Ensuring Access to General Surgery Act of 2021

II 117TH CONGRESS 1ST SESSION S. 1593 To amend the Public Health Service Act with respect to the designation of general surgery shortage areas, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 12, 2021 Mr. SCHATZ introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act with respect to the designation of general surgery shortage areas, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Ensuring Access to 4 General Surgery Act of 2021’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 (1) According to the Bureau of Health Work- 8 force, the United States faces a shortage of physi- 9 cians. 10 VerDate Sep 11 2014 00:37 May 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1593.IS S1593 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1593 IS (2) A 2016 study entitled ‘‘Supply and Demand 1 of General Surgeons: Projections From 2014–2030’’, 2 prepared by the University of North Carolina at 3 Chapel Hill for the American College of Surgeons, 4 found that the supply of general surgeons will grow 5 slightly by 2030 but will not keep up with overall 6 growth in the United States population or demand 7 for surgical services. 8 (3) A 2020 report released by the Association 9 of American Medical Colleges projects shortages in 10 all surgical specialties of between 17,100 and 28,700 11 surgeons by 2033. 12 (4) A 2020 report prepared by the Health Re- 13 sources and Services Administration for the Com- 14 mittee on Appropriations of the Senate found a mal- 15 distribution of general surgeons nationwide, with 16 rural areas having only 69 percent of the general 17 surgeons needed to meet demand for care. 18 (5) In order to accurately prepare for future 19 physician workforce demands, comprehensive, impar- 20 tial research and high-quality data are needed to in- 21 form dynamic projections of physician workforce 22 needs. 23 (6) A variety of factors, including health out- 24 comes, utilization trends, growing and aging popu- 25 VerDate Sep 11 2014 00:37 May 27, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1593.IS S1593 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1593 IS lations, and delivery system changes, influence work- 1 force needs and should be considered as part of 2 flexible projections of workforce needs. 3 (7) Given the particularly acute needs in many 4 rural and other surgical workforce shortage areas, 5 additional efforts to assess the adequacy of the cur- 6 rent general surgeon workforce are necessary. 7 SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGICAL 8 HEALTH PROFESSIONAL SHORTAGE AREAS. 9 Part D of title III of the Public Health Service Act 10 (42 U.S.C. 254b et seq.) is amended by adding at the end 11 the following: 12 ‘‘Subpart XIII—General Surgery Shortage Areas 13 ‘‘SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORT- 14 AGE AREAS. 15 ‘‘(a) GENERAL SURGERY SHORTAGE AREA DE- 16 FINED.—For purposes of this section, the term ‘general 17 surgery shortage area’ means, with respect to an urban, 18 suburban, or rural area in the United States, an area that 19 has a population that is underserved by general surgeons. 20 ‘‘(b) STUDY AND REPORT.— 21 ‘‘(1) STUDY.—The Secretary, acting through 22 the Administrator of the Health Resources and Serv- 23 ices Administration, shall conduct a study on the fol- 24 VerDate Sep 11 2014 00:37 May 27, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1593.IS S1593 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1593 IS lowing matters relating to access by underserved 1 populations to general surgeons: 2 ‘‘(A) Whether current shortage designa- 3 tions, such as the designation of health profes- 4 sional shortage areas under section 332, results 5 in accurate assessments of the adequacy of local 6 general surgeons to address the needs of under- 7 served populations in urban, suburban, or rural 8 areas. 9 ‘‘(B) Whether another measure of access 10 to general surgeons by underserved populations, 11 such as one based on general surgeons prac- 12 ticing within hospital service areas, would pro- 13 vide more accurate assessments of shortages in 14 the availability of local general surgeons to 15 meets the needs of those populations. 16 ‘‘(C) Potential methodologies for the des- 17 ignation of general surgery shortage areas, in- 18 cluding the methodology described in paragraph 19 (2). 20 ‘‘(2) METHODOLOGY FOR THE DESIGNATION OF 21 AREAS.