AAFP Notches Workforce, Rural Care Win in New CMS Rule

The Academy called for this boost to the primary care workforce in a June 7 letter responding to the Hospital Inpatient Prospective Payment System and Long-term Care Hospital Prospective Payment System annual proposed rule. The win on rural emergency hospitals is included in the final rule, issued Aug. 1 for fiscal year 2024, along with a fact sheet.

Rural emergency hospitals, a Medicare provider type established by the Consolidated Appropriations Act of 2021 — and among that law’s family medicine wins — were designed to ensure continued care access for patients in areas affected by hospital closures. Under the law, Medicare-participating critical access hospitals or rural hospitals with 50 or fewer beds could apply for conversion to REHs; redesignated facilities began receiving Medicare payment for REH services on Jan. 1 of this year.

At the inception of REHs, the Academy recognized that the program would better position family physicians to improve access to high-quality care in rural communities. This latest rule enacts refinements for which the AAFP had advocated.

The AAFP sent its guidance alongside the Council of Academic Family Medicine. That body’s membership includes the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine and the Association of Family Medicine Residency Directors.

“About 13% of family physicians in small rural areas and 29% of family physicians in frontier areas provide emergency department coverage in addition to their primary ambulatory practice,” the AAFP said in the June 7 letter. “An analysis of 2017 Medicare claims data found that 7.9% of rural family physicians, which is equal to 635 physicians, practice solely in an emergency department, with another 879 rural family physicians (or 45.6% of rural family physicians) practicing in emergency departments in addition to other settings. These data confirm that a significant and increasing number of family physicians practice emergency medicine in rural areas.”

CMS’ final rule quotes that letter, acknowledging the role of family physicians in delivering emergency care, particularly in rural areas.

“A few commenters stated that family physicians are an essential source of emergency care in rural areas and are uniquely suited to work in REHs,” the agency said. “The commenters stated that multiple studies have demonstrated that, while many family physicians provide emergency care in urban and suburban communities, rural family physicians are more likely to work in emergency departments. The commenters stated that the Accreditation Council for Graduate Medical Education requirements for family medicine residents include several proficiencies important for providing emergency care and that in addition to emergency services, REHs can offer other outpatient services like pregnancy and delivery care, behavioral health services and primary care, all of which are within family physicians’ scope of training.”