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Provider Deserts

Interventional and Diagnostic Provider Deserts

The U.S. Department of Health and Human Services, Health Resources and Services Administration defines primary care health professional shortage areas, in part, as “geographic areas …. [that] … either have either have a population to full-time-equivalent primary care physician ratio of at least 3,500:1, or a population to full-time equivalent primary care physician ratio of less than 3,500:1 but greater than 3,000:1 and unusually high needs for primary care services or insufficient capacity of existing primary care providers.”
As noted in a 2019 Health Affairs article, however, “to the extent that current policy interventions focus on expanding primary care but not specialist care in rural areas, they appear to be misguided and unlikely to reduce disparities in rural health outcomes. Notably, multiple studies have found that regular treatment by specialist physicians in the ambulatory care setting is associated with better quality of care and reduced risk of death or hospitalization for people with chronic conditions.  This does not detract from the value of primary care. However, access to primary care does not appear to drive rural-urban health outcome disparities.”
OBFA’s 2024 review of information provided by Redi-data found significant specialty care deserts across a spectrum of interventional and diagnostic providers, including A) Urology, B) Cardiology, C) Radiation Oncology, D) Vascular Surgery, E) Interventional Radiology, and F) Diagnostic Radiology.  Importantly, according to this data, there are significant interventional and diagnostic provider deserts where there are NO such providers in the majority of counties in a majority of states.  These deserts correspond to critical cuts since 2006 to these same specialties under the Medicare Physician Fee Schedule (MPFS) of -8%, -18%, -21%, -29%, -35%, and -39% respectively.  As a result of these ongoing cuts, CMS data show that for at least 195 office-based services under the MPFS, reimbursement no longer covers even the direct costs (e.g. supplies and equipment) for such services.
Ongoing cuts to interventional and diagnostic providers under the MPFS are a key driver in the collapse of independent providers and an ongoing catalyst of health system consolidation.  OBFA believes MPFS reform must include policies to address these concerns, including policies to remove high-cost supply and equipment from the MPFS.

Interventional and Diagnostic Provider Desert Maps

Data Notes:
1. Redi-Data does not display counties with none of the targeted specialities so missing counties were crosswalked from in order to provide a full list of counties. Counties with none of the selected interventional / diagnostic provider are colored in red in the associated map.
2. The data does not distinguish between whether the address is a work address or a home address. 
3. Interventional / Diagnostic Providers include: A) Vascular Surgery, B) Urology, C) Radiation Oncology, D) Interventional Cardiology, E) Vascular & Interventional Radiology, F) Diagnostic Radiology

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OBFA’s vision is for a Physician Fee Schedule that provides payment stability for office-based specialists and fundamental reform of the so-called "budget-neutrality" provision. 

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