—Among the methodologies considered under 22 paragraph (1)(C) for the designation of general sur- 23 gery shortage areas, the Secretary shall analyze the 24 VerDate Sep 11 2014 00:37 May 27, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1593.IS S1593 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1593 IS effectiveness and accuracy of the following method- 1 ology: 2 ‘‘(A) DEVELOPMENT OF SURGERY SERVICE 3 AREAS.—Development of surgery service areas 4 through the identification of hospitals with sur- 5 gery services and the identification of popu- 6 lations by zip code areas using Medicare patient 7 origin data. 8 ‘‘(B) IDENTIFICATION OF SURGEONS.— 9 Identification of all actively practicing general 10 surgeons. 11 ‘‘(C) SURGEON TO POPULATION RATIOS.— 12 Development of general surgeon-to-population 13 ratios for each surgery service area. 14 ‘‘(D) THRESHOLDS.— 15 ‘‘(i) IN GENERAL.—Determination of 16 threshold general surgeon-to-population ra- 17 tios for the number of general surgeons 18 necessary to treat a population for each of 19 the following levels: 20 ‘‘(I) Optimal supply of general 21 surgeons. 22 ‘‘(II) Adequate supply of general 23 surgeons. 24 VerDate Sep 11 2014 00:37 May 27, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1593.IS S1593 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1593 IS ‘‘(III) Shortage of general sur- 1 geons. 2 ‘‘(IV) Critical shortage of general 3 surgeons. 4 ‘‘(ii) CONSIDERATIONS.—In deter- 5 mining the thresholds under clause (i), the 6 Secretary shall not assume that the cur- 7 rent supply of general surgeons nationwide 8 is the optimal or adequate level and shall 9 consider additional factors such as wait 10 times, health outcomes, ground transpor- 11 tation time to the nearest health care cen- 12 ter with a general surgeon, critical access 13 hospitals with surgical capabilities but 14 lacking a general surgeon, and patient ex- 15 perience. 16 ‘‘(3) REPORT.—Not later than 1 year after the 17 date of the enactment of this subpart, the Secretary 18 shall submit to Congress a report on the study con- 19 ducted under this subsection. 20 ‘‘(4) CONSULTATION.—In conducting the study 21 under paragraph (1), the Secretary shall consult 22 with relevant stakeholders, including medical soci- 23 eties, organizations representing surgical facilities, 24 VerDate Sep 11 2014 00:37 May 27, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1593.IS S1593 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1593 IS organizations with expertise in general surgery, and 1 organizations representing patients. 2 ‘‘(5) PUBLICATION OF DATA.—The Secretary 3 shall periodically collect and publish in the Federal 4 Register— 5 ‘‘(A) data comparing the availability and 6 need of general surgery services in urban, sub- 7 urban, or rural areas in the United States; and 8 ‘‘(B) if the Secretary designates one or 9 more general surgery shortage areas under sub- 10 section (c), a list of the areas so designated. 11 ‘‘(c) DESIGNATION OF GENERAL SURGERY SHORT- 12 AGE AREAS.— 13 ‘‘(1) METHODOLOGY DEVELOPED THROUGH 14 REGULATION.—Based on the findings of the report 15 under subsection (b)(3), the Secretary may establish, 16 through notice and comment rulemaking, a method- 17 ology for the designation of general surgery shortage 18 areas under this section. 19 ‘‘(2) REQUIREMENTS.—If the Secretary elects 20 to develop methodology under paragraph (1), the fol- 21 lowing shall apply: 22 ‘‘(A) Using the methodology established 23 under paragraph (1) and taking into consider- 24 VerDate Sep 11 2014 00:37 May 27, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1593.IS S1593 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1593 IS ation the data referred to in subsection (b)(5), 1 the Secretary shall— 2 ‘‘(i) designate general surgery short- 3 age areas in the United States; 4 ‘‘(ii) publish a descriptive list of the 5 areas; and 6 ‘‘(iii) review annually, and, as nec- 7 essary, revise such designations. 8 ‘‘(B) The Secretary shall follow similar 9 procedures with respect to notice to appropriate 10 parties, opportunities for comment, dissemina- 11 tion of information, and reports to Congress in 12 designating general surgery shortage areas 13 under this section as those that apply to the 14 designation of health professional shortage 15 areas under section 332. 16 ‘‘(C) In designating general surgery short- 17 age areas under this subsection, the Secretary 18 shall consult with relevant stakeholders, includ- 19 ing medical societies, organizations representing 20 surgical facilities, organizations with expertise 21 in general surgery, and organizations rep- 22 resenting patients.’’. 23 Æ VerDate Sep 11 2014 00:37 May 27, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S1593.IS S1593 kjohnson on DSK79L0C42PROD with BILLS