PRESERVING PATIENT ACCESS TO PHARMACY SERVICES FOR MEDICALLY UNDERSERVED POPULATIONS

To advocate for funding and innovative payment models to preserve patient access to acute and ambulatory care pharmacy services by rural or medically underserved populations; further,

To support the use of telehealth to maintain pharmacy operations and pharmacist-led comprehensive medication management that extend patient care services to and enhance continuity of care for rural or medically underserved populations; further,

To advocate that the advanced communication technologies required for telehealth be available to rural or medically underserved populations; further,

To advocate for funding of loan forgiveness or incentive programs that recruit pharmacists and pharmacy technicians to practice in rural or medically underserved populations.

Rationale

Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs) are areas or populations designated by the Health Resources and Services Administration as having too few primary care providers, high infant mortality, high poverty, or a high elderly population. Whereas MUAs are a geographic designation, MUPs have a shortage of primary care health services for a specific population within an established geographic area. MUPs may face economic, cultural, or linguistic barriers to healthcare; examples include low-income, Medicaid-eligible, unhoused, migrant or seasonal worker, or Native American populations. Many federal programs use different types of shortage designations to determine eligibility. Trends within the healthcare industry are also increasing the number of MUPs. Closure of hospitals, waning interest in primary care practice among medical graduates, and the fiscal challenges of providing care in areas with declining populations or fewer insured patients contribute to this problem. Nationally, hospitals in rural areas and MUAs are at high financial risk due to low reimbursement rates and decreasing local populations. These factors make it difficult for hospitals to cover fixed costs, let alone remain up-to-date with technological advances and emerging healthcare practices. The impact of these closures on access to and continuity of care is substantial, such as loss of access to emergency care in the community and acute mental health or substance abuse disorder treatment services.

Regardless of hospital closures, MUAs commonly struggle to recruit and retain healthcare providers, especially when hospitals close due to provider relocation. As a result, MUAs and MUPs are often left without access to vital care sites, which further exacerbates gaps in access to specialty care (i.e., impacted population missing regular specialists visits and losing their access point for referrals after local hospital closures). Once hospitals close, other healthcare resources dwindle, leading to hospital deserts and dramatic decreases in access to and continuity of care. As the number of hospital deserts increase, residents are forced to seek care elsewhere, if at all. In a 2018 Government Accountability Office report, elderly and low-income populations were more likely to be negatively impacted by rural hospital closures, and these populations were also found to be more likely to delay or forgo care after a hospital closure if the patient had to travel longer distances. Not all rural hospital closures lead to complete loss of healthcare access, which is often due to successful transitions of services to community-based primary care. Here, residents still have access to primary care services but not necessarily critical services, such as those necessary for cardiac arrest or stroke. There is no systematic approach to determine which services are critical to provide locally or virtually (e.g., telehealth), and not every hospital closure smoothly transitions residents or their healthcare needs to a primary care facility.