Shortcomings in Medicare bonus payments for physicians in underserved areas

Health Affairs

Volumn 22, Issue 4, 2003, Pages 173-178

  Shugarman, Lisa R ^a   Farley, Donna O ^a  

^a RAND CORPORATION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; EVALUATION; HEALTH CARE PLANNING; HEALTH INSURANCE; HUMAN; LEGAL ASPECT; MANPOWER; MEDICARE; PERSONNEL MANAGEMENT; PROFESSIONAL PRACTICE; PROSPECTIVE PAYMENT; RURAL HEALTH CARE; STATISTICS; UNITED STATES;

HUMANS; MEDICALLY UNDERSERVED AREA; MEDICARE ASSIGNMENT; MEDICARE PART B; MEDICARE PAYMENT ADVISORY COMMISSION; PHYSICIAN INCENTIVE PLANS; PROFESSIONAL PRACTICE LOCATION; RURAL HEALTH SERVICES; UNITED STATES;

EID: 0041660834     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.22.4.173     Document Type: Article

References (19)

1. Physician Payment Review Commission, "Increasing the Availability of Health Professionals in Shortage Areas," in Annual Report to Congress (Washington: PPRC, 1992), chap. 5, 123-139;
2. and H.K. Rabinowitz et al., "Demographic, Educational, and Economic Factors Related to Recruitment and Retention of Physicians in Rural Pennsylvania," Journal of Rural Health (Spring 1999): 212-218.
3. PPRC, "Improving Access to Health Services in Rural Areas," in Annual Report to Congress (Washington: PPRC, 1991), chap. 17, 316-348.
4. T.C. Ricketts et al., "How Many Rural Doctors Do We Have?" Journal of Rural Health (Summer 2000): 198-207.
5. P.L. 100-203, sec. 4043, 101 Stat. 1330, 1330-85 [42 U.S. Code 1395(m)].
6. Omnibus Budget Reconciliation Act of 1989, P.L. 101-239, sec. 6102(c)(1), 103 Stat. 2106, 2184.
7. D.O. Farley et al., Trends in Special Medicare Payments and Service Utilization for Rural Areas in the 1990s, RAND MR-1595-CMS (Santa Monica, Calif.: RAND, 2002).
8. North Carolina Rural Health Research and Policy Analysis Center, "Mapping Rural Health," Health Resources and Services Administration Cooperative Agreement no. CSURC0004-01-0 (1998).
9. Centers for Medicare and Medicaid Services, Carriers Manual, Part 3, Chapter III, cms.hhs.gov/manuals/14_car/3b3000.asp (21 April 2003).
10. The professional component is the physician work component of a bill. For example, the physician's review of an x-ray is the professional component, while the technical component includes charges for taking the x-ray.
11. HPSA designations were available in the ARF for 1993, 1995, 1996, and 1997. The 1993 HPSA designations were used with the 1992 and 1994 claims, the 1996 designations were used with the 1996 claims, and the 1997 designations were used with the 1998 claims. Additional details are given in the full study report. See Farley et al., Trends in Special Medicare Payment and Service Utilization for Rural Areas in the 1990s, 224.
12. In 1991 two bills were introduced in the Senate to extend bonus payments to nonphysician providers' services (102d Congress, S. 2103, S.2104). Neither bill passed.
13. Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203).
14. American Medical Association, Physicians' Current Procedure Terminology (Chicago: AMA, 1997).
15. Somewhat less than 1 percent of the claims with a bonus payment modifier were coded for services provided in urban HPSAs for urban beneficiaries. These payments are included in the total amounts examined in the analyses.
16. These dollar amounts have not been adjusted for inflation.
17. Informal communication with CMS staff, 12 March 2001.
18. L.J. Goldsmith and T.C. Ricketts, "Proposed Changes to Designations of Medically Underserved Populations and Health Professional Shortage Areas: Effects on Rural Areas," Journal of Rural Health (Winter 1999): 44-54.
19. S. 2914, 107th Congress.