Configuration and Delivery of Primary Care in Rural and Urban Settings

Area of Science:

• Health Services Research
• Rural Health
• Primary Care Delivery

Background:

• Rural primary care capacity is a concern due to workforce shortages and high-risk patients.
• Limited research exists on primary care configuration across the rurality spectrum.

Purpose of the Study:

• To compare the structure, capabilities, and payment reform participation of physician practices across different rurality levels (isolated, small town, micropolitan, metropolitan).
• To examine the characteristics and healthcare utilization of Medicare beneficiaries served by these practices.

Main Methods:

• An observational study using IQVIA OneKey data and 2017 Medicare claims.
• Included a subset from the National Survey of Healthcare Organizations and Systems (47% response rate).
• Analyzed 27,716,967 Medicare beneficiaries assigned to practices.

Main Results:

• Rural practices were smaller, more primary care-focused, system-owned, and served more beneficiaries.
• Rural beneficiaries had higher poverty and disability rates.
• Outpatient utilization and care delivery capabilities were similar across rurality levels, with notable exceptions in quality metrics (mammograms, diabetes eye exams) and higher readmissions in rural areas.
• Isolated and micropolitan practices showed less engagement in quality-focused payment programs.

Conclusions:

• Rural primary care practices demonstrate comparable capabilities and outpatient/inpatient utilization to urban counterparts, despite demographic and workforce differences.
• Quality metrics outside primary care and readmissions highlight disparities for rural patients.
• Most isolated rural beneficiaries seek care in more urban areas.