- The Centers for Medicare & Medicaid Services (CMS) is working to address patient care access and other issues faced by individuals residing in rural areas, according to a recent blog post from agency administrator Seema Verma.
The post, published to recognize National Rural Health Day on November 15, outlined the barriers to health and care that the nearly 60 million people who live in rural regions experience.
“We at CMS recognize the many obstacles that rural Americans face, including living in communities with disproportionally higher poverty rates, more chronic conditions, and more uninsured or underinsured people,” Verma wrote. “Many rural communities lack access to specialty care and have a fragmented healthcare delivery system with an overworked and shrinking health workforce.”
What’s more, patients living in rural areas tend to see care that does not live up to clinical quality standards, especially when compared to care delivered in urban areas.
In a new report outlining the disparities in care quality experienced by urban- and rural-dwelling individuals, CMS asserted that more must be done to support patients accessing care in remote regions.
With the exception of flu vaccination rates, both Medicare Advantage (MA) and fee-for-service (FFS) beneficiaries reported similar patient experiences. However, when looking at clinical care guidelines, differences emerged.
MA beneficiaries living in rural areas saw worse clinical care for 18 out of 33 measures compared to those living in urban areas. They saw better care for only 2 measures. Ideally, care quality will be equal across all 33 measures in both urban and rural areas.
When looking across racial lines, the CMS researchers saw disparities in both patient experience and clinical quality.
For example, black MA beneficiaries living in rural areas saw worse care than their urban counterparts. FFS patients reported similar care quality, as did Hispanic patients in both FFS and MA plans.
When looking at clinical quality measures, racial disparities likewise emerged. For black patients, rural patients received worse care for 18 of 33 quality measures. For Hispanic patients, rural residents received worse care for 20 of 33 measures, and white patients received worse care for 15 of 33 measures.
These results indicated that patients living in rural areas need better access to quality healthcare.
“This analysis revealed a pattern in which rural residents, regardless of race or ethnicity, commonly received worse clinical care than urban residents,” the CMS researchers explained. “Future research is needed to understand whether this pattern reflects poorer dissemination of clinical practice guidelines to rural areas, poorer translation of those guidelines into clinical practice, or some other cause.”
Inadequate care quality or care access in rural areas is a costly issue and in some cases can cost lives, Verma stated in her blog post. CDC statistics showed that many of the deaths that occurred in rural areas during 2014 could have been prevented. This included heart disease deaths, those from cancer, unintentional injuries, chronic lower respiratory disease, and stroke.
And while rural areas are working to close care access gaps through better partnerships, new business models, and use of patient engagement technology, CMS working to do its part, Verma added.
For example, CMS released its Rural Health Strategy this past spring. The Strategy called for five focus points:
- Apply a rural lens to CMS programs and policies
- Improve access to care through provider engagement and support
- Advance telehealth and telemedicine
- Empower patients in rural communities to make decisions about their healthcare
- Leverage partnerships to achieve the goals of the CMS Rural Health Strategy
Additionally, CMS has revamped its payment processes to reflect the value connected health can bring to patient care access in rural areas, Verma said. The Medicare Physician Fee Schedule, for example, will now include payments for virtual check-ins. This means rural providers will be paid when a patient calls to determine if an in-person visit is necessary.
Additionally, Medicare will pay for store-and-forward telehealth, meaning a provider will receive reimbursement when a patient sends in pictures or videos of an ailment.
CMS has also made it easier for small practices and those practicing in rural areas to successfully participate in the Quality Payment Program and Merit-based Incentive Payment System (MIPS). Through these changes, 94 percent of rural providers participating in MIPS have received either a neutral or positive payment.
The agency has plans to continue its investment in rural healthcare, although Verma did not disclose those plans in her blog post.
“I’m proud of our achievements, but we are not stopping here,” Verma concluded. “We will continue to develop and improve our rural health-related thinking and policies to foster innovation and solutions for rural health.”