According to the Rural Health Information Hub, Kansas has 82 critical access hospitals, 187 rural health clinics, 54 federally qualified health center sites located outside of urbanized areas, and 26 short-term hospitals located outside of urbanized areas. Additionally, the Center for Healthcare Quality and Payment Reform reports there are currently 104 rural hospitals, 60 of which are at risk of closing. These hospitals continue to face a shortage of health care workers, which has been exacerbated by the COVID-19 pandemic. This memorandum describes the reasons for that shortage and the State’s response to it.
Defining the Health Care Workforce
According to the U.S. Census Bureau’s 2019 American Community Survey, there were 22 million workers in the health care industry in 2019, which is one of the largest and fastest-growing sectors in the United States, accounting for 14 percent of all U.S. workers. The Center for Health Workforce Studies notes the health care workforce refers to all people who deliver or assist in the delivery of health services or who help operate health care facilities. This includes:
- Health care professionals working inside the health care sector, such as in hospitals;
- Health care professionals working outside the health care sector, such as in schools or for insurance companies; and
- Health care professionals working in private offices.
The health care sector has seen growth in employment, and is expected to increase by 12 percent by 2029. However, the COVID-19 pandemic has impacted the health care workforce and expanded the needs of the health care sector. In Kansas, this burden is magnified because of the shortage of physicians, services, and hospitals across the state.
Shortage of Health Care Workers
In Kansas, there is and will likely continue to be a shortage of physicians due to location and the aging population of Kansas physicians, which has only been exacerbated by the COVID-19 pandemic. According to the Kansas Health Institute (KHI), the southeast and southwest parts of the state have fewer primary care physicians per resident compared with the rest of the state. While these impacted areas also have a smaller population, the fewer number of primary care physicians provides residents with fewer options for adequate services, and access is dependent on insurance qualifications.
Regarding age, 15.6 percent of primary care physicians indicated they were 65 years or older in a 2019 State Board of Healing Arts survey. When reviewing the age distribution of primary care physicians in Kansas by region, KHI reports 42.2 percent of physicians from the southeast region are 55 years or older, and in the southwest region, that number is 45.2 percent. KHI notes innovative practices, such as rural rotations, job shadowing programs that promote health care work to students in rural areas, student loan repayment programs, and other incentives that would attract students in the health care field to stay in or come to Kansas, could assist in providing the workforce necessary for Kansas residents in future years.
Responses to the Health Care Worker Shortage
Telemedicine
According to the Rural Health Information Hub, to expand services to more individuals in need of care, telemedicine is becoming an increasingly popular form of health care service. In all areas of Kansas, but especially in the rural parts of the state, telemedicine can provide residents with increased access to options for care. Telemedicine removes the location barrier some people face by not having a health care facility in close proximity, or, in cases of specialized needs, allows individuals to receive care without the risk of passing along an illness.
Recent Kansas Law
COVID-19 Pandemic
In the 2020 Special Session, the Legislature passed HB 2016 to address the health care worker shortage and health care emergency created by the COVD-19 pandemic. The bill enacted and amended law regarding a number of health care topics, including:
- Telemedicine. The bill authorized quarantined physicians to practice telemedicine, and it authorized physicians licensed in another state to practice telemedicine in Kansas; and
- Temporary Emergency Licensure. The bill authorized the State Board of Healing Arts to grant a temporary emergency license to practice any profession licensed, certified, registered, or regulated by the agency for the purpose of preparing for, responding to, or mitigating any effect of COVID-19. It also eased certain health care professional licensure renewal or reinstatement requirements, and it allowed physicians licensed and in good standing in another state to practice in Kansas.
The provisions of the bill expired on January 26, 2021. The 2021 Legislature passed 2021 SB 14 and 2021 SB 283, which further extended these provisions until March 31, 2022.
Rural Emergency Hospital Act
In the 2021 Legislative Session, the Legislature passed and the Governor signed into law Senate Sub. for HB 2208, which enacted the Rural Emergency Hospital Act. The Act created a category of licensure to enable certain Kansas hospitals to become licensed as rural emergency hospitals and receive federal health care reimbursement under that designation. The bill required benefits coverage for services provided by rural emergency hospitals if covered when performed by a general hospital or critical access hospital.
The bill also established the Rural Hospital Innovation Grant Program, which is administered by the Secretary of Health and Environment for the purpose of strengthening and improving the health care system, increasing access to health care services in eligible counties, and helping communities achieve optimal health via transitional assistance.
The Secretary may award a Rural Hospital Innovation Grant (grant) to a county that applies in accordance with the provisions of the bill. The bill allows the Secretary to award a grant only if the state moneys to be awarded in the grant have been matched by private stakeholders, including hospital foundations or other organizations, on a basis of $2 of private stakeholder moneys for every $1 of state moneys.
The bill establishes the Rural Hospital Innovation Grant Fund (Fund), administered by the Secretary. The bill requires the Director of the Budget to certify and determine on June 15, 2021, the unencumbered federal funds received by the State that may be used to award the grants. An aggregate amount equal to $10.0 million in available special revenue funds was to be transferred to the Fund on July 1, 2021. If the aggregate certified special revenue funds were less than $10.0 million, the bill requires the difference between $10.0 million and the amount certified to be transferred from the State General Fund to the Fund on July 1, 2021.
The Program sunsets July 1, 2025.
by Nicole Hrenchir
Legislative Fellow
785-296-3535