Rural health clinics : improved access at a cost

256 Pages·2002·7.1 MB·English

by  Cheh, Valerie

Centers for Medicare &. Medicaid Services
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PDF TRACKING FORM
TrackingJob Number 68 Printed: 04/23/2002
Document Title Rural Health Clinics: Improved Health Care at a Cost
Author Calerie Cheh, Rachel Thompson Document Date 25-Nov-97
Document Description: Final Report
Project Specifics
SR Number 95-058
Project Number 500-92-0047/03
Project Title Evaluation ofRural Health Clinics
Awardee Mathematica Policy Research
Project Officer Mazumdar, Sidd
Principle Investigator Cheh, Valerie
Funding Level 316051
Start Date 09/01/1995
End Date 11/30/1997
Project Description: The Rural Health Clinic Services Act of 1977 authorized a new type ofprovider for
certification and licensure. A rural health clinic (RHC) must be located in a rural
health professional shortage area, medically underserved area, or Governor-designated
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Initiated (CMS): : sgalloway Date: 23-Apr-02 Accepted (IQ): Date:
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Released (IQ): Date: Received (Sub): Date:
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Finished (Sub): Date: QC'd (IQ): Date:
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Returned (IQ): Date: pproved (CMS): Date:
version 1.0

Contract No.: 500-92-0047
MPR
Reference No.: 8293
Rural Health Clinics: Improved
Access at a Cost
November 25, 1997
Authors:
Valerie Cheh
Rachel Thompson
Programmer:
Mei-Ling Mason
Submitted to: Submitted by:
Office of Research and Demonstrations Mathematica Policy Research. Inc.
Health Care Financing Administration P.O. Box 2393
7500 Security Boulevard C-3-15-06 Princeton, NJ 08543-2393
MD
Baltimore, 21244-1850 [phone]
Project Officer: Project Director:
Dr. Siddhartha Mazumdar Valerie Cheh

CONTENTS
Chapter Page
EXECUTIVE SUMMARY
xi
OVERVIEW
I 1
A. Program Background ,2
B. Rural Health Clinic Characteristics 4
C. Growth in the Rural Health Clinics Program 7
D. Prior Studies on the RHC Program 11
E. Overview of Evaluation Design 13
II EFFECTS OF RURAL HEALTH CLINICS ON ACCESS TO CARE 17
A. Provider Availability and Stability 19
1. Physician Staff 20
2. Midlevel Practitioners 23
3. Financial Stability 27
B. Level of Services Received by Community Residents 29
1. Service Utilization 30
2. Reasons for Increased Utilization 35
3. Emergency Room Utilization 40
C. Discussion 42
THE EFFECT OF RURAL HEALTH CLINICS ON
III
MEDICAID AND MEDICARE COSTS
45
A. Medicaid Program Costs 47
1. California 47
2. Texas 47
in

CONTENTS
(continued)
Chapter Page
III C. Medicare Program Costs 50
(continued)
D. Differences in Hospital-Based Reimbursements 53
E. Will the new Hospital Cost Cap Change the Disparity? 55
F. Are the Costs Reasonable? 56
G. Discussion 57
IV THE STATE VIEW 59
A. Support for the Rural Health Clinic Program 59
B. RHCs and Cost Containment Policies 61
C. Changing the Hospital Reimbursement Method 63
D. Maine's Opposition to Rural Health Clinics 64
E. Discussion 66
V THE FUTURE OF RURAL HEALTH CLINICS UNDER
MEDICAID MANAGED CARE
67
A. Limited Involvement with Medicaid Managed Care 67
B. Limited Protection for Cost-Based Providers 70
C. States' Views on Medicaid Managed Care in Rural
Areas Not Yet Tested 72
VI DISCUSSION 73
A. Clinics Added Provider Staff 73
B. Clinics Expanded Access to Care 74
iv