Centers for Medicare &. Medicaid Services ro ec I 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 sh i Initiated (CMS): : sgalloway Date: 23-Apr-02 Accepted (IQ): Date: 1 Released (IQ): Date: Received (Sub): Date: m Finished (Sub): Date: QC'd (IQ): Date: J m 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 (609) 799-3535 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