Ensuring Access to General Surgery Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2859 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 NOVEMBER 14, 2019 Mr. SCHATZ (for himself and Mr. BARRASSO) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, 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 2019’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 02:00 Nov 20, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2859.IS S2859 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 2859 IS (1) According to the Bureau of Health Work- 1 force, the United States faces a shortage of physi- 2 cians. 3 (2) A 2016 study entitled ‘‘Supply and Demand 4 of General Surgeons: Projections From 2014–2030’’, 5 prepared by the University of North Carolina at 6 Chapel Hill for the American College of Surgeons, 7 found that the supply of general surgeons will grow 8 slightly by 2030 but will not keep up with overall 9 growth in the United States population or demand 10 for surgical services. 11 (3) A 2019 report released by the Association 12 of American Medical Colleges projects shortages in 13 all surgical specialties of between 14,300 and 23,400 14 surgeons by 2032. 15 (4) In order to accurately prepare for future 16 physician workforce demands, comprehensive, impar- 17 tial research and high-quality data are needed to in- 18 form dynamic projections of physician workforce 19 needs. 20 (5) A variety of factors, including health out- 21 comes, utilization trends, growing and aging popu- 22 lations, and delivery system changes, influence work- 23 force needs and should be considered as part of 24 flexible projections of workforce needs. 25 VerDate Sep 11 2014 02:00 Nov 20, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2859.IS S2859 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 2859 IS (6) Given the particularly acute needs in many 1 rural and other surgical workforce shortage areas, 2 additional efforts to assess the adequacy of the cur- 3 rent general surgeon workforce are necessary. 4 SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGICAL 5 HEALTH PROFESSIONAL SHORTAGE AREAS. 6 Part D of title III of the Public Health Service Act 7 (42 U.S.C. 254b et seq.) is amended by adding at the end 8 the following: 9 ‘‘Subpart XIII—General Surgery Shortage Areas 10 ‘‘SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORT- 11 AGE AREAS. 12 ‘‘(a) GENERAL SURGERY SHORTAGE AREA DE- 13 FINED.—For purposes of this section, the term ‘general 14 surgery shortage area’ means, with respect to an urban, 15 suburban, or rural area in the United States, an area that 16 has a population that is underserved by general surgeons. 17 ‘‘(b) STUDY AND REPORT.— 18 ‘‘(1) STUDY.—The Secretary, acting through 19 the Administrator of the Health Resources and Serv- 20 ices Administration, shall conduct a study on the fol- 21 lowing matters relating to access by underserved 22 populations to general surgeons: 23 ‘‘(A) Whether current shortage designa- 24 tions, such as the designation of health profes- 25 VerDate Sep 11 2014 02:00 Nov 20, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2859.IS S2859 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 2859 IS sional shortage areas under section 332, results 1 in accurate assessments of the adequacy of local 2 general surgeons to address the needs of under- 3 served populations in urban, suburban, or rural 4 areas. 5 ‘‘(B) Whether another measure of access 6 to general surgeons by underserved populations, 7 such as one based on general surgeons prac- 8 ticing within hospital service areas, would pro- 9 vide more accurate assessments of shortages in 10 the availability of local general surgeons to 11 meets the needs of those populations. 12 ‘‘(C) Potential methodologies for the des- 13 ignation of general surgery shortage areas, in- 14 cluding the methodology described in paragraph 15 (2). 16 ‘‘(2) METHODOLOGY FOR THE DESIGNATION OF 17 AREAS.—Among the methodologies considered under 18 paragraph (1)(C) for the designation of general sur- 19 gery shortage areas, the Secretary shall analyze the 20 effectiveness and accuracy of the following method- 21 ology: 22 ‘‘(A) DEVELOPMENT OF SURGERY SERVICE 23 AREAS.—Development of surgery service areas 24 through the identification of hospitals with sur- 25 VerDate Sep 11 2014 02:00 Nov 20, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2859.IS S2859 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 2859 IS gery services and the identification of popu- 1 lations by zip code areas using Medicare patient 2 origin data. 3 ‘‘(B) IDENTIFICATION OF SURGEONS.— 4 Identification of all actively practicing general 5 surgeons. 6 ‘‘(C) SURGEON TO POPULATION RATIOS.— 7 Development of general surgeon-to-population 8 ratios for each surgery service area. 9 ‘‘(D) THRESHOLDS.—Determination of 10 threshold general surgeon-to-population ratios 11 for the number of general surgeons necessary to 12 treat a population for each of the following lev- 13 els: 14 ‘‘(i) Optimal supply of general sur- 15 geons. 16 ‘‘(ii) Adequate supply of general sur- 17 geons. 18 ‘‘(iii) Shortage of general surgeons. 19 ‘‘(iv) Critical shortage of general sur- 20 geons. 21 ‘‘(3) REPORT.—Not later than one year after 22 the date of the enactment of this subpart, the Sec- 23 retary shall submit to Congress a report on the 24 study conducted under this subsection. 25 VerDate Sep 11 2014 02:00 Nov 20, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2859.IS S2859 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 2859 IS ‘‘(4) CONSULTATION.—In conducting the study 1 under paragraph (1), the Secretary shall consult 2 with relevant stakeholders, including medical soci- 3 eties, organizations representing surgical facilities, 4 organizations with expertise in general surgery, and 5 organizations representing patients. 6 ‘‘(5) PUBLICATION OF DATA.—The Secretary 7 shall periodically collect and publish in the Federal 8 Register— 9 ‘‘(A) data comparing the availability and 10 need of general surgery services in urban, sub- 11 urban, or rural areas in the United States; and 12 ‘‘(B) if the Secretary designates one or 13 more general surgery shortage areas under sub- 14 section (c), a list of the areas so designated. 15 ‘‘(c) DESIGNATION OF GENERAL SURGERY SHORT- 16 AGE AREAS.— 17 ‘‘(1) METHODOLOGY DEVELOPED THROUGH 18 REGULATION.—Not later than 12 months after the 19 date of the submission of the report under sub- 20 section (b)(3), the Secretary may establish, through 21 notice and comment rulemaking, a methodology for 22 the designation of general surgery shortage areas 23 under this section. 24 VerDate Sep 11 2014 02:00 Nov 20, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2859.IS S2859 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 2859 IS ‘‘(2) REQUIREMENTS.—If the Secretary elects 1 to develop methodology under paragraph (1), the fol- 2 lowing shall apply: 3 ‘‘(A) Using the methodology established 4 under paragraph (1) and taking into consider- 5 ation the data referred to in subsection (b)(5), 6 the Secretary shall— 7 ‘‘(i) designate general surgery short- 8 age areas in the United States; 9 ‘‘(ii) publish a descriptive list of the 10 areas; and 11 ‘‘(iii) review annually, and, as nec- 12 essary, revise such designations. 13 ‘‘(B) The Secretary shall follow similar 14 procedures with respect to notice to appropriate 15 parties, opportunities for comment, dissemina- 16 tion of information, and reports to Congress in 17 designating general surgery shortage areas 18 under this section as those that apply to the 19 designation of health professional shortage 20 areas under section 332. 21 ‘‘(C) In designating general surgery short- 22 age areas under this subsection, the Secretary 23 shall consult with relevant stakeholders, includ- 24 ing medical societies, organizations representing 25 VerDate Sep 11 2014 02:00 Nov 20, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2859.IS S2859 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 2859 IS surgical facilities, organizations with expertise 1 in general surgery, and organizations rep- 2 resenting patients.’’. 3 Æ VerDate Sep 11 2014 02:00 Nov 20, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S2859.IS S2859 pamtmann on DSKBC07HB2PROD with BILLS