TABLES
1.1 Chronological History of Medicare Payment Policies for Rural Hospitals ............................. 4
1.2 Profile of Non-Metropolitan Hospitals, by Size and Special Designation Status, 1999.......... 6
1.3 Federal Provisions for Rural Health Clinics and Federally Qualified Health Centers
Before Implementation of the BBA of 1997 ......................................................................... 8
1.4 Payment Limits for the Medicare All-Inclusive Rates for Independent RHCs and
FQHCs, 1988, 1990–1997 ................................................................................................... 12
1.5 Health Professional Shortage Area Total Bonus Payments, by Selected Calendar
Years .................................................................................................................................... 16
1.6 Distribution of Bonus Payments for Health Professional Shortage Areas and Other
Areas, by Specialty, 1992 .................................................................................................... 17
1.7 Distribution of Bonus Payments for Health Professional Shortage Areas and Other
Areas, by Service, 1992 ....................................................................................................... 17
2.1 Region Groupings .................................................................................................................. 31
2.2 Facility Designation Codes .................................................................................................... 33
2.3 Number of FQHCs and Rural Health Clinics, by Type and Data Source, 1994.................... 35
2.4 Medicare Specialty Codes Used to Identify Physician Claims Eligible for the
Medicare Bonus Payments .................................................................................................. 37
2.5 HCPCS Codes Used to Define Primary Care Services for the Bonus Payment
Analysis ............................................................................................................................... 38
3.1 Distribution of U.S. Counties, by Metropolitan and Non-Metropolitan County
Categories, Based on 1993 Urban Influence Codes ............................................................ 42
3.2 Distribution of Frontier Counties, by Metropolitan and Non-Metropolitan County
Categories, Based on 1993 Urban Influence Codes and 1990 Population Census.............. 42
3.3 Distribution of Metropolitan, Non-Metropolitan, and Frontier Counties, by HHS
Region.................................................................................................................................. 43
3.4 Percentage Distribution of Metropolitan and Non-Metropolitan Counties, by HHS
Region.................................................................................................................................. 43
3.5 Average Total Population by Metropolitan, Non-Metropolitan, and Frontier
Counties, Selected Years ..................................................................................................... 44
3.6 Average County per Capita Income, by Metropolitan, Non-Metropolitan, and
Frontier Counties, Selected Years ....................................................................................... 45
3.7 Medicare Beneficiaries, by Metropolitan, Non-Metropolitan, and Frontier Counties,
Selected Years ..................................................................................................................... 46
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3.8 Medicare Beneficiaries as a Percentage of Total Population, by Metropolitan, NonMetropolitan, and Frontier Counties, Selected Years.......................................................... 46
3.9 Distribution of Medically Underserved Areas and Primary Care Health Professional
Shortage Areas, by Metropolitan and Non-Metropolitan Counties, Selected Years........... 47
3.10 Distribution of Medically Underserved Areas and Primary Care Health Professional
Shortage Areas, by Metropolitan and Non-Metropolitan Counties, 1997 HPSAs .............. 48
3.11 Average Supply of Physicians and Hospitals, by Metropolitan, Non-Metropolitan,
and Frontier Counties, 1996 or 1997 ................................................................................... 49
3.12 Average Supply of Skilled Nursing and Home Health Providers, by Metropolitan,
Non-Metropolitan, and Frontier Counties, 1994 ................................................................. 50
3.13 Average Supply of Nursing Homes and Rural Health Clinics, by Metropolitan,
Non-Metropolitan, and Frontier Counties, 1994 ................................................................. 51
4.1 Distribution of All Short-Term Hospitals in Non-Metropolitan Counties, by County
Category, Selected Years..................................................................................................... 54
4.2 Distribution of Non-Metropolitan Counties, by the Number of Hospitals in the
County, Selected Years........................................................................................................ 55
4.3 Number of Short-Term Hospitals in Non-Metropolitan Counties, by HHS Region,
Selected Years ..................................................................................................................... 55
4.4 Mix of Ownership for All Short-Term Hospitals in Non-Metropolitan Counties, for
All Hospitals and Hospitals in Frontier Counties, Selected Years ...................................... 56
4.5 Mix of Ownership for All Short-Term Hospitals in Non-Metropolitan Counties, by
County Category, Selected Years ........................................................................................ 58
4.6 Average Number of Certified Beds and Staffing for Short-Term Hospitals in NonMetropolitan Counties, by County Category, Selected Years............................................. 59
4.7 Average Hospital Bed Supply per Population and per Square Mile for NonMetropolitan Hospitals, by County Category, 1993 and 1997 ............................................ 60
