Closing the Rural Care Gap: A Push for Physical Therapists

ALEXANDRIA, VA – February 25, 2026 – A major national advocacy effort is underway to address a critical but often overlooked gap in American healthcare: the scarcity of physical therapists in rural and medically underserved communities. The American Physical Therapy Association (APTA) is urging Congress to pass bipartisan legislation aimed at bolstering the therapy workforce and expanding patient access to essential rehabilitative services that are crucial for managing chronic pain, recovering from injury, and maintaining independence.

At the heart of the campaign is H.R. 5621, the Physical Therapist Workforce and Patient Access Act, a bill that proposes a strategic, two-pronged approach to draw healthcare professionals to the areas that need them most. The push comes after APTA submitted formal comments to the House Ways and Means Subcommittee on Health, highlighting the urgent need for policy solutions to remedy the growing healthcare disparities between urban and rural populations.

The Legislative Fix: Incentives and Access

The Physical Therapist Workforce and Patient Access Act seeks to directly address the financial barriers that often prevent new graduates from practicing in lower-paying rural settings. The bill’s primary provision would add physical therapists to the National Health Service Corps (NHSC) Loan Repayment Program. Administered by the Health Resources and Services Administration (HRSA), the NHSC provides financial incentives to healthcare providers who agree to work in designated Health Professional Shortage Areas (HPSAs).

If the bill passes, licensed physical therapists could receive up to $50,000 in student loan repayment in exchange for a two-year service commitment at an approved clinic in a rural or underserved region. This incentive is designed to make practicing in these communities a more viable career option for therapists, who often graduate with significant student debt.

"By including physical therapists in the National Health Service Corps, this bipartisan legislation affirms the essential role of physical therapist services in preventing disability, managing chronic conditions, and restoring quality of life for millions of Americans," said APTA President Kyle Covington, PT, DPT, PhD. "It expands access to care where it is needed most, helping ensure that patients in rural and underserved areas can receive the rehabilitative care they need to support independence, health, and well-being."

Beyond individual incentives, H.R. 5621 also aims to improve the healthcare infrastructure in these communities. The legislation would amend the Social Security Act to give federal community health centers, such as Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), greater flexibility in how they provide and bill for physical therapy services under Medicare. This change would make it easier for these vital local clinics to integrate rehabilitative care into their offerings, creating a more sustainable access point for patients.

A Critical Shortage with Real Consequences

The push for legislative action is fueled by stark realities on the ground. According to federal data, a staggering 85% of rural communities are designated as Health Professional Shortage Areas. For residents, this often means traveling long distances—sometimes over an hour each way—to access care. These geographical barriers are compounded by financial hurdles and a lack of awareness about the benefits of physical therapy.

This shortage has profound consequences. In areas where chronic conditions like arthritis, diabetes, and heart disease are more prevalent, the absence of accessible physical therapy can lead to poorer health outcomes, increased reliance on pain medication, and higher long-term healthcare costs. Physical therapy is a proven, non-pharmacological approach to pain management, and its scarcity in rural areas can limit options for patients seeking alternatives to opioids.

Research shows that early access to physical therapy can significantly lower overall healthcare costs. Studies have found that patients who see a physical therapist first for low back pain have lower medical costs and are less likely to receive opioid prescriptions, injections, or surgery. By delaying or forgoing care due to distance or cost, patients in underserved areas risk more severe disability, prolonged recovery times, and a greater need for expensive interventions like hospitalization or long-term care.

Untangling Medicare's Financial Knot

In addition to workforce incentives, the APTA is calling for broader reforms to address financial policies that penalize therapy providers and threaten the viability of clinics, particularly in rural areas. A key target for repeal is the Multiple Procedure Payment Reduction (MPPR) policy, a complex Medicare rule that has been in effect for over a decade.

The MPPR policy reduces Medicare reimbursement when a therapist provides more than one service to a patient on the same day. While the first procedure is paid in full, the practice expense component of any subsequent service is cut by 50%. This policy applies even if the services are distinct and necessary components of a comprehensive treatment plan, such as combining manual therapy with therapeutic exercise.

Originally implemented as a cost-saving measure to offset a different budget formula that has since been repealed, critics argue the MPPR is an outdated and arbitrary policy. It disincentivizes efficient, high-quality care and creates a significant financial burden for clinics, resulting in an average Medicare payment reduction of up to 7% for a typical therapy practice. For a small rural clinic operating on thin margins, such a reduction can be the difference between staying open and closing its doors, further diminishing access to care for the community.

Repealing the MPPR, advocates argue, would provide much-needed financial stability for therapy providers and remove a significant barrier to delivering the most effective and comprehensive care to patients in a single visit.

Building a Broad Coalition for Change

Demonstrating the widespread recognition of the problem, the push for H.R. 5621 is supported by a diverse and influential coalition of more than 40 organizations. This broad front includes not only healthcare groups like the National Association of Community Health Centers and the National Rural Health Association but also organizations representing the communities themselves, such as the American Farm Bureau Federation.

This bipartisan support in Congress and the extensive coalition underscore a growing consensus that strengthening the rural healthcare workforce is not just a professional issue for therapists but a fundamental component of national health and economic well-being. By combining workforce incentives with crucial payment reforms, supporters believe these policies can create a more equitable healthcare landscape where a patient's zip code does not determine their ability to access life-changing rehabilitative care.