Firsthand accounts of stories, alongside insights from nurse practitioners, administrators, health policy leaders, and several other oncology providers and researchers shaped a deeper understanding of how administrative delays, such as prior authorization, intersect with staffing shortages, transportation barriers, and infrastructure gaps in rural communities.
read time: 10 minutes
Earlier this summer, our team attended the 2025 Rural Oncology Conference in Lawrence, KS—a convening of frontline clinicians, health system leaders, and rural cancer care advocates working to close equity gaps across the Midwest. We heard firsthand from multiple oncologists like Wade Swenson, Emily McGovern, and Zachary Schroeder, co-founders of the Rural Cancer Institute.
Their stories, alongside insights from nurse practitioners, administrators, health policy leaders, and several other oncology providers and researchers shaped a deeper understanding of how administrative delays, such as prior authorization, intersect with staffing shortages, transportation barriers, and infrastructure gaps in rural communities.
Rural oncology teams juggle the same prior authorizations volume with 20 percent fewer staff than urban counterparts (Unger et al., 2025). A recent survey reported that 92 percent of radiation oncologists say prior authorizations delay care and lead to negative patient outcomes (ASCO, 2022). In one account shared by the American Medical Association, Dr. Debra Patt waited two weeks for a peer-to-peer call that ultimately approved a breast cancer treatment—too late for the patient to benefit (Robeznieks, 2023).
These delays aren’t abstract; they are daily obstacles. In rural oncology care, a decentralized hub-and-spoke care model is being used to reduce operational costs and minimize patient travel (Swenson et al., 2024). But even within this structure, resource gaps persist. At one spoke site, providers were reported to handle an average of 40 prior authorizations per week, losing nearly 3 nurse FTEs annually to paperwork. That impact is echoed across the country.
As Valerie Davis, former nurse practitioner at the Cancer Center of Kansas noted,
“We celebrate every time a prior auth gets approved… sometimes you just have to celebrate the small victories”.
Rural oncology care is deeply personal. In his 2024 article, “Thank You for Being Here: Insights From Rural Oncology Practice,” Dr. Swenson described patient visits as “communal encounters,” steeped in trust and shared history. Yet that trust is strained by systemic inefficiencies.
According to conference speakers:
These aren’t just IT hiccups. They’re access gaps that delay care.
The cost of administrative inefficiency is felt viscerally in rural settings. Over 88% of community oncology clinics rate their admin burden as “high” or “very high,” and more than a third have staff dedicated solely to prior authorization management (Applied Policy, 2023).
Large health systems can absorb the impact by scaling up administrative teams. Rural clinics can’t. They’re forced to stretch already limited resources even thinner, often pulling clinical staff away from patient care to manage denials, faxes, and appeals. As Dr. McGovern emphasized,
“In rural oncology, you’re doing notes, then figuring out how to get patients gas cards, follow-up appointments, and over SDOH barriers. It doesn’t stop at the chart.”
Workforce shortages in rural oncology are a documented issue (Barragan-Carrillo, 2025). Rural areas face significantly lower access to oncology specialists, sometimes just one-third the availability seen in urban regions (Lent et al., 2023). These shortages are compounded by high administrative burden, rising rural cancer incidence, and increasing reliance on value-based care metrics (Kenamond et al., 2022), all which strain limited clinical staff.
Yet oncology offers a rare path to financial resilience. As Dr. Swenson shared:
“We turned margins from 0% to 30% in 9 months by anchoring services in oncology—but only after removing admin bottlenecks.”
The outlook grows even more precarious with the recent Medicaid cuts introduced in the “Big Beautiful Bill.” While framed as cost-saving reform, these reductions threaten to destabilize already fragile rural healthcare systems that disproportionately serve Medicaid populations. For rural oncology clinics, where margins are razor-thin and administrative costs are rising, even small changes in reimbursement or eligibility can trigger service cuts, staff reductions, or closures. As financial safety nets shrink, clinics will be forced to do more with less—managing high-cost, high-need cancer care while navigating shrinking coverage and intensifying prior authorization requirements.
The result isn’t just operational strain—it’s reduced access to care for thousands of rural patients who already face barriers due to geography, poverty, and clinician shortages.
The cumulative effect of these pressures?
Delayed diagnosis. Missed treatment windows. Broken trust.
