critical determinant of the U.S. physician workforce, determining the overall number of physicians, as well as whether they serve as primary care physicians—whose shortages are particularly acute—or specialists,” said Candice Chen, MD, MPH, lead author of the analysis and an associate professor of health policy and management at GW Milken Institute SPH. “Community health centers and teaching health centers that train the next generation of physicians are a crucial component of efforts to strengthen and upgrade our nation’s health system, particularly for patients who live in communities where it is difficult to access medical care.”
Chen and her co-authors determined the potential saving associated with the THCGME program based on recent research that examines the cost effectiveness of health center-based care. Residents based in community health centers are trained to provide high-quality, cost-efficient care. Patients who receive most of their care in community health center settings have lower medical expenditures overall than those who get their care in other settings. If the THCGME program is reauthorized, the patient care provided by THC residents during the training period could yield up to $288 million in Medicaid and Medicare savings between 2019 and 2023.
In addition, significant savings are associated with the post-training period. Research shows that residents trained in lower spending regions are more cost-efficient in their subsequent practice, with lower average spending per patient, per year. In community health centers, five consecutive cohorts of graduating THC physicians could produce up to $238 million in Medicare savings and $1.2 billion in Medicaid savings over five years, from 2019 to 2023. The total of all the potential during-and post-residency THCGME savings to public programs equates to $1.8 billion over the five-year period.
Residencies influence where physicians ultimately practice, including whether they practice in rural or medically underserved communities. The goal of the THCGME program is not only to provide expanded opportunities for training, but also to improve access to high-quality care by increasing the numbers of well-trained physicians and dentists practicing in medically underserved communities after they complete residency training. By 2018, the THCGME program had graduated 880 primary care physicians and dentists since the inception of the program, of whom 64 percent were practicing in primary care – nearly double the national average for all physicians – and 58 percent were practicing in medically underserved or rural communities.
“Efforts to increase the number of primary care physicians in America, including those who graduate from THCGME programs, can result in significant long-term health care savings and better access to high-quality primary care,” said Leighton Ku, PhD, MPH, director of the Center for Health Policy Research at GW Milken Institute SPH.
In addition to Chen and Ku, the authors of the analysis are Marsha Regenstein, PhD and Fitzhugh Mullan, MD. “Examining the Cost Effectiveness of Teaching Health Centers,” can be accessed here.