4.8 Non-Metropolitan Hospitals Offering Selected Services, by County Category,
Selected Years ..................................................................................................................... 62
4.9 Distribution of All Short-Term Hospitals in Non-Metropolitan Counties, by Shortage
Area Designation, 1993 and 1997 ....................................................................................... 63
4.10 Average Number of Certified Beds and Staffing for Short-Term Hospitals in NonMetropolitan Counties, by Shortage Area Designation, 1993 and 1997 ............................. 64
4.11 Non-Metropolitan Hospitals Offering Selected Services, by Shortage Area
Designation, 1993 and 1997 ................................................................................................ 65
4.12 Number of Hospitals in Non-Metropolitan Counties, by Medicare Special Payment
Designation, Selected Years ................................................................................................ 66
4.13 Distribution of Ownership of Non-Metropolitan Hospitals, by Medicare Special
Payment Designation, 1992, 1995, and 1998 ...................................................................... 68
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4.14 Average Number of Certified Beds and Staffing for Short-Term Hospitals in NonMetropolitan Counties, by Medicare Special Payment Designation, Selected Years ......... 69
4.15 Non-Metropolitan Hospitals Offering Selected Services, by Medicare Special
Payment Designation, Selected Years ................................................................................. 70
4.16 Non-Metropolitan Hospitals Reclassified for Urban Wage Index, by County
Category, 1992, 1995, and 1998.......................................................................................... 71
4.17 Non-Metropolitan Hospitals Reclassified for Urban Wage Index, by Medicare
Special Payment Designation, 1992, 1995, and 1998 ......................................................... 71
4.18 Non-Metropolitan Hospitals Reclassified for Urban Wage Index, by HHS Region,
1992, 1995, and 1998 .......................................................................................................... 72
4.19 Distribution of Inpatient Stays for Non-Metropolitan Hospitals, by County
Category, Selected Years..................................................................................................... 73
4.20 Distribution of Inpatient Stays for Non-Metropolitan Hospitals, by Medicare
Payment Designation, Selected Years ................................................................................. 73
4.21 Distribution of Inpatient Stays for Non-Metropolitan Hospitals, by Hospital
Location and Medicare Payment Designation, 1992 and 1998 ........................................... 74
4.22 Distribution of Inpatient Stays at Non-Metropolitan Hospitals for Disabled and
ESRD Medicare Beneficiaries, by Medicare Payment Designation, 1992, 1995, and
1998 ..................................................................................................................................... 75
4.23 Distribution of Inpatient Stays for Non-Metropolitan Hospitals, by Source of
Admission and Medicare Payment Designation, 1992 and 1998 ........................................ 76
4.24 Distribution of Inpatient Stays for Non-Metropolitan Hospitals, by Type of
Admission and Medicare Payment Designation, 1992 and 1998 ........................................ 77
4.25 Distribution of Inpatient Stays for Non-Metropolitan Hospitals, by Discharge
Destination and Medicare Payment Designation, 1992 and 1998....................................... 78
4.26 Average DRG Weights for Non-Metropolitan Hospitals, by County Category and
Frontier County Status, Selected Years ............................................................................... 79
4.27 Average DRG Weights for Non-Metropolitan Hospitals, by Medicare Payment
Designation, Selected Years ................................................................................................ 79
4.28 Average Total Spending and Medicare Spending per Inpatient Stay for
Beneficiaries at Non-Metropolitan Hospitals, by County Category, Selected Years.......... 80
4.29 Average Medicare Spending per Inpatient Stay for Non-Metropolitan Hospitals,
Actual and Standardized for DRG Weight = 1, by Medicare Payment Designation,
Selected Years ..................................................................................................................... 81
4.30 Hospitalization Rate and Average Length of Stay for Non-Metropolitan
Beneficiaries, by County Category, Selected Years............................................................ 82
4.31 Total and Medicare Spending per Capita on Inpatient Hospital Services for NonMetropolitan Beneficiaries, by County Category, Selected Years ...................................... 83
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4.32 Average Total and Medicare Spending per Inpatient Stay for Non-Metropolitan
Beneficiaries, by County Category, Selected Years............................................................ 84
4.33 Hospitalization Rates and Average Length of Stay for Non-Metropolitan
Beneficiaries, by Hospital Payment Designation, Selected Years ...................................... 85
4.34 Average Medicare Spending per Capita on Inpatient Stays for Non-Metropolitan
Beneficiaries, and Share of Spending, by Hospital Payment Designation, Selected
Years .................................................................................................................................... 86
4.35 Average Medicare Spending per Inpatient Stay for Non-Metropolitan Beneficiaries,
by Hospital Payment Designation, Selected Years ............................................................. 87
4.36 Hospitalization Rate and Average Length of Stay for Non-Metropolitan
Beneficiaries, by Shortage Area, 1993, 1995, and 1997 ..................................................... 88
4.37 Average Total and Medicare Spending per Inpatient Stay for Non-Metropolitan
