Rural FPs Do So Much. Here’s What We’re Doing for You

Because the political noise around the coming election is cranked all the way up, I want to talk now about a much quieter day next month that should not go overlooked. That’s National Rural Health Day, the annual observation led by the National Organization of State Offices of Rural Health, which this year happens on Nov. 21.

In a country challenged by a primary care shortage, I can’t overstate the enormity of what rural family physicians do. Seventeen percent of AAFP members live and work in rural areas — the highest percentage of any specialty. Many of you are the only physician in your area. One day is not enough to recognize and celebrate what you’re doing, which includes not only comprehensive longitudinal care but also mentoring students and residents, mitigating health disparities and making a vital difference in the country’s maternal morbidity and mortality crisis.

So I want to update you on some of the ways the Academy is advocating for you, and invite you to join in with the actions I outline in the Your Voice Needed sections below.

Better Payment

Because lagging Medicare physician payment hammers small and rural family medicine practices especially hard, I’ll start by reiterating the Academy’s drive to fix the Medicare physician fee schedule with changes including an annual inflationary update tied to increases in the Medicare Economic Index.

Medicaid payment rates need an overhaul, too, we told a Senate hearing on rural health this past spring. When Medicaid payment goes up, so does patient access. Right now the low rates (only about 66% of the Medicare rate for primary care services on average, and as low as 33% in some states) make it difficult for beneficiaries to access primary care.

We’re also striving to improve access to (and physician payment for) the home-based primary care — what doctors once referred to as “house calls” — that rural communities often acutely need. As the AAFP told Congress this year, this care keeps patients from having to resort to ER visits, and should be appropriately recognized and compensated. Policy should also support rural home care by

• encouraging participation in value-based primary care models that align with the AAFP’s VBP guiding principles; and

• covering telehealth (including audio-only) for all Medicare beneficiaries via, or in consultation with, their usual primary care physician.

A Stronger Workforce

I’m pleased to report a couple of recent state-level rural workforce wins championed by Academy chapters. The Colorado AFP helped pass a law to fund expansion of rural-track training in that state. And in Iowa, following advocacy from family physicians there, the Rural Iowa Primary Care Loan Repayment Program will next year see a $125,000 boost to its annual appropriation of more than $2 million.

At the federal level, we realized a victory in June when the administration earmarked $11 million to establish new residency programs in rural communities — including six family medicine residencies with enhanced obstetrical training.

We told lawmakers that more action is still needed, though, including robust support for a program that provides startup grants for new rural residency programs. That’s because most physicians end up practicing within 100 miles of their residencies, but most of that training happens at large academic medical centers in urban areas — furthering the maldistribution of clinicians that has led to some 7% of U.S. counties lacking a primary care physician. (About 20% of Americans live in rural communities, but only 12% of primary care physicians practice in these areas.)

On the legislative side, the AAFP supports the Rural Health Preceptor Tax Fairness Act, which would create a $1,000 nonrefundable tax credit for health preceptors in rural areas. This is well in line with Academy policy.

We also continue to call for passage of

• the Doctors of Community Act, which would permanently authorize the vitally important Teaching Health Center Graduate Medical Education program;

• the Rural Physician Workforce Production Act, which would boost rural residency training; and

• the Rural Obstetrics Readiness Act, which would establish training programs to help clinicians at facilities without dedicated obstetric units respond to obstetric emergencies.

Relatedly, the AAFP backs the Keeping Obstetrics Local Act, which would increase Medicaid payment rates for labor and delivery services for eligible rural and high-need urban hospitals, and require all states to provide a full year of postpartum Medicaid coverage, among other potential boons. It’s sensible legislation that deserves bipartisan support.

To prevent care erosion in obstetric deserts, the Academy also recently urged CMS to delay or phase in proposed new quality-assessment and performance requirements for hospitals providing obstetrical services. While we support the agency’s aim of improving maternal health care outcomes and reducing disparities, its rule as written would introduce significant compliance barriers and administrative complexity that would challenge smaller facilities providing care where it’s most needed — especially absent reforms to physician payment.

Your Voice Needed, Part 1

Please join two important AAFP Speak Out campaigns. One calls on Congress to permanently reauthorize the Teaching Health Center Graduate Medical Education program and increase its funding. The other urges passage of the Strengthening Medicare for Patients and Providers Act, which would secure the annual inflationary updates to Medicare payment I talked about above.

Your Voice Needed, Part 2

If you haven’t already, I hope you’ll participate in this all-member survey asking how you perceive and use artificial intelligence, and what you need from it in the future. It’s open through Nov. 4, and the data will help ensure that health care AI centers primary care.

Your Voice Needed, Part 3

Finally, given all of the things we’re talking about here, and as I urged you a few weeks ago, please vote Nov. 5 — wherever you are.