Across rural Pennsylvania, skilled nursing facilities are a lifeline. For many communities, they are the only place where seniors and medically complex patients can receive consistent, post-acute and long-term care close to home.
That is why a little-known flaw in Medicare policy demands urgent attention.
As federal officials prepare the next Medicare physician fee schedule, they face a choice: correct a technical inconsistency now or allow it to further erode physician access in the very settings where patients need it most.
At issue is how Medicare reimburses physicians for care delivered in skilled nursing facilities. Under the current system, payments are reduced in so-called “facility” settings based on the assumption that the facility itself absorbs many of the operational costs.
In theory, that distinction may appear reasonable. In practice, particularly in rural areas, it fails.
Skilled nursing facilities in our communities are not extensions of large hospital systems. They often operate with limited staff and rely on a small number of physicians who travel between sites, manage highly complex patients and devote significant time to on-site care. These realities are not adequately reflected in Medicare’s current reimbursement structure.
Recent updates to the physician fee schedule have only widened the gap. Changes in how practice expenses are calculated have shifted payments away from facility-based care and toward office-based settings. The result is a growing financial disincentive for physicians to provide care in skilled nursing facilities.
For rural Pennsylvania, the implications are serious.
Recruiting and retaining physicians is already a challenge in many of our communities. When Medicare policy makes it less viable for physicians to practice in nursing facilities, fewer will render care in that ecosystem. This is not hypothetical; we are already seeing increased strain on provider availability.
When physician access declines, patient care suffers. Delays in evaluation and treatment become more common. Recoveries take longer. Preventable complications increase. Families are often forced to travel farther from home to ensure their loved ones receive appropriate care.
This is not simply an inconvenience. It undermines the stability of the entire rural care network.
Fortunately, there is a clear and practical solution available to federal regulators at the Centers for Medicare and Medicaid Services.
For example, Medicare currently distinguishes between different “places of service,” including skilled nursing facilities (Place of Service 31) and nursing facilities (Place of Service 32). Under the latter, policymakers already recognize that physicians incur meaningful costs when delivering care.
Aligning the reimbursement approach for skilled nursing facilities with that of other nursing operations would correct a longstanding inconsistency. It would also better reflect the real-world demands placed on physicians practicing in these settings.
This is not a call for sweeping new spending or a partisan policy shift. It is a targeted, commonsense adjustment to ensure Medicare policy keeps pace with how care actually is delivered, especially in rural America.
Pennsylvania’s rural communities cannot afford policies that unintentionally push physicians away from their most vulnerable patients.
We urge federal policymakers, including leaders in Congress and the administration, to act during the upcoming rule-making process. Addressing this issue now will help preserve access to timely, high-quality care for thousands of seniors who depend on skilled nursing facilities every day.
In rural health care, small policy details can have outsized consequences. This is one of those moments where getting the details right matters.
Helen Hawkey is board chairman of the Pennsylvania Rural Health Association, dedicated to enhancing the health and well-being of Pennsylvania’s rural citizens and communities.