For many rural providers, the emotional burden of administrative delays is constant, and clinicians say they carry the emotional toll home with them. “It’s not just policy—it’s about being there for your patient when the system puts roadblocks in front of them,” said one conference speaker. Valerie Davis put it even more bluntly: “These are our friends. Our neighbor. Our parents. Our friends’ parents. You take it home with you”.
One speaker described trying to initiate radiation and imaging within a day for a rapidly progressing lung cancer, only to be stalled by prior authorization denials that could take weeks.
And as telehealth expands, these delays will multiply. If the imaging center doesn’t share the same EHR with the infusion site, or the radiation group uses a separate billing NPI, each step risks triggering a new denial. And for patients driving 75 miles one-way for care, rescheduling isn’t just inconvenient—it’s destabilizing to successful care outcomes.
This is where a stronger commitment to equity must begin, not just in principle, but in execution.
CMS’s first strategic pillar is health equity, closely followed by access, aiming to improve prior authorization burdens in rural communities by requiring Medicare Advantage, state Medicaid programs, and the Children’s Health Insurance Program (CHIP) to adhere to specific timeframes, denial reasons, and publish annual metrics (89 FR 8758, CMS, 2024). Turning that vision into reality requires targeted action—especially in rural oncology, where clinics confront the nation’s greatest disparities. These settings are navigating shrinking care teams, rising patient volumes, and thin margins that strain both clinical and administrative operations.
Addressing these challenges demands more than policy mandates. It requires technology interventions that streamline administrative workloads, safeguard clinician time, and ensure that patients can access life-saving therapies promptly—regardless of geography.
Recent empirical research underscores the transformative potential of artificial intelligence (AI)–enabled automation in rural cancer care operations. Studies show that AI-powered decision support and workflow automation can reduce documentation burdens, enhance staff efficiency, and simplify complex administrative tasks such as prior authorization and insurance verification (Bhardwaj et al., 2023). In rural contexts—where workforce shortages and burnout are prevalent—the ability to automate repetitive functions can improve care coordination and operational sustainability.
Natural language processing (NLP), a branch of AI focused on interpreting unstructured clinical data, has demonstrated promising results within oncology workflows. NLP solutions can reliably extract critical patient and payer information from electronic health records (EHRs), reducing manual entry errors and accelerating time-to-treatment—an especially important factor for rural patients, who frequently experience delays (Albashayreh et al., 2024).
Furthermore, AI-enabled automation directly supports value-based care objectives by reducing administrative delays, improving documentation quality, and decreasing claim denials—all of which disproportionately impact rural populations facing geographic and financial barriers. Rather than replacing human resources, these technologies augment clinical capacity—freeing frontline staff to prioritize patient-centered care and spend less time on paperwork (Ferber et al., 2025).
As healthcare delivery moves toward greater equity, evidence suggests that responsible, evidence-backed automation represents a promising path to strengthen the viability and sustainability of rural oncology practices (Benedum et al., 2023).
Want to learn more? Contact us to explore how automation could ease the administrative load on your team.
Albashayreh, A., Bandyopadhyay, A., Zeinali, N., Zhang, M., Fan, W., & White, S. G. (2024). Natural language processing accurately differentiates cancer symptom information in electronic health record narratives. JCO Clinical Cancer Informatics, 8. https://doi.org/10.1200/cci.23.00235
American Hospital Association (AHA). (2025, February). The growing impact of Medicare Advantage in rural hospitals across America. https://www.aha.org/guidesreports/growing-impact-medicare-advantage-rural-hospitals-across-america
Applied Policy. (2023, August). Prior authorizations and health equity. https://www.appliedpolicy.com/prior-authorizations-and-health-equity/
