Legislature(2011 - 2012)CAPITOL 106
03/08/2011 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB1 | |
| HB78 | |
| Presentation: Alaska Healthcare Workforce Plan | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 1 | TELECONFERENCED | |
| *+ | HB 78 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HB 78-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
3:41:45 PM
CHAIR KELLER announced that the next order of business would be
HOUSE BILL NO. 78, "An Act establishing a loan repayment program
and employment incentive program for certain health care
professionals employed in the state; and providing for an
effective date."
CHAIR KELLER offered an analogy for HB 78 to that of investing
in new tires for an old car that has everything wrong. He
offered his belief that the destiny of the Patient Protection
and Affordable Care Act was still in the court system, and that
the costs of the health care system were no longer supportable.
He opined that a government subsidy for loans, as proposed by HB
78, was not a solution.
3:43:29 PM
REPRESENTATIVE HERRON expressed his appreciation for the
opportunity to hear testimony regarding incentives for medical
providers and for the "possible passage of this bill through the
House."
3:44:25 PM
LIZ CLEMENT, Staff, Representative Bob Herron, Alaska State
Legislature, directed attention to the latest proposed committee
substitute.
3:44:51 PM
REPRESENTATIVE DICK moved to adopt the proposed Committee
Substitute (CS) for HB 78, 27-LS0147\I, Mischel, 3/2/11, as the
working document. There being no objection, Version I was
before the committee.
3:45:10 PM
MS. CLEMENT emphasized the challenges to the health care
workforce in rural and urban areas. She explained that proposed
HB 78 offered incentives to attract certain medical providers to
Alaska. She reported that 46 states had sponsored "support for
service programs" and that many states had found these to be
extremely beneficial for immediate alleviation of workforce
shortages. She confirmed that research had indicated that loan
repayment and incentive programs, similar to proposed HB 78, had
been among the most effective methods for recruitment and
retention of quality health care providers. She pointed out
that medical providers could receive either loan repayment
assistance or direct cash incentives. She pointed out that few
states offered a direct cash incentive, which could attract
recent graduates as well as experienced mid-career medical
professionals.
3:47:22 PM
MS. CLEMENT announced that the program would be administered by
Department of Health and Social Services (DHSS) and allow for 90
participants each year, from 10 approved health care
professions, which included dentists, pharmacists, nurse
practitioners, and physical therapists. She reported that the
various levels of loan repayment or financial incentive would be
determined by community location and profession. She noted that
these determinations would be in statute and monitored by DHSS.
She pointed to the numerous letters of support [Included in
members' packets].
3:48:59 PM
REPRESENTATIVE MILLETT asked for the definition to "a very hard-
to-fill position."
MS. CLEMENT explained that these would be designated by DHSS,
based, in part, by the time necessary to recruit a provider for
that position.
3:50:37 PM
REPRESENTATIVE MILLETT asked if this would be determined by the
DHSS commissioner.
MS. CLEMENT agreed.
3:51:06 PM
CHAIR KELLER suggested that a question to be asked would be for
the determination of the criteria.
3:51:35 PM
CHAIR KELLER opened public testimony.
3:51:49 PM
DR. MARY LOEB, Medical Director, Sunshine Community Health
Center, testified to the difficulty in filling key medical
positions. She detailed that it was 18 months to recruit a
dentist, 24 months to recruit a behavioral health specialist,
and another 18 months to recruit for numerous provider
positions. She stated that this would offer needed support for
recruitment of qualified personnel.
3:54:02 PM
NANCY DAVIS, Executive Director, Alaska Pharmacists Association,
informed the committee that there were no public programs in
Alaska to actively recruit and retain pharmacists. She reported
that Alaska was one of only four states without a pharmacy
school, so recruitment was the only method to obtain the
necessary pharmacists. She testified that the 250 association
members were in support of HB 78.
3:55:18 PM
ELIZABETH RIPLEY, Executive Director, Mat-Su Health Foundation,
explained that the Mat-Su Health Foundation was a non-profit
organization, which invested into grants to improve the health
and wellness of Alaskans living in Mat-Su. She detailed that
one of the four strategies to reach the goal of becoming the
healthiest borough in Alaska was to reduce the barriers to
health care access, which included a lack of health care
professionals. She directed attention to her letter detailing
the recruitment experience and offering support for proposed HB
78 [Included in members' packets]. She acknowledged that all
recruits reviewed opportunities before making a decision, as
competition was quite robust. She pointed out that culture,
climate, geography, and lack of amenities all combined to make
recruitment even more difficult. She identified these as
significant difficulties for recruitment in rural clinics and
community health centers. She opined that the work force had
numerous options throughout the United States, as 47 states had
loan repayment programs. She stressed the necessity for a
quality health care work force in the primary care settings in
order to keep people out of costly acute care. She declared
that an investment in loan repayment and direct incentive
programs was a solid investment with a healthy return. She
offered support of proposed HB 78.
