As the only doctor left in Patrick County, my days are defined by the patients in my waiting room, not by government payment calculations. Since 1991, my practice has grown to care for over 38,000 patients — a critical lifeline made even more vital after our local hospital closed its doors in 2017.
But right now, a massive mathematical error by the Centers for Medicare and Medicaid Services (CMS) is threatening our very ability to keep our doors open. Specifically, CMS is using a flawed calculation known as the Accountable Care Prospective Trend (ACPT) that completely fails to reflect real-world cost growth, penalizing independent practices like mine for care we have already delivered.
Nearly 500,000 community clinicians across the country are facing a collective $700 million pay cut. At a time when millions of Americans struggle to see a primary care doctor — and rural areas like ours are already starved for medical infrastructure — this isn’t just a budget adjustment. It is a direct threat to the health of our community.
Representative Griffith fights for our local clinics
Thankfully, our local leaders recognize this danger. Congressman Morgan Griffith, who represents our region, understands the unique pressures facing rural health providers. In a direct letter to CMS Administrator Dr. Mehmet Oz, he and other lawmakers asked CMS to fix these inaccurate calculations and secure stable payment benchmarks for doctors. They understand that local doctors need predictable, honest budgets to keep patients healthy and keep clinic doors open.
Like many independent doctors, I chose a different path than corporate healthcare. I refuse to treat patients like numbers, rushing people through the exam room just to bill for as many visits as possible to keep the lights on. Instead, our practice partners with Medicare in the Medicare Shared Savings Program, designed to reward quality of care over quantity of patients.
In simple terms, we are rewarded for keeping our patients healthy and out of the emergency room. When we successfully manage chronic conditions like diabetes and heart disease, preventing avoidable hospital trips, the financial savings are shared back with our practice.
The real cost to Patrick County
While this healthcare model has been pivotal for our practice, the ACPT’s mathematical error hits hard. Our small team is facing a deficit of more than $50,000 in critical funding for care already delivered to our community. These are vital resources that were meant to be reinvested directly into local patient health.
When independent practices earn these shared savings, that money doesn’t go into a corporate vacuum. We reinvest it right here at home. Right now, I am actively trying to recruit and hire the next generation of young doctors and nurses to Patrick County so we can expand our services and better support our community.
Losing $50,000 to a federal oversight severely limits our ability to recruit staff and build the local healthcare network our neighbors desperately need.
Modernizing Medicare for the future of medicine
CMS has already recognized that the ACPT is not working. In their newest medical models, they have established guardrails to protect healthcare providers from these exact types of mathematical errors. Without applying those same protections to us, or making an immediate adjustment to the ACPT to reflect true cost trends, the financial sustainability of rural, independent clinics is at serious risk.
We want to continue providing a high level of dedicated care, but we need the government’s financial formulas to align with the actual, skyrocketing costs of staffing, medical supplies and daily operations.
If we want this patient-first approach to be the enduring future of medicine, we must ensure the formulas supporting it are as resilient as the doctors practicing it. We urge CMS to fix the ACPT calculations and establish future guardrails that accurately reflect the real economic environment. Primary care is the backbone of our community. By correcting this technical gap, CMS can ensure that rural doctors like me can stay focused on what we do best: caring for our neighbors.
Richard Cole, MD, is a board-certified family physician and founder/owner of Patrick County Family Practice of Stuart, VA. He leads the team at Patrick County Family Practice, delivering care to residents of Patrick County and surrounding areas.
