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Variations in Medicare AAPCC Rates During the 1990s for Metropolitan and Non-Metropolitan Counties

机译：20世纪90年代大都市和非大都市县医疗保险aapCC率的变化

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The Health Care Financing Administration (HCFA) contracted with RAND to perform an analysis of Medicare special payments to rural providers and implications for access and costs of care for rural Medicare beneficiaries, with a focus on underserved areas. The payment provisions examined include (1) bonus payments to physicians in rural HPSAs; (2) reimbursements to rural health clinics and federally qualified health centers; (3) special payments for sole community hospitals, Medicare-dependent hospitals, rural referral centers, EACHIRPCH hospital networks, and Medical Assistance Facilities; and (4) capitation payments in rural counties. This report presents the findings of our analysis of trends in the Medicare adjusted average per capita costs (AAPCCs) and determinants of those trends. Section 1 presents background on rural issues and Medicare payment methods, and Section 2 describes our analytic methods. In Section 3, we describe the distribution of metropolitan and non-metropolitan counties by groupings of counties, and we examine trends in provider supplies by county categories. In Section 4, trends in AAPCC rates for urban and rural counties are described, and results of a model that estimates determinants of these rates are presented. Sections 5 contains a discussion of these findings and implications for further analysis of rural payment issues. This draft report is one of four reports being prepared from our analyses of Medicare special payment policies for rural providers. The other reports address trends during the 199Os in rural hospitals with special Medicare payment designations, bonus payments for rural physicians, and payments for rural health clinics and Federally Qualified Health Centers.

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