Addressing the Disparity of Care for Rural Patients

By Matt Phillion

Patients in rural areas often face barriers to access to healthcare that limit their ability to get the types of care they need. On the same spectrum, providers in those rural areas face similar challenges—while roughly 20% of Americans live in rural areas, barely a tenth of physicians practice in these areas, resulting in a shortage of some 20,0000 primary care physicians for this population by 2025.

Beyond primary care, rural areas also often face a lack of support for sub-specialists, hospitalists, and emergency care physicians.

The challenges don’t just stop at lack of staffing. Rural hospitals struggle financially, particularly now as COVID subsidies expire and reimbursements decline. Half of rural hospitals lost money in the past years, and 418 rural hospitals have been labeled as vulnerable to closure.

What can the industry do to help bring care to these areas where it is lacking?

“I grew up in a town in central Illinois of about 20,000 people, and I got interested in healthcare by interacting with the physicians in my hometown,” says Jay Anders, MD, chief medical officer for Medicomp Systems. “It’s a rural community still, but when I was growing up, we had two hospitals, maybe 350 beds in the area. In 2024, there’s one hospital and the other is a derelict building, and the existing hospital is about half the size and merged with a larger health system in Springfield, Illinois. There really isn’t a freestanding community hospital where I grew up.”

This story is a familiar one across the country, Anders explains. Hospitals are closing because of any number of pressures, whether it’s access to providers or the ability to pay them.

“It’s really hard to stay in business these days,” he says. “Ninety million people live in rural America and they’re being treated by less than 10% of the country’s physicians.”

Anders says we need both federal and state governments to weigh in to truly address this issue.

“At the state level, there are medical schools that have programs to both train physicians to practice in rural settings and also offer a lower cost of tuition to practice in those places,” he says. “It’s a method to train physicians who are interested in this area to begin with, or if not, to get them interested to help solve this issue of manpower.”

It’s not just a lack of physicians, of course, Anders points out.

“Nurses are going to go where they’re going to make a good living,” he says. “Agency nursing work with a big company work with smaller hospitals, and it costs these hospitals a tremendous premium to get these nurses to come to their facilities.”

It’s about a third of the cost to bring on a nurse who lives and works in the area versus working with an agency, he notes.

Meanwhile, on the federal level, asking for intervention is a little tougher, Anders explains.

“The problem they need to start looking at, the problem they now have, is a differential reimbursement when you have care provided in a rural setting. We need to enhance these payments so these hospitals can stay afloat,” he says.

The federal government pays for 60% of the healthcare in the U.S., Anders says, and it will require policy changes about how to fund these hospitals so they can afford to pay for doctors, nurses, healthcare IT, and other essentials.

“This has to happen so that these organizations are not forced into consolidation with larger healthcare systems to survive,” he says. “These moves are driven primarily by financial needs. Healthcare IT can be provided by a larger institution rather than acquiring it on your own, you have access to nurse and physician recruitment. It’s a financial thing, but also a care thing: they’re in business to provide patient care and they’re not able to do that currently unless they start to consolidate.”

Looking at other options

COVID taught the healthcare industry many lessons, and one of those lessons was that telemedicine could be a viable solution to many access-to-care issues.

“We were all stuck at home, doing video visits, and it wasn’t bad care. It was good care. There are things in these rural settings we can do to enable the enhancement of care,” says Anders.

Telemedicine addresses some of those pains involving access to specialized care: a game changer when the consultants you need are a hundred miles away, he explains.

“As long as you have good interoperability and are able to share information, you can work with a specialist, whether it’s a neurosurgeon, a hematologist, experts to help your local primary care physician treat their patient,” says Anders.

We’ve already seen options like virtual ICUs to enable remote monitoring and other technological options, Anders notes, but at the core of these options is that interoperability and shared information.

“The thing people will have to do, and the government has started looking into this, is sharing medical data. We’ve got to have a flow back and forth with detailed medical records that enable coordination of care,” he says.

In fact, better interoperability and sharing of data has opened the door to a sort of specialization that enables rural hospitals to maximize their effectiveness through focusing on types of care.

“We’ve seen some small hospitals say they won’t do, for example, oncology but they will do cardiac care, so they cut down the breadth of specialty care to focus on what they can do well,” says Anders. “I think technology has a big role to play in this. The more physicians and caregivers can communicate, the better the care is, especially in rural areas.”

Concentrating resources on what you’re best at can be a cost-effective tactic, Anders notes—provided those other specialties are covered elsewhere and there are no barriers to access and communication.

Cost and access barriers

One of the biggest barriers to all of these options is having the financial strength to invest in the technology and resources you need.

“You’ve got to be profitable enough to embrace the new world,” says Anders. “So it does boil down to fancies, but also the acquisition and retention of quality staff in these areas.”

This is an area where those education programs can play a powerful role. Students who want to practice in rural areas who don’t leave school in catastrophic student loan debt have the flexibility and ability to practice in rural areas, Anders explains.

“You’ve got to want to do it, but you also need to come out of school without having to go into specialty care in a large urban area so you can pay back that debt,” says Anders. “I spent 20 years teaching students, and it was interesting to see some kids just light up when they envisioned themselves practicing in that situation. These programs actually open the door to that, so they’re not saddled with prohibitive loans.”

The schools still recruit and teach top-tier students, but in a way foster and reward those who are willing to serve the communities they come from when they graduate.

“We really need rural doctors, and if we can give you an edge up while you get that education, that’s a real enticement to do so,” says Anders.

Pushing for change

Improving care in rural areas involves legislation and government funding, of course, but it also requires those practitioners who are already there to make sure their voices are heard.

“It’s time to rattle the cage a bit,” says Anders. “The practice of rural medicine is unique: it’s different than say Pittsburgh where I am now, where we have every specialty known to man. These practitioners need to make not only their voices heard, but also the voices of their patients.”

He also urges patients in these areas to make some noise as well.

“When you have to send someone to a regional medical center 90 minutes from home, that makes it harder to see grandma in the hospital. Patients need to be involved with their congressmen both local and federal to move that bar a bit. Make them notice us—we’re here and kind of lost,” says Anders. “A lot of energy is focused on those big urban areas, so we need activism by both physicians and patients on the local and state level.”

But the weight of change doesn’t just fall no those practicing or engaging with medicine.

“Nationally, our leadership is starting to look at this, but not to the degree it needs,” he says. “Practicing medicine in rural areas is different, and it needs a different kind of reimbursement. Funnel healthcare dollars into those areas to make sure they get the same care they can get in urban centers. Rural areas face a trifecta of pain points: the care is not as good, they can’t access it, they can’t get to it.”

The time for change is now, Anders notes. With 90 million people in rural areas all getting older than their urban counterparts, we can expect higher costs in these areas as well. But the better the interventions are, the lower those costs are going to be.

“The ROI is much higher in a rural setting than in an urban setting,” says Anders.

The risk for things to worsen if action isn’t taken is significant, he explains.

“We need the realization that there’s a lot of folks out there not getting great care, and it’s costing more than it should. The more we can demonstrate that, the better we’re going to be,” he says. “It’s really time to leverage information technology to enhance care. If you want to do something impactful, let’s get these rural hospitals connected, so the flow of information goes where it needs to, and put some interest and funding in the right places so we’re all hooked up.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.