Rural PCPs Better at Discussing Costs of Care

Rural areas are expected to strongly feel the increased demand for primary care services as a result of the Affordable Care Act, and a new study has revealed that there are a few meaningful differences between rural and urban primary care physicians (PCPs) on key measures of professionalism.

The report in the National Rural Health Association’s Journal of Rural Health used responses from 840 physicians, 15% of which practiced in rural communities (9% in large rural and 6% in small/isolated rural areas).

"In terms of professional beliefs and behaviors, we found that rural and urban doctors are more alike than they are different," study leader Eric G. Campbell, PhD, director of Research at the Mongan Institute for Health Policy at Massachusetts General Hospital and professor of Medicine at Harvard Medical School, said in a statement. "Despite our results and other evidence, the perception still exists that rural primary care is not as good as that available in cities. So we needed to learn more about the factors driving that misperception and the role it may play in the continuing shortage of rural physicians in the U.S."

The authors found that rural PCPs are significantly more likely to participate in quality improvement in their practices and hospitals and have a personal, as well as professionals, relationships with patients.

Perhaps that close relationship with their patients is why rural physicians are more likely to agree that physicians should discuss the costs of care with their patients. While just 29% of urban PCPs agreed they should talk to patients about costs of care, 40% of rural PCPs said the same. Rural physicians were also more likely than urban physicians to report having added Medicaid or uninsured patients to their panels during the preceding year.

"Rural physicians are dedicated to providing high-quality care and committed to supporting safety-net patients," Anne Kirchhoff, PhD, MPH, corresponding author and an assistant professor of Pediatrics at the University of Utah, said in a statement. "The Affordable Care Act should help more rural primary care providers receive payments for care they currently provide without charge. But as the Medicaid expansion is limited to only half the states, many rural providers will still shoulder a disproportionate cost burden compared with urban physicians."

Rural PCPs were only slightly more likely to agree that they should know the overall cost of the care they provide (56% compared to 52% of urban PCPs).

However, even though rural physicians were more likely to discuss costs of care with patients, they were not as drug-cost-conscious as they could be, according to Campbell.

According to the responses, 90% of rural physicians reported fulfilling patient requests for brand-name drugs when less expensive generics were available compared to 77% of urban PCPs. Furthermore, rural PCPs admitted to feeling less prepared to evaluate new medical information.

"We need to further explore the implications of these findings, particular since a significant number of the patients enrolling in new ACA-sponsored health plans will be from rural areas," Campbell said.