4:00:26 PM
MS. RIPLEY, in response to Chair Keller, said that the direct
incentive programs were highly successful in other states.
4:01:24 PM
REPRESENTATIVE SEATON, referring to page 3, line 22 of Version
I, asked if the loan repayment differential between urban and
rural health care professionals was adequate.
MS. RIPLEY replied that although she was not specifically
addressing the payment differential, it was adequate, but that
urban hospitals had other tools to assist in recruitment.
4:03:17 PM
JULIE MCDONALD, Pharmacist, shared her story of pharmacy school,
and her consequent work history, and she reported that her
student loans exceeded $200,000. She declared that costs were a
major factor and that proposed HB 78 would be a powerful
incentive to bring people here.
4:08:10 PM
JIM TOWLE, Executive Director, Alaska Dental Society, shared a
story of an inquiry from a person interested in dentistry in
Alaska, but burdened with student loans, who expressed that
incentives would influence her decision. He stated that these
inquiries were not uncommon. He stressed that proposed HB 78
was a valuable incentive for recruitment.
4:09:49 PM
REPRESENTATIVE SEATON asked if the loan repayment differential
for urban and rural health care professionals was adequate.
MR. TOWLE agreed that it was adequate.
4:10:23 PM
RICHARD PECK, Board President, Iliuliuk Family and Health
Services, Inc., stated that proposed HB 78 was necessary to
attract and retain medical providers. He offered the support of
the board for HB 78.
4:11:40 PM
SHELLEY HUGHES, Government Affairs Director, Alaska Primary Care
Association, shared that she had been a member of the
stakeholders working group in 2008 looking for a solution. She
emphasized that this strategy was "the best bang for the buck."
She reported that nationally there was a shortage of physicians
and Alaska was getting hit hard. She reported that it was
expensive and difficult to recruit and retain, and even more so
in rural areas. She relayed that the physician vacancy in
tribal positions was over 28 percent, and the vacancy rate for
other medical provider positions was over 35 percent. She
stated that the medical directors from the Community Health
Centers had relayed that applicants always inquired about
incentive and loan repayment programs. She stated that the
turnover rate for medical professionals was about three years.
She remarked that the incentive and loan repayments would also
complement the "grow our own" program, as Alaskans would return
to Alaska. She compared the average loan debt to that of a
mortgage. She pointed out that proposed HB 78 targeted people
who were ready to work and, as there was not any pay until there
was service, the return was 100 percent. She asked the
committee to consider the costs of no action, as rural health
care clinics generated revenue and were "economic engines." She
opined that Medicaid costs would increase without additional
medical providers in the bush. She pointed out that proposed HB
78 included a financial match so that the health care industry
also had "skin in the game." She also noted that the Alaska
Health Care Commission had recommended loan repayment and
incentives as a strategy for increasing the medical workforce in
Alaska. She directed attention to the wide spread support from
all the medical industry sectors.
4:18:11 PM
RHONDA RAYE, Physical Therapist, pointed out that there was not
a physical therapy program in Alaska. She commented that a loan
repayment program was a big incentive when searching for jobs.
She spoke in support of HB 78.
4:20:29 PM
REPRESENTATIVE HERRON asked if the financial incentive was
enough to compete with other states, and he asked for a
comparison with Alaska.
MS. HUGHES, in response, said that the amounts were competitive,
and she offered to report back with actual comparative numbers.
She pointed to the importance of hiring experienced
professionals in rural locations.
4:22:11 PM
REPRESENTATIVE HERRON asked to confirm that "a very hard to fill
position" was not designated solely to rural areas.
MS. HUGHES replied that it was based on the length of the
vacancy and the difficulty for hiring. She offered her belief
that this would tend toward smaller, more remote locations.
4:23:39 PM
JUSTIN RUFFRIDGE, Pharmacist, reported that there was little
opportunity for loan repayment from the State of Alaska,
especially as there was not a pharmacy school in the state. He
stated his support of HB 78. He offered his belief that HB 78
was a necessary component in order for Alaska to be competitive
with other states.
