Loan Repayment

Promising Practice: Loan Repayment Programs in Nebraska Yielding Huge Payoffs

i Dec 6th No Comments by

By Beth Blevins

Loan repayment programs in rural Nebraska are showing huge payoffs: family medicine providers who participate in them are significantly less likely to leave small towns and rural areas than those who don’t.

“We’re trying to maximize the impact and the opportunities for loan repayment in rural and urban underserved areas in the state,” said Thomas Rauner, Program Manager at the Nebraska Office of Rural Health (NORH). “So we are assessing how effective the programs are, and how are they working.”

Towards that end, NORH issued a report in July that examined the impact of incentive programs on retention of family practice providers—the most frequent specialty participating in loan repayment programs and serving in rural areas, Rauner said. The findings showed that these programs are especially effective in rural areas of the state—for example, participating small town and rural area providers are more likely to remain in their positions than non-obligated providers by 23% and 42%, respectively. They remain significantly longer by 2.3 years (small town) and 4.3 years (rural) than non-obligated providers.

A sample visual from the “Analyzing the Impact of Incentive Programs on Retention of Family Practice Providers in Rural Nebraska” report.

One thing that makes the report interesting, Rauner said, is that it offers visual representations of the data. “We’ve been working in the last few years to come up with more visualization components,” he said. “You can look at number, but a picture makes it easier to understand and share with a much broader group.” In the future, he said, they will share data by a place-based and legislative format.

Though the report was issued earlier this year, it has been in the making for nearly two decades with resources from the State Office of Rural Health and Primary Care Office grant programs, Rauner said. “The data on family medicine providers was analyzed by a graduate student intern in our office, using information from the University of Nebraska Medical Center (UNMC) Health Professions Tracking Service (HPTS), which they collaborated with our office to develop over 20 years ago,” he said.

HPTS tracks providers enrolled in all state and federal loan repayment programs during and after their obligation, Rauner said. “Using HPTS, we’re able to track all the healthcare providers in our state,” he said. “The system also allows them not only to track whether physicians who served their obligation out there stay longer in practice than those who did not have obligations, but also gives them the capacity to look at that data over time.”

HPTS data can also be used for economic analysis, Rauner said. “Some of the more interesting findings from the report was that analysis based on years worked shows there is a significant economic benefit associated with rural healthcare providers—a total of $3.6 billion,” he said. “This benefit far outweighs the financial investment in incentive programs.”

HPTS tracks physicians as well as dentists, physician assistants, nurses, graduate-level mental health providers, and allied health providers—those who qualify for loan repayment in the state. Its data also has been used by UNMC authors for reports on primary care nurse practitioners, on physician assistants, and on the status of healthcare workforce in the state.

In addition to HPTS, Rauner said, NORH uses the Practice Sights Retention Management System “to solicit feedback from the providers while serving their obligation, determining if they would like and need to continue receiving loan repayment assistance, and their anticipated and actual retention.”

The data from the two systems benefit both providers and communities, Rauner said. “There are many variables when it comes to assessing workforce needs,” he said. “Each community desires the right care, right time, right place, and the right cost. NORH is continuing to work with communities to develop such a system of care, while working to improve the process and utility of loan repayment programs.”

With the proven success of the loan repayment programs in Nebraska, NORH also has been working to get more healthcare students enrolled in them. “We’ve been trying to simplify it as much as possible,” Rauner said. “We recently combined and changed our loan repayment applications to be a single online application. This will allow NORH to track and process applications for loan repayment and determine the best fit for the provider and the site.”

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Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.


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Promising Practice: Team Effort in Idaho Achieves New Funding for Physician Repayment Program

i Sep 28th No Comments by

by Beth Blevins

Remarkably, less than a year after the Idaho State Office of Rural Health (ID SORH) set a goal to find new funding for a physician loan repayment program, the state legislature appropriated $640,000 annually for it.

“It’s something we’re thrilled about,” said Mary Sheridan, ID SORH Director. “I think it points to the reasons we take advantage of new opportunities, even though we may be unsure of the ultimate outcome.”

Mary Sheridan (third from left) with the Idaho team that attended the NCSL meeting last June.

That opportunity was a three-day meeting in June 2017, convened by the National Conference of State Legislatures (NCSL), on “Challenges and Innovations in Rural Health Policy.”  Sheridan attended the meeting along with three Idaho state legislators, the Primary Care Office Program Manager, and deputy administrators from the Division of Public Health and Division of Medicaid.

The NCSL event, funded through a cooperative agreement with the Health Resources and Services Administration, included presentations from rural health policy experts and state-specific team meetings for developing collaborative action plans to improve rural health. Idaho was one of eight states attending.

“Our team there identified three goals: securing reimbursement and funding for community paramedic programs, securing funding for loan repayment, and expanding telehealth,” Sheridan said. “Afterward, the team typically met monthly to share updates and progress on all project goals. The on-going support from NCSL post-meeting was truly helpful in moving the loan repayment legislation forward.” Members of the team are currently working on the other two goals, Sheridan said.

It was a team effort that got the loan repayment legislation to the floor in the next (January 2018) legislative session. “One strategy was for me to provide a presentation on loan repayment and physician shortages to the Idaho legislature’s Health and Welfare committees,” Sheridan said. “Team members made it happen. They worked with legislative leadership to schedule it on the calendar and NCSL actually came to that presentation and lent their support. The Idaho Medical Association worked actively with legislators on the issue and it went from there.” A legislator who was on the team introduced House Bill (HB 472) to fund the loan repayment program.

“It’s remarkable how fast it went, especially when you realize this is the first time we’ve ever had state funding for loan repayment,” she said.

HB 472 provides state funding for the Rural Physician Incentive Program (RPIP), a program that already existed but which had been paid for with student fees‑Idaho students attending out-of-state medical schools in Washington and Utah at in-state tuition rates had been assessed $1,600 per year, which went into the RPIP fund. In order to qualify for loan repayment, physicians must work in a Health Professional Shortage Area (HPSA) in Idaho and receive up to $25,000 per year for four years.

According to the Idaho Physician Workforce Profile, Idaho has a significant shortage of primary care physicians, ranking 49 out of 50 states for physician workforce. “Approximately 98% of the state is designated as a HPSA for primary care and dental, and 100% for mental health,” Sheridan said. “So loan repayment is hugely important for us, and is certainly a tool for recruitment and retention of physicians in rural and underserved communities.” NCSL estimates that the $640,000 loan appropriation will fund about six more physicians per year, more than double the current number.

Sheridan said that she is pleased that so much has resulted from the NCSL meeting, especially since she initially had few expectations going into the meeting. “In fact, when I first got the invitation I thought, ‘if we’re going to just take Idaho there, why can’t we just meet in Idaho and do this very same thing?’” she said. “But I think it was that structure of being away and focused on an issue, of us learning together and having facilitated discussions to create this plan that provided an opportunity to really focus on rural health in Idaho in a very coordinated and collaborative fashion.”

Sheridan added, “The NCSL event provided a unique opportunity to identify Idaho-specific rural health issues. We’re extremely pleased to have participated. It truly provided leverage and new collaborative opportunities to advance rural health in Idaho.”

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Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.

Data and Systems to Monitor and Evaluate Loan Repayment Programs (Dr. Pathman-T. Rauner)

i Feb 12th No Comments by

Data and Systems to Monitor and Evaluate Loan Repayment Programs (Dr. Pathman-T. Rauner)