Trends in Bonus Payments for Physician Services to Rural Medicare Beneficiaries

摘要

The Health Care Financing Administration (HCFA) contracted with RAND to analyze Medicare special payments to rural providers and their implications for access and costs of care for rural Medicare beneficiaries. The purpose of the research is to provide a comprehensive overview of Medicare special payments to rural providers over the last decade, to (1) estimate the relative contribution of these special payments to the Medicare capitation rates in rural counties and (2) help identify and assess alternative approaches to assuring access. The focus of the study is on services in geographic areas designated by the Health Resources and Services Administration (HRSA) as either Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAIPs). In the first phase of the project, historical trends in payments under several special payment policies are being analyzed. The special payment provisions being examined include: Capitation payments in rural counties, especially in underserved areas; Reimbursements to Rural Health Clinics and Federally Qualified Health Centers; Special payments for sole community hospitals, Medicare-dependent hospitals, rural referral centers, EACH/RPCH hospital networks, and Medical Assistance Facilities; and Bonus payments to physicians in rural HPSAs; This preliminary report presents the results of the analysis of trends in Medicare bonus payments for physician services to rural beneficiaries from 1992 through 1998.