MedPAC questions whether medically underserved areas need to be redefined and updated

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A new analysis looking at rural access to care questioned the use of medically underserved area designations to identify medically vulnerable populations. (Getty/OgnjenO)

More than three-fourths of traditional Medicare beneficiaries live in a full or partial medically underserved area (MUA), leading to questions on how such areas are defined.

New data from the Medicare Payment Advisory Commission released Thursday showed that 18% of Medicare fee-for-service beneficiaries lived in a MUA in 2018, the latest year for which data are available, and 60% lived in a partial MUA. The high number sparked questions over whether the area designation is precise enough to identify safety net providers that need more help.

Staff members said part of the issue is that the MUAs have not been updated recently to reflect demographic and other changes. MUAs are defined by the federal government as areas that have a small number of primary care providers, high infant mortality or high poverty.

“Many MUAs were designated decades ago and have not been evaluated since,” said commission staff member Brian O’Donnell. “MUAs may be evaluated too broadly.

Another issue is that MUAs do not include advance practice registered nurses or physician assistants, which can offer similar services as a primary care physician does.

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Advance nurses and physician assistants make up more than a third of the physicians that bill Medicare.

The commission found that in 2018, physician assistants and advance nurses made up 34% of the primary care doctors that billed Medicare. In rural areas, they represented 40% of those who billed Medicare.

“These findings suggest that the measure of primary care supply used in the identification of MUAs likely fails to account [for] a third or a half of all primary care physicians,” O’Donnell said. “The underestimate will continue to grow in magnitude if the supply of [physician assistants] continues to expand and supply of physicians continues to remain flat.”

MedPAC looked at the data as part of a congressionally mandated directive to explore rural Medicare beneficiaries’ access to care. The commission will include a final report in its June 2022 report to Congress.

“These results suggest MUAs by themselves might not be useful to identify vulnerable populations and support safety-net providers,” O’Donnell said.

However, MUAs are identified as a method by lawmakers to deliver more resources to improve care disparities.

For example, Sen. Amy Klobuchar, D-Minnesota, introduced a bill earlier this year that aims to keep international doctors who are in MUAs and rural areas in the country longer.