[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1140 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                S. 1140

To amend the Public Health Service Act with respect to the designation 
       of general surgery shortage areas, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 30, 2023

Mr. Schatz (for himself, Mr. Barrasso, Ms. Cantwell, Mr. Marshall, and 
  Ms. Sinema) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 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 2023''.

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 2021 report released by the Association of American 
        Medical Colleges projects shortages in all surgical specialties 
        of between 15,800 and 30,200 surgeons by 2034.
            (4) A 2020 report prepared by the Health Resources and 
        Services Administration for the Committee on Appropriations of 
        the Senate found a maldistribution of general surgeons 
        nationwide, with rural areas having only 69 percent of the 
        general surgeons needed to meet demand for care.
            (5) 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.
            (6) 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.
            (7) 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 SURGICAL HEALTH PROFESSIONAL 
              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.--
                            ``(i) In general.--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.
                            ``(ii) Considerations.--In determining the 
                        thresholds under clause (i), the Secretary 
                        shall not assume that the current supply of 
                        general surgeons nationwide is the optimal or 
                        adequate level and shall consider additional 
                        factors such as wait times, health outcomes, 
                        ground transportation time to the nearest 
                        health care center with a general surgeon, 
                        critical access hospitals with surgical 
                        capabilities but lacking a general surgeon, and 
                        patient experience.
            ``(3) Report.--Not later than 1 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.--Based on 
        the findings 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 a 
        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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