In the face of rural physician shortages, the Health Resources and Services Administration (HRSA) unveiled a new tool on April 11 to help assess whether a rural hospital is currently a teaching hospital. Knowing whether a hospital is eligible to begin receiving Medicare funding for new programs is critical, given Medicare funding caps on existing teaching hospitals' ability to grow residency programs as well as rules permitting non-teaching hospitals to start training residents and begin receiving Medicare graduate medical education (GME) funding. The tool HRSA unveiled is meant to be used as a first step for the public to identify new potential rural residency training sites.

During its recent "Rural GME Eligibility Webinar," HRSA released the link to a database created and launched jointly by the University of North Carolina Sheps Center and the HRSA Data Warehouse. The tool uses hospital cost report data to determine whether a hospital self-reported as hosting training programs (on Worksheet S-2 of the cost report), reported resident full-time equivalents (FTEs) or received indirect medical education (IME) funding at any point between 1997 and 2013. According to data presented during the webinar, of 1,018 rural hospitals, 120 are already teaching hospitals and 898 are not. One notable difference among those rural hospitals that were already training residents was the median number of acute care inpatient beds: 107 beds for those rural hospitals that were already teaching hospitals, and 60 for those that did not yet train any residents.

The agency acknowledged that the tool has limitations. In addition to general data quality issues, HRSA noted that a hospital had to be classified as rural as of June 30, 2014, to be considered rural for purposes of the database. Additionally, using cost report data like that available through the tool can only be viewed as a first step in determining whether a hospital is already a teaching hospital or not. Hospitals have not always been aware of the Centers for Medicare & Medicaid Services (CMS) requirement to report all resident rotations (no matter how short) on the hospital cost report, so there may be instances when per-resident amounts or GME caps have been established, even though residents were not reported on the hospital's cost report.

In addition to unveiling the new tool, HRSA also indicated that additional information would be forthcoming regarding the Rural Residency Planning and Development (RRPD) program, a grant program designed to cover planning and development costs for new rural primary care residency programs.

Dentons' Health Care team will continue to follow this issue. We can answer your questions about Medicare funding for rural and urban residency training programs, rural training tracks and new programs.