Dire Straights from Missouri
Missouri’s healthcare scenario is a prime example for the national crisis of healthcare—growing regions where access to primary care, urgent/emergent services, and pharmacy care is limited or disappearing quickly, also known as healthcare deserts. The state’s unique setup of urban centers with rural outreaches showcase how geography, provider type, payer systems, and regulatory trends are shaping the future of American healthcare, still containing several flaws. Numerous examples currently exist to showcase these flaws, negatively impacting patient outcomes, including but not limited to: widespread shortages, divides between urban & rural options, independent VS corporate provider types, payer systems, and regulatory trends.
Missouri is disproportionally higher than most of the nation in Health Professional Shortage Areas (HPSAs), with over 95 of 114 counties designated as primary care shortage areas. Pharmacy deserts continue to expand, especially in rural counties, and hospital closures have left some residents traveling over 30 miles for emergency care. Rural patients often must travel 20 to 60 minutes to access their closest pharmacy, primary care office, and even emergency care opportunities. Urban patients typically have access to all necessary healthcare options within 5 to 10 minutes.
As a general average, independent providers are heavily concentrated in rural areas, serving as critical access points and delivering uniquely customized services to individuals. These locations continue to be among the first to be closing, largely due to squeezed margins & delayed payments from national payer programs, workforce shortages due to increasing age of existing providers & fewer providers graduating from programs to enter the workforce, as well as an ever-increasing inability for patients to afford higher-than-ever out-of-pocket expenses since the implementation of the “Affordable Care” Act. As a couple of examples, we have a local primary care office that has operated at a loss for physicians since the retirement of the primary physician, leaving a highly part-time physician to lead 2 to 3 part- and full-time nurse practitioners, and over the past year has been without a practicing physician on-site due to the lack of provider access, and patients are continually leaving the clinic for more distant providers in other local towns, creating more hardship and stress on both these patients as well as the other providers’ offices that are typically already fully booked…
Rural counties typically have higher levels of impoverished population, with lower overall literacy and incomes, and an astounding 20 to 30% higher levels of common chronic medical conditions (such as diabetes, high blood pressure, and obesity, for example). With my example above, the clinic was based out of a corporate medical system, and still struggles to maintain adequate provider coverage in the rural spaces, despite their claims they have outreaches into these rural communities. The less personalized care with higher turnover, decreasing opportunities for patient scheduling, and more providers coming out of retirement to aid than newer providers entering the market leave many communities concerned if these clinics will be the next to close due to lower volumes, reimbursements, and delayed payer reimbursements with ever-changing insurance coverage options accepted by various providers…
Many state to approach these issues, we need to have expanded opportunities for telehealth for these patients. However, limited literacy alongside issues with sufficient broadband in these rural areas leave patients just as stranded with telehealth as it does with in-person access. Limiting provider types through regulations also has hindered gap closures in Missouri compared with other states. Pharmacists are being allowed to operate with limited scope expansions to provide some acute & chronic disease care to patients, with exceptional outcome improvement in these independent & rural settings across various locations within the United States. In Missouri, we have staggering numbers of healthcare deserts, growing almost daily, with maternal and mental health leading those statistics statewide… We must act now, to uphold one of the highest decrees as healthcare providers: do no harm.