Congress must act to save rural Iowa’s safety net

For years, rural access to emergency health care has dwindled as hospitals closed and cash-strapped health systems rolled back vital infrastructure in rural areas.

Sadly, it is also increasingly difficult for Iowans to see specialty providers - including cardiologists, oncologists, radiologists and physical and occupational therapists. Nationwide, access to specialty care in rural communities is abysmal, with only 30 specialists per 100,000 residents compared with 263 specialists per 100,000 residents in urban regions, according to the National Rural Health Association.

Now, as patients delay or cancel their visits to the doctor due to coronavirus fears, more specialty care providers feel the pressure to close - exacerbating the appalling access problems that existed before the COVID-19 pandemic. As a physical therapist here in Urbandale, I can speak to this reality firsthand. Since the onset of the public health emergency, we've seen patient volume drop sharply - despite the fact that many of the patients we serve continue to suffer from chronic pain, fall-related medical injuries, and post-surgical care needs.

Unfortunately, the challenges we face have been compounded by federal policy that threatens to slash Medicare payments.

Severe payment cuts for 2021 have been proposed in a new payment rule issued by the agency that runs Medicare. If implemented as written, the rule would impose draconian cuts to a slew of specialty providers in 2021, including emergency medicine (-7 percent), interventional radiology (-9 percent), cardiac surgery (-9 percent), and physical and occupational therapy (-9 percent), among others. The latest hit comes on top of a steady stream of Medicare cuts to physical and occupational therapy over the last decade.

As health care providers grapple with the health and financial burdens of COVID-19, these specialty cuts would be the sledgehammer that breaks the camel's back. For the sake of Iowa's rural patients and the medical practices, we can't allow that to happen.

Since Medicare seems unwilling to help, Congress must step up. Fortunately, on this front, there's reason to be at least a little optimistic.

Recently, a bipartisan coalition of House lawmakers sent a letter to congressional leadership urging them to include provisions in the next pandemic relief package that would delay specialty payment cuts. The initiative comes on the heels of another letter sent by more than 160 bipartisan lawmakers to Medicare officials, expressing deep concern over the prospect of undermining health care providers amid a national health emergency.

As these letters point out, the driving force behind Medicare's proposed rule - to increase payments for 'evaluation and management” (E/M) services furnished by providers such as primary care physicians - while justified, shouldn't come at the cost of undermining specialty providers.

On behalf of my colleagues and the rural patients we serve, I urge Iowa's congressional delegation, including Sen. Chuck Grassley, to support these well-meaning efforts to prevent America's specialty health care safety net from deteriorating even further.

John Brandt, DPT, ATC, LAT is clinic director of ATI Physical Therapy in Urbandale, a member of the Alliance for Physical Therapy Quality & Innovation.