"What rural providers do is all part of the safety net," Elehwany says. "If you try to help rural physicians and fix the SGR problem that is wonderful, but not if you do that by cutting rural emergency medical services or cutting critical access hospitals or some of these rural Medicare (Preferred Provider Organization) hospitals where nearly every physician out there in rural areas is based."
"If you close the hospitals, the doctors aren't going to be able to practice," she says. "If you cut ambulance funding, there isn't going to be anyone to provider transportation. More than any other type of healthcare delivery system, the rural healthcare providers really are on a team that is united and they need to work together simply because there are so many challenges to overcome: the distances, the geography the weather, mountain ranges… just to serve the population."
More bad news: Attached to the SGR are Rural Medicare Extender provisions that will also expire with a permanent fix. These provisions were tacked on to the SGR after Congress saw the devastating effect on rural hospitals when Medicare switched to the prospective payment system in the 1980s. These include supplemental payments for Medicare-dependent hospitals, low-volume hospitals, and critical access hospitals.