[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1841 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 1841
To amend the Public Health Service Act with respect to the designation
of general surgery shortage areas, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 21, 2019
Mr. Bera (for himself, Mr. Bucshon, Mr. Peters, and Mr. Mullin)
introduced the following bill; which was referred to the Committee on
Energy and Commerce
_______________________________________________________________________
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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ensuring Access to General Surgery
Act of 2019''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) According to the Bureau of Health Workforce, the United
States faces a shortage of physicians.
(2) A 2016 study entitled ``Supply and Demand of General
Surgeons: Projections From 2014-2030'', prepared by the
University of North Carolina at Chapel Hill for the American
College of Surgeons, found that the supply of general surgeons
will grow slightly by 2030 but will not keep up with overall
growth in the United States population or demand for surgical
services.
(3) A 2018 report released by the American Association of
Medical Colleges projects shortages in all surgical specialties
of between 20,700 and 30,500 surgeons by 2030.
(4) In order to accurately prepare for future physician
workforce demands, comprehensive, impartial research and high
quality data are needed to inform dynamic projections of
physician workforce needs.
(5) A variety of factors, including health outcomes,
utilization trends, growing and aging populations, and delivery
system changes, influence workforce needs and should be
considered as part of flexible projections of workforce needs.
(6) Given the particularly acute needs in many rural and
other surgical workforce shortage areas, additional efforts to
assess the adequacy of the current general surgeon workforce
are necessary.
SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGERY SHORTAGE AREAS.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following:
``Subpart XIII--General Surgery Shortage Areas
``SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORTAGE AREAS.
``(a) General Surgery Shortage Area Defined.--For purposes of this
section, the term `general surgery shortage area' means, with respect
to an urban, suburban or rural area in the United States, an area that
has a population that is underserved by general surgeons.
``(b) Study and Report.--
``(1) Study.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall conduct a study on the following matters
relating to access by underserved populations to general
surgeons:
``(A) Whether current shortage designations, such
as the designation of health professional shortage
areas under section 332, results in accurate
assessments of the adequacy of local general surgeons
to address the needs of underserved populations in
urban, suburban, or rural areas.
``(B) Whether another measure of access to general
surgeons by underserved populations, such as one based
on general surgeons practicing within hospital service
areas, would provide more accurate assessments of
shortages in the availability of local general surgeons
to meets the needs of those populations.
``(C) Potential methodologies for the designation
of general surgery shortage areas, including the
methodology described in paragraph (2).
``(2) Methodology for the designation of areas.--Among the
methodologies considered under paragraph (1)(C) for the
designation of general surgery shortage areas, the Secretary
shall analyze the effectiveness and accuracy of the following
methodology:
``(A) Development of surgery service areas.--
Development of surgery service areas through the
identification of hospitals with surgery services and
the identification of populations by zip code areas
using Medicare patient origin data.
``(B) Identification of surgeons.--Identification
of all actively practicing general surgeons.
``(C) Surgeon to population ratios.--Development of
general surgeon-to-population ratios for each surgery
service area.
``(D) Thresholds.--Determination of threshold
general surgeon-to-population ratios for the number of
general surgeons necessary to treat a population for
each of the following levels:
``(i) Optimal supply of general surgeons.
``(ii) Adequate supply of general surgeons.
``(iii) Shortage of general surgeons.
``(iv) Critical shortage of general
surgeons.
``(3) Report.--Not later than one year after the date of
the enactment of this subpart, the Secretary shall submit to
Congress a report on the study conducted under this subsection.
``(4) Consultation.--In conducting the study under
paragraph (1), the Secretary shall consult with relevant
stakeholders, including medical societies, organizations
representing surgical facilities, organizations with expertise
in general surgery, and organizations representing patients.
``(5) Publication of data.--The Secretary shall
periodically collect and publish in the Federal Register--
``(A) data comparing the availability and need of
general surgery services in urban, suburban or rural
areas in the United States; and
``(B) if the Secretary designates one or more
general surgery shortage areas under subsection (c), a
list of the areas so designated.
``(c) Designation of General Surgery Shortage Areas.--
``(1) Methodology developed through regulation.--Not later
than 12 months after the date of the submission of the report
under subsection (b)(3), the Secretary may establish, through
notice and comment rulemaking, a methodology for the
designation of general surgery shortage areas under this
section.
``(2) Requirements.--If the Secretary elects to develop
methodology under paragraph (1), the following shall apply:
``(A) Using the methodology established under
paragraph (1) and taking into consideration the data
referred to in subsection (b)(5), the Secretary shall--
``(i) designate general surgery shortage
areas in the United States;
``(ii) publish a descriptive list of the
areas; and
``(iii) review annually, and, as necessary,
revise such designations.
``(B) The Secretary shall follow similar procedures
with respect to notice to appropriate parties,
opportunities for comment, dissemination of
information, and reports to Congress in designating
general surgery shortage areas under this section as
those that apply to the designation of health
professional shortage areas under section 332.
``(C) In designating general surgery shortage areas
under this subsection, the Secretary shall consult with
relevant stakeholders, including medical societies,
organizations representing surgical facilities,
organizations with expertise in general surgery, and
organizations representing patients.''.
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