MGMA proposes ways for Congress to tackle rural health care shortage

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Congress can act to alleviate the shortage of health care providers in rural and other underserved areas by eliminating the proposed 3.36% reimbursement cut under Medicare’s Physician Fee Schedule (PFS), increasing the number of Medicare-supported medical residency positions and implementing prior authorization reform.

These are among the recommendations outlined in an October 5 letter from the Medical Group Management Association (MGMA) in response to a request from the U.S. House of Representatives Ways and Means Committee. The Committee said it is looking for solutions to problems such as the shrinking health care workforce, industry consolidation, and patchwork financing models, all of which make accessing care especially difficult for people in rural and underserved areas.

According to the National Rural Health Association, the nation’s rural areas have 39.8 primary care physicians and 30 specialists per 100,000 residents, compared to 53.3 and 263 per 100,000, respectively, in urban areas.

Noting that Medicare physician payments decreased by 26% between 2001 and 2023 when adjusted for inflation, the letter calls the proposed reimbursement cuts “untenable.” It recommends instead that Congress adopt the Strengthening Medicare for Patients and Providers Act, which includes annual inflation-based payment updates based on the Medicare Economic Index, and work to mitigate the impact of the PFS’s budget neutrality requirements.

Regarding medical residency positions, the letter urges Congress to pass the Resident Physician Shortage Reduction Act of 2023. Doing so, it says, would increase the number of Medicare-supported residency positions by 14,000 over seven years. It calls the slots “a lifeline to ensuring that patients have access to care” in rural areas of the country.

It also recommends continuing funding for the Teaching Health Center Graduate Medical Education Program, saying it represents “a great opportunity to address healthcare disparities” since the majority of the teaching health centers are in rural and high-need areas. Funding for the program is set to expire at the end of 2023.

Addressing the prior authorization burden, MGMA says, would help reduce resignations and turnover among health care employees since prior authorizations are a major contributor to burnout among physicians and staff. In MGMA’s 2022 regulatory burden survey, 89% of association members reported hiring additional staff or redistributing their staffing resources to process prior authorizations due to the increased number of requests, with 82% saying prior authorization requirements were very or extremely burdensome.

“Requiring practices to divert critical resources away from clinical care to comply with these unnecessarily burdensome administrative processes is antithetical to an efficient health care system,” the letter notes. It urges Congress to enact the GOLD CARD and Reducing Unnecessary Delays in Care acts since they would make important changes to prior authorization.

Other recommendations contained in the letter include:

• Providing financial incentives to support rural practices transitioning into value-based care by reinstating the 5% payment bonus for participating in alternative payment methods, and
• Implementing policies that aid and provide technical support to groups participating in rural accountable care organizations, such as those in the Value in Health Care Act. Doing so would help rural practices transition to value-based care (VBC) by providing access to the upfront investment and other tools needed to succeed under VBC models.