4:24:56 PM
KAREN PERDUE, CEO & President, Alaska State Hospital and Nursing
Association, reported on the medical work force shortages in
Alaska, noting that some professions in the urban areas were
doing well. She relayed that hiring was cyclical in Alaska, and
she opined that the hiring situation would worsen with shortages
in both rural and urban areas. She pointed to specialist areas
which were very difficult to fill. She offered her belief that
proposed HB 78 would offer much greater help to smaller clinics
and community health centers than to hospitals. She stated that
health care was defined by the providers and the service to the
patients. In reference to an earlier analogy by Chair Keller,
she suggested that HB 78 was a replacement for the motor, not
the tires.
4:29:03 PM
CHAIR KELLER asked if HB 78 offered an appropriate incentive.
MS. PERDUE replied that the bill was a good start.
4:30:04 PM
PAT CARR, Chief, Health Planning and Infrastructure, Division of
Health Care Services, Department of Health and Social Services,
stated that HHSS had been following HB 78.
4:30:45 PM
CHAIR KELLER asked what the determinater of success would be in
5 years.
MS. CARR replied that an evaluation for measures of success
would include increased access to care, with increased
providers. She referenced HB 78 and detailed that, among
others, the number of applicants, the enrollees, the
geographical area, the length of vacancies, the employment
patterns, and the enrollment of professionals would be included
in the evaluation process. She pointed to other surveys,
including the Behavioral Risk Factor Survey, which could also be
used in evaluation. She summarized that a tracking tool to
determine the dispersal of the funding and to measure any
decrease in length of job vacancies would be necessary for the
evaluation.
4:34:22 PM
CHAIR KELLER asked if criteria needed to be developed for the
selection of applicants.
MS. CARR replied that the criteria were not yet available. She
directed attention to a current HHSS repayment program which
would act as a model, and noted that the advisory group would
also make suggestions.
4:35:38 PM
REPRESENTATIVE HERRON, referring to Version I, pointed to page
2, line [17], and stated concern with "a lifetime maximum period
of 12 years." He asked for a better definition of "hard to
fill," and if any of these professions would be eligible for
hire with the State of Alaska.
MS. CARR, reflecting on discussions about "a lifetime maximum
period of 12 years," stated that support for retention should be
extended to people returning to school for continued education.
She stated that the time frame was still under advisement. In
response to Representative Herron, she said that "hard to fill"
could either be defined in statute or be added as a program
regulation for the discretion of the advisory committee or the
commissioner.
4:38:50 PM
REPRESENTATIVE HERRON asked if a recipient of the incentives or
loan repayments in HB 78 could work for the State of Alaska.
MS. CARR replied that this had not yet been defined. She noted
that some of the professional categories referenced in the bill
were employed by the state, and that the state also had
difficulty with recruitment of certain health care providers.
4:39:37 PM
REPRESENTATIVE SEATON, referring to the lifetime maximum period
of 12 years, asked about any limitations.
MS. CARR offered her belief that the bill did not preclude an
individual from staying in the same position for the entire
time. She pointed out that, within the 12 year period, there
were periods of application renewal.
4:41:16 PM
REPRESENTATIVE SEATON reflected that the program had a 90 person
enrollment maximum, but that there was not a priority for any
new entrants.
MS. CARR, in response to Representative Seaton, said that this
was not specified in the bill.
4:42:35 PM
REPRESENTATIVE SEATON pondered whether the intent for the
incentive program was to have someone receive payment for 12
years, if others were applying for the program.
MS. CLEMENT, in response to Representative Seaton, said that
more changes to HB 78 were forthcoming.
4:44:34 PM
DELISA CULPEPPER, Chief Operating Officer, Alaska Mental Health
Trust Authority, Department of Revenue, said that the Alaska
Mental Health Trust Authority supported long term loan repayment
and direct incentives and that these were important factors for
workforce strategies.
4:46:03 PM
MARIE DARLIN, Coordinator, AARP Capital City Task Force,
directed attention to its letter of support for HB 78 [Included
in members' packets]. She stated that HB 78 was important to
increase the number of health care providers for seniors. She
pointed out that proper medical care would allow seniors to
remain in Alaska, and she noted that seniors provided an
economic input of more than $1.5 billion to Alaska.
4:47:14 PM
CHAIR KELLER closed public testimony.
[HB 78 was held over.]