CHICAGO — Despite advances including the Affordable Care Act and Medicaid expansion bringing insurance coverage and health care accessibility to millions of Americans, the health of rural Americans continues to lag behind those in suburban and urban areas. To help address the issue and help achieve optimal health for all Americans, physicians, residents and medical students at the Special Meeting of the AMA House of Delegates (HOD) today adopted new policies to address the health needs of the rural population, protect and enhance their access to health care, and ensure payment to rural hospitals is adequate and appropriate.

Specifically, the new policy calls for public and private payers to take the following actions to ensure payment to rural hospitals is adequate and appropriate:

• Create a capacity payment to support the minimum fixed costs of essential services, including surge capacity, regardless of volume

• Provide adequate service-based payments to cover the costs of services delivered in small communities

• Adequately compensate physicians for standby and on-call time to enable very small rural hospitals to deliver quality services in a timely manner

• Use only relevant quality measures for rural hospitals and set minimum volume thresholds for measures to ensure statistical reliability

• Hold rural hospitals harmless from financial penalties for quality metrics that cannot be assessed due to low statistical reliability

• Create voluntary monthly payments for primary care that would give physicians the flexibility to deliver services in the most effective manner with an expectation that some services will be provided via telehealth or telephone.

“On average, rural residents are older, sicker, and less likely to have health insurance—a particularly dangerous combination at a time when more than 40 percent of rural hospitals are at risk of closing,” said AMA President Susan R. Bailey, M.D. “Most of the hospitals at risk of closing are small rural hospitals, serving isolated communities. Without long-term solutions, the health needs of rural populations will not be met. The AMA has long advocated for telehealth as a critical part of effective, efficient, and equitable health care delivery, and ensuring telehealth and telephone access in rural communities is particularly important.”

The new policy also encourages transparency among rural hospitals regarding their costs and quality outcomes, and encourages employers and rural residents to choose health plans that adequately and appropriately reimburse rural hospitals and physicians.