American Society for Clinical Oncology (ASCO). (2022, November). Prior authorization survey summary (November 2022). https://www.asco.org/news-initiatives/policy-news-analysis/nearly-all-oncology-providers-report-prior-authorization
Barragan-Carrillo, R., Asirwa, F. C., Dienstmann, R., Pendhakar, D., & Ruiz-Garcia, E. (2025). Global Oncology: Tackling disparities and promoting innovations in Low- and Middle-Income countries. American Society of Clinical Oncology Educational Book, 45(3). https://doi.org/10.1200/edbk-25-473930
Benedum, C. M., Sondhi, A., Fidyk, E., Cohen, A. B., Nemeth, S., Adamson, B., Estévez, M., & Bozkurt, S. (2023). Replication of Real-World evidence in oncology using electronic health record data extracted by machine learning. Cancers, 15(6), 1853. https://doi.org/10.3390/cancers15061853
Bhardwaj, A. S., Liu, M., Pintova, S., Williams, C., Liggins, J., Soto, H., Favre, D., Noble-Kirk, A., & Smith, C. B. (2023). Implementation of a streamlined prior authorization process to improve cancer care delivery. Journal of Clinical Oncology, 41, 1531. https://doi.org/10.1200/jco.2023.41.16_suppl.1531
Centers for Medicare & Medicaid Services. (CMS, 2024). Advancing health care in rural, tribal, and geographically isolated communities: FY 2024 year in review. CMS Office of Rural Health Policy. Retrieved July 31, 2025, from https://www.cms.gov/priorities/health-equity/rural-health
Ferber, D., Nahhas, O. S. M. E., Wölflein, G., Wiest, I. C., Clusmann, J., Leßmann, M., Foersch, S., Lammert, J., Tschochohei, M., Jäger, D., Salto-Tellez, M., Schultz, N., Truhn, D., & Kather, J. N. (2025). Development and validation of an autonomous artificial intelligence agent for clinical decision-making in oncology. Nature Cancer. https://doi.org/10.1038/s43018-025-00991-6
Kenamond, M. C., Mourad, W. F., Randall, M. E., & Kaushal, A. (2022). No oncology patient left behind: Challenges and solutions in rural radiation oncology. The Lancet Regional Health – Americas, 13, 100289. https://doi.org/10.1016/j.lana.2022.100289
Lent, A. B., Derksen, D., Jacobs, E. T., Barraza, L., & Calhoun, E. A. (2023). Policy recommendations for improving rural cancer services in the United States. JCO Oncology Practice, 19(5), 288–294. https://doi.org/10.1200/op.22.00704
Robeznieks, A. (2023, March). Facing care denial, oncologist sees 4-week wait for P2P consult. American Medical Association. American Medical Association. https://www.ama-assn.org/practice-management/prior-authorization/facing-care-denial-oncologist-sees-4-week-wait-p2p-consult
Shin, J. Y., Chino, F., Cuaron, J. J., Washington, C., Jablonowski, M., McBride, S., & Gomez, D. R. (2024). Insurance denials and patient treatment in a large academic radiation oncology center. JAMA Network Open, 7(6), e2416359. https://doi.org/10.1001/jamanetworkopen.2024.16359
Swenson, W. T., Lindow, M., Reycraft, J., Bjerga, L., Schroeder, Z., Swenson, A. P., & Westergard, E. (2024). The case for decentralizing cancer care: the Rural Oncology Home. NEJM Catalyst, 5(5). https://doi.org/10.1056/cat.23.0344
Swenson W. T. (2024). Thank You for Being Here: Insights From Rural Oncology Practice. JCO Oncology Practice, 20(5), 595–596. https://doi.org/10.1200/OP.23.00760
Unger, J. M., McAneny, B. L., & Osarogiagbon, R. U. (2025). Cancer in rural America: Improving access to clinical trials and quality of oncologic care. CA a Cancer Journal for Clinicians. https://doi.org/10.3322/caac.70006
Joshua Upshaw, PhD
Co-Founder, CEO, PI, Hidalga Technologies, LLC
Elizabeth Grace Schmidt, MCS
Software Engineer, Medical Coder, Marketing Lead, Hidalga Technologies, LLC
Valerie Davis, former Nurse Practitioner at Cancer Center of Kansas
Ruiling Yuan, MD, Community Oncologist and Hematologist at Self Regional Healthcare
Wade Swenson, MD, Medical Oncologist and Hematologist Lakewood Health, Founder of the Rural Cancer Institute
Emily McGovern, DO, Rural Medical Oncologist, Co-Founder of the Rural Cancer Institute
This article is published by Hidalga Technologies, LLC, an Arkansas based healthcare science and technology company building intelligent, clinically aligned workflow optimization systems for specialty medical practices.
© 2025 Hidalga Technologies, LLC. All rights reserved.
Reproduction or redistribution of this content without written permission is prohibited. For reprint or citation inquiries, contact@hidalgatech.com.
Disclaimer: This content is intended for informational purposes only and does not constitute medical, legal, or reimbursement advice. Always consult your compliance, billing, or clinical team before making operational decisions.
You must be logged in to post a comment.