CDC report underscores value provider status legislation would hold for rural America


ATLANTA — In what may be a serendipitous turn of events, on the same day the Senate re-introduced provider status legislation, the Centers for Disease Control and Prevention issued a report outlining the disparities between medically underserved communities in rural areas vs. their urban center counterparts.

According to the CDC, Americans living in rural areas have a higher mortality rate than their urban counterparts. “This new study shows there is a striking gap in health between rural and urban Americans,” stated CDC Director Tom Frieden. “To close this gap, we are working to better understand and address the health threats that put rural Americans at increased risk of early death.”

While the agency explores the disparity between rural Americans and urbanites, Congress can help close that gap by passing provider status legislation, especially as the impact this provider status regulation can have on rural communies was not lost on the bill's sponsors.

“A lot of people in rural Iowa have easier access to a pharmacist than a doctor,” stated Sen. Grassley, R-Iowa.  “Where that pharmacist is licensed to provide a service, Medicare ought to pay the pharmacist for it.  That’s what this bill does.  It’s good for pharmacists because they get paid for providing services to rural seniors.  It’s good for rural seniors because they keep access to their local pharmacist and don’t have to go to the  doctor for straightforward medication management.”


“Across the country and in Pennsylvania pharmacists play a critical role in helping seniors receive access to routine healthcare services like wellness checks,” added Sen. Bob Casey, D-Pa. “This legislation will aid those in rural communities who may not live in close proximity to the doctor but do have regular contact with their pharmacist. I’m hopeful that Congress will move forward on this commonsense legislation in the coming year.”  

“Seniors in rural Ohio shouldn’t have to travel long distances to see their doctor for a simple health screening when the pharmacist down the street can offer the same services,” noted Sen. Sherrod Brown, D-Ohio. “We can better serve our seniors and taxpayers by cutting through the red tape and giving seniors more choice on where they go for care.”

“Pharmacists are highly trained professionals and the most accessible health care providers for patients,” stated Douglas Hoey, CEO National Community Pharmacists Association, in a release issued Friday in support of the provider status legislation. “Many states allow pharmacists to provide services such as health and wellness screenings, immunizations and chronic disease state management," he said. "This legislation would expand access for seniors to these basic services at their pharmacy and free physicians in these underserved communities [both rural and urban] to focus their attention on other health needs.”

According to the NCPA 2016 Digest, sponsored by Cardinal Health, 32% of independent community pharmacies are located in population areas of less than 20,000 people, 50% are located in areas of populations between 20,000 and 50,000, and collectively over 80% are serving areas with population centers of less than 50,000.

In addition, Medicaid which has disproportionate number of patients in rural areas, comprises 17% of the average independent pharmacy's business, which is much higher than their chain counterparts. 

Approximately 1,800 rural independent pharmacies serve as the only pharmacy provider in their community, with the next closest pharmacy many miles away, NCPA noted.

According to the CDC report, the 15% of the U.S. population who live in rural areas, representing some 46 million Americans, are more likely to die from five leading causes than their urban counterparts.

The agency found in 2014, many deaths among rural Americans were potentially preventable, including 25,000 from heart disease, 19,000 from cancer, 12,000 from unintentional injuries, 11,000 from chronic lower respiratory disease and 4,000 from stroke. The percentages of deaths that were potentially preventable were higher in rural areas than in urban areas.

"Many independent pharmacies serve traditionally underserved rural and urban communities and are particularly well positioned to administer to the basic health care needs of these populations," Hoey said. "[That makes provider status] common-sense bipartisan legislation that improves access to care and should be swiftly enacted.”

To help close the gap outside of legislation, the CDC recommended healthcare providers in rural areas can:

  • Screen patients for high blood pressure and make control a quality improvement goal. High blood pressure is a leading risk factor for heart disease and stroke;Increase cancer prevention and early detection;

  • Rural healthcare providers should participate in the state-level comprehensive control coalitions. Comprehensive cancer control programs focus on cancer prevention, education, screening, access to care, support for cancer survivors and overall good health;

  • Encourage physical activity and healthy eating to reduce obesity. Obesity has been linked to a variety of serious chronic illnesses, including diabetes, heart disease, cancer and arthritis;

  • Promote smoking cessation. Cigarette smoking is the leading cause of preventable disease and death in the United States and is the most significant risk factor for chronic lower respiratory disease; and

  • Engage in safer prescribing of opioids for pain. Healthcare providers should follow the CDC guideline when prescribing opioids for chronic pain and educate patients on the risks and benefits of opioids and using nonpharmacologic therapies to provide greater benefit.


The Health Resources and Services Administration, which houses the Federal Office of Rural Health Policy, will collaborate with CDC on the series and will help to promote the findings and recommendations to rural communities, CDC stated.

“We have seen increasing rural-urban disparities in life expectancy and mortality emerge in the past few years. CDC’s focus on these critical rural health issues comes at an important time,” said Health Resources and Services Administration acting administrator Jim Macrae.


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