Population Care

3 ways Congress can boost care access in rural, underserved areas

Tanya Albert Henry , Contributing News Writer

AMA News Wire

3 ways Congress can boost care access in rural, underserved areas

Oct 27, 2023

While experts project a shortage of up to 124,000 physicians by 2034, there is already a need for more than 17,000 physicians to close existing gaps in primary care health-professional shortage areas.

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On top of that, experts predict that there will be about 25% fewer rural physicians practicing by the end of the decade, as the AMA noted in a detailed letter (PDF) to the chair of the powerful House Ways and Means Committee.

To improve health care access in rural and underserved areas, Congress must:

  • Create a sustainable Medicare physician payment system.
  • Boost the physician workforce.
  • Support innovative approaches to care.

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The AMA’s recommendations, provided in response to a House Ways and Means Committee request for information, draw heavily on the AMA Recovery Plan for America’s Physicians. The AMA is working to rebuild critical components of the medical profession by, among other things:

Learn about the Recovery Plan’s progress so far.

The Medicare physician payment must be revamped to improve access to health care in rural and underserved areas, as well as to prevent access from becoming even more difficult in the coming years, says the letter from AMA Executive Vice President and CEO James L. Madara, MD.

Congress must act to create inflationary-based updates to physician payment for Medicare. When adjusted for inflation in practice costs, Medicare physician payment rates fell 26% from 2001 to 2023 because physicians do not get an automatic yearly inflation-based payment update.

In addition, Congress must step in and reform the Medicare Merit-based Incentive Payment System (MIPS) to avert unwarranted penalties, particularly on physician practices that are small, in rural areas and in underserved areas. Congress also needs to help practices transition to value-based care and increase transparency and oversight in MIPS.

In the letter, Dr. Madara outlined three legislative changes that would help streamline and improve MIPS, drive quality improvements and reduce negative impacts on small, rural and safety net practices, while also reducing unnecessary burdens on physician practices.

“Annual Medicare physician payments equal to the full MEI [Medicare Economic Index] should be enacted to provide an annual update that reflects practice cost inflation,” Dr. Madara wrote. “Additionally, the Medicare budget-neutrality rules should be reformed to reduce the near-constant threat to physician payment caused by routine updates to the payment system, such as updates to the cost of clinical labor or supplies and equipment.”

Learn how you can take part in the fight to fix Medicare on behalf of your patients and practices at the AMA's Fix Medicare Now website.

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With research showing that nearly 60% of physicians practice in the state where they completed their residency training, Congress should create more rural residency positions to help curtail the rural physician shortage, the AMA told the House committee.

In addition to increasing the cap on graduate medical education slots, Congress should provide more scholarships and loan-repayment programs to help ease the immense student-loan debt burden physicians rack up.

Lawmakers also should give physician-led teams more support and reject any efforts that would inappropriately expand nonphysicians’ scope of practice beyond their clinical training. Contrary to what’s often claimed, expanding the scope of practice for nonphysicians does not increase patient access in rural or underserved areas, Dr. Madara noted.

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Lastly, lawmakers should permanently lift restrictions that prevent Medicare patients from accessing telehealth services and also extend Medicare’s 5% incentive payments for physicians who participate in alternative payment models.

This can be done by passing the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (S. 2016/H.R. 4189) and the Value in Health Care Act (H.R. 5013).

“While the CONNECT Act does not extend every flexibility enacted in response to the COVID-19 public health emergency, it does permanently remove the antiquated geographic restrictions and enable Medicare patients, both in urban and rural areas, to access telehealth services wherever they can access a telecommunications system,” Dr. Madara wrote.