Editor’s note: R. Shawn Martin is executive vice president and CEO of the American Academy of Family Physicians.
Throughout the 2024 election cycle, much of the national debate centered around the economic security of Americans. However, one critical issue that didn’t gain widespread attention but was heavily discussed in numerous House and Senate races was the growing problem of diminishing access to physicians and healthcare services for the estimated 60 million people living in rural communities.
Since 2010, there have been 150 rural hospital closures and conversions. These closures have severely diminished access to primary care, obstetrical and emergency services in rural areas. It is estimated that over 10,000 physicians have left rural practice or have chosen not to work in rural communities since 2010.
As a result, rural residents now face longer travel times to receive care, and there is increased pressure on the remaining physicians. According to the Health Resources and Services Administration, nearly 75 million people live in 7,501 primary care health professional shortage areas, or HPSAs. Of particular concern is the fact that women of reproductive age make up a disproportionately large segment of the rural population. According to the U.S. Census Bureau and the HHS, approximately 20 million women between the ages of 15 to 44 live in rural communities across the United States.
Over the past two decades we have introduced new models of care like rural health clinics, new modalities of care like telemedicine and numerous policies aimed at establishing financial stability for rural practices.
Each of these programs are important and they should continue. However, I also suggest that they are failing miserably.
Hospitals continue to close, the primary care physician shortage in rural communities continues to grow, maternal mortality rates continue to increase and the spread of chronic disease amongst rural populations is rampant.
America’s family physicians are the backbone of rural healthcare. I take great pride in the fact that 17% of family physicians practice in rural communities, and that over 90% of U.S. counties are served by a family physician. However, while we celebrate their contributions, more must be done to support them and make rural practices a more viable career option.
We need to think bigger, bolder and outside the box. The people living in rural communities deserve high-quality, physician-led care. To that end, I am proposing seven key policies designed to incentivize growth in the rural primary care workforce. These policies will not only increase access to care for millions of rural Americans but will also empower them to lead healthier, more fulfilling lives.
1. Tax credits for physicians practicing in Health Professional Shortage Areas
Any primary care physician providing services to Medicare and/or Medicaid patients in a designated HPSA would be eligible for a $50,000 tax credit on their federal income taxes in each year that they meet the qualifying requirements. Additionally, if the physician provides prenatal, obstetrical and postpartum services, they would be eligible for an additional $25,000 tax credit in each year that they meet the qualifying requirements.
2. Professional liability insurance coverage via Federal Tort Claims Act
To expand access to obstetrical care in rural communities, all physicians providing obstetrical services in designated HPSAs should have their professional liability insurance requirements protected by the Federal Tort Claims Act. This policy would reduce the financial barrier that prevents many physicians from providing obstetrical services in their rural practices.
3. Tax deduction for teaching and mentoring medical students and residents in rural practices
Primary care physicians practicing in an HPSA that mentor medical students in their practice would be eligible for a $500 per month tax deduction for each month they engaged with a medical student, with a maximum deduction of $6,000 per year.
4. Rural medicare payment enhancement
Primary care physicians practicing in a HPSA should receive an annual bonus equal to 15% of the previous year’s total evaluation and management charges paid by traditional, fee-for-service Medicare.
5. Prompt pay in Medicare Advantage
All Medicare Advantage plans are required to pay each claim submitted by a physician practicing in an HPSA within 30 days of submission.
6. Healthy Americans incentive
All commercial insurers and insurers participating in the marketplace would be required to provide each covered life up to four primary care visits per year at no cost to the patient. Insurers would be required to pay the physician 100% of the allowable charge for a 99214 visit for each encounter.
7. Direct contracting with primary care physicians for Medicare and Medicaid patients
The CMS and the Center for Medicare and Medicaid Innovation should design and implement a pilot program whereby Medicare and/or Medicaid beneficiaries receive an annual stipend that can be used to secure primary care services through a direct primary care model.
The bottom line is that rural communities deserve healthcare that is just as robust and accessible as what is available in urban and suburban areas. I challenge the new Congress and administration to make this a reality to protect the well-being of the millions of Americans who call these communities home.
