HJAR Nov/Dec 2022

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2022 15 consistently from all of the education insti- tutions is that there have to be clinical sites to where those nurses can come and learn. One of the questions we’ve heard here at Washington Regional is, “Are there sites and are there clinical opportunities at night, on weekends?”Oftentimes, I’m told of peo- ple that are already working in healthcare who would like to go back and be a nurse, but they can’t do that Monday through Fri- day between 8 a.m. and 5 p.m. They have child care issues. They have other jobs. So, one of the things that we’re really focusing on is how we can grow what those training opportunities are to increase the pipeline of those students who are interested and just need that educational opportunity. Editor I understand that to open more well-needed residency spots in Northwest Arkansas, which will hopefully lead to more physicians living and practicing in the area, Washington Regional had to lower its payment level for Medicare, which I am assuming is your largest payer. Explain that to us. Shackelford Arkansas is an underserved rural state, and the No. 1 challenge of increasing graduate medical education is how you finance or pay for those residen- cies moving forward. Like a lot of hospitals and health systems, Washington Regional was capped, so what Medicare would reimburse us as we tried to grow residents wasn’t possible because of that cap. But becauseArkansas is a rural state, there was an opportunity that Washington Regional chose, which was to apply for and to be paid under the rural Arkansas wage base. And by agreeing to do that, it gave us a new opportunity to not be capped and to have a new period to grow graduate medical edu- cation. So, yes, Medicare is the largest payer, and being paid at the rural Arkansas rate as opposed to the Fayetteville or Springdale or Rogers MSA rate lowered that reim- bursement. But it created an opportunity to grow graduate medical education mov- ing forward. One of the first steps we took was to go to theArkansas Legislative Council, and we asked for, and they provided, a grant. That grant helped cover some of the gap between what we were paid under the urban versus the rural rates and also gave us some dol- lars to be able to create these residency slots moving forward. There are costs — you have to bring faculty and get programs approved before the first residents ever come — and that was a big part of our support. Moving forward, although Medicare will not cover all of the costs of training more doctors, the fact that we are not capped and can get some reimbursement fromMedicare is allowing us to implement our plan to create 90 new graduate medical education physi- cians at Washington Regional by the year 2030.