In response to a congressional RFI, provider advocates give input on ways to bolster rural healthcare

Hospital and physician groups were among the respondents to a request by a key congressional committee for information on improving rural healthcare.

In an RFI issued in September, the House Ways and Means Committee sought policy solutions for augmenting access to — and the quality of — healthcare in relatively remote areas.

“The committee will identify how geographic barriers, misaligned Medicare payment incentives and consolidation may be driving facility closures and workforce shortages — hurting overall access to healthcare — while innovative care models and technology are improving such care,” Rep. Jason Smith (R-Mo.), the Ways and Means chair, wrote in the RFI.

Topics to be addressed through the RFI included:

• Geographic payment differences
• Provider and facility financing
• Site-neutral payments
• Workforce investments
• Innovative care approaches

Pushing for stable funding

Among various recommendations from the American Hospital Association (AHA) in response to the RFI was to make permanent the Medicare-Dependent Hospital designation and the low-volume hospital payment adjustment. Both are funded through 2024.

“Providing certainty and stability in rural Medicare hospital payments is essential to creating a sustainable rural financing system,” AHA’s letter states.

Congress also should work to bolster the workforce, including by passing legislation to increase the number of Medicare-funded residency slots and a separate bill to protect workers against violence and intimidation, AHA said.

AHA also endorses legislation that would establish a loan repayment program for eligible clinicians who agree to work for five years in a rural area that has a provider shortage, as well as legislation to raise the area wage adjustment floor for hospitals. Also worth implementing is an extension of a visa waiver program to ensure a steady supply of physicians from overseas, the association said.

In its comment letter, the National Rural Health Association (NRHA) expressed support for a bill that would make it easier for hospitals to qualify as critical access hospitals (CAHs), thus allowing them to receive cost-based reimbursement in Medicare. The bill also includes a provision exempting rural hospitals from the 2% Medicare sequester and reauthorizes a program that provides vital technical assistance to CAHs and other rural hospitals.

NRHA also wrote that Congress should exempt rural hospitals from site-neutral payment policies that are under consideration. Furthermore, “Any savings generated from site-neutral payment should be reinvested in the rural healthcare infrastructure,” NRHA states. “Savings could also be redirected to help rural providers address their patients’ social determinants of health.”

The physician perspective

The Medical Group Management Association (MGMA) offered recommendations to support rural physician practices, noting that rural areas account for 60% of the 7,200 designated health professional shortage areas.

MGMA hopes Congress can prevent a proposed 3.36% cut to Medicare physician payments for 2024 and pass legislation establishing an annual inflation-based payment update that’s linked to the Medicare Economic Index.

“This cut is untenable for practices and must be averted to ensure the financial viability of medical groups,” the letter states.

Medicare physician payment dropped by 2% in 2023 after remaining essentially flat over the previous two decades. In its comments, MGMA said payment has decreased by 26% since 2001 when accounting for inflation.

MGMA also supports legislation designed to alleviate some issues with prior authorization, given that administrative burden “is particularly felt by rural practices and contributes to staff burnout.” Despite having bipartisan and bicameral support during the prior Congress, the bill did not gain traction beyond the committee level.

The association also backs a bill designed to make participation in alternative payment models more fruitful for physicians.

NRHA wrote that recruitment of nurse practitioners (NPs) could be improved via a bill that was drafted to increase access to services furnished by advanced practice providers.

“Emphasizing practice autonomy is a proven strategy to recruit NPs to rural areas,” NHRA wrote.