Beneficiaries, by Shortage Area, 1993, 1995, and 1997 ..................................................... 89
4.38 Average Total and Medicare Spending per Capita on Inpatient Services for NonMetropolitan Beneficiaries, by Shortage Area, 1993, 1995, and 1997 ............................... 89
5.1 Number of Rural Health Clinics and Federally Qualified Health Centers, by Type,
1992–1998 ........................................................................................................................... 96
5.2 Annual Percentage Change in Number of FQHCs and RHCs, by Type, 1993–1998........... 97
5.3 Ownership Status of RHCs, by Type, 1992–1998 ................................................................. 98
5.4 Staffing Mix of RHCs, 1992–1998 ........................................................................................ 99
5.5 Total Non-Metropolitan Counties with RHCs and FQHCs, Selected Years ....................... 100
5.6 Number of RHCs and Non-Metropolitan FQHCs in the Same County as One or More
Other Clinics, 1992–1998.................................................................................................. 101
5.7 Former Provider Type Among RHCs, by Type, 1992–1998 ............................................... 102
5.8 Non-Metropolitan FQHCs That Previously Were Medicare-Certified as RHCs,
1992–1998 ......................................................................................................................... 103
5.9 Geographic Location of RHCs and Non-Metropolitan FQHCs, 1992–1998....................... 104
5.10 Number of RHCs and Non-Metropolitan FQHCs, by HHS Region and Type of
Clinic, 1992 and 1998........................................................................................................ 106
5.11 Total Non-Metropolitan FQHCs and RHCs, by Location in Underserved Areas and
Type of Clinic, 1993 and 1997 .......................................................................................... 107
5.12 Percentage of Beneficiaries Using an FQHC or RHC, by County Category, Selected
Years .................................................................................................................................. 109
5.13 Estimated Medicare Spending for FQHC and RHC Services, by County Category
and Type of Clinic, Selected Years ................................................................................... 110
5.14 Average Medicare Spending per Encounter for FQHC and RHC Services, by
County Category and Type of Clinic, Selected Years....................................................... 111
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5.15 Average Medicare per Capita Payments for Beneficiaries in Counties Served by a
Clinic, by County Category and Type of Clinic, 1991, 1994, and 1998 ........................... 112
5.16 Average Total Allowed per Capita Amounts for Beneficiaries in Counties Served
by a Clinic, by County Category and Type of Clinic, 1991, 1994, and 1998 ................... 113
5.17 Medicare per Capita Payments for All Beneficiaries in Each County, by County
Category and Type of Clinic, 1991, 1994, and 1998......................................................... 114
5.18 Total Allowed per Capita Payments for All Beneficiaries in Each County, by
County Category and Type of Clinic, 1991, 1994, and 1998 ............................................ 115
6.1 Distribution of Basic Medicare Payments to Physicians and Bonus Payments for
Services to Non-Metropolitan Beneficiaries, by County Category, Selected Years ......... 120
6.2 Distribution of Basic Medicare Payments to Physicians and Bonus Payments for
Services to Non-Metropolitan Beneficiaries, by Health Professional Shortage Area,
Selected Years ................................................................................................................... 121
6.3 Distribution of Basic Medicare Payments to Physicians and Bonus Payments for
Services to Non-Metropolitan Beneficiaries, by Medically Underserved Area,
Selected Years ................................................................................................................... 122
6.4 Distribution of Medicare per Capita Spending and Bonus Payments to Physicians for
Services to Non-Metropolitan Beneficiaries, by County Category, Selected Years ......... 123
6.5 Distribution of Basic Medicare per Capita Spending and Bonus Payments to
Physicians for Services to Beneficiaries, by Health Professional Shortage Area,
Selected Years ................................................................................................................... 124
6.6 Distribution of Medicare per Capita Spending and Bonus Payments to Physicians for
Services to Non-Metropolitan Beneficiaries, by HHS Region, Selected Years ................ 125
6.7 Distribution of Medicare Bonus Payments to Physicians for Services to NonMetropolitan Beneficiaries, by Physician Specialty, Selected Years ................................ 126
6.8 Distribution of Medicare Bonus Payments to Physicians for Services to NonMetropolitan Beneficiaries in Health Professional Shortage Areas, by Physician
Specialty, 1994 and 1998................................................................................................... 127
6.9 Distribution of Medicare Bonus Payments to Physicians for Services to NonMetropolitan Beneficiaries in Health Professional Shortage Areas, by Type of
Service, Selected Years ..................................................................................................... 128
6.10 Distribution of Medicare Bonus Payments to Physicians for Primary Care Services
to Non-Metropolitan Beneficiaries, by Physician Specialty, Selected Years.................... 129
6.11 Distribution of Medicare Bonus Payments to Physicians for Primary Care Services
in Health Professional Shortage Areas and Other Areas, by Physician Specialty,
1994 and 1998 ................................................................................................................... 130
6.12 Distribution of Medicare Payments to Physicians