Assessment and Redesign of Medicare Fee Schedule Areas (Localities). Volume 1.Text

摘要

Medicare physician payment reform (PPR) mandated by the Omnibus ReconciliationAct of 1989 includes a national fee schedule adjusted by a geographic practice cost index unique to each Medicare Fee Schedule Area (MFSA), i.e., a Medicare payment locality. Medicare payment localities were established by local insurance carriers at the inception of the Medicare program in 1966 according to local criteria for medical practice and economic conditions. As such, localities have no consistent geographic basis and may reflect historical relationships that are no longer relevant. There have been few changes in payment locality definitions until the implemenation of PPR in 1991 when a number of multiple localities became state-wide MFSAs reducing the number of localities to 240. Recognizing that changes may be needed in MFSA designations, the Health Care Financing Administration contracted to reevaluate localities. Volume I of this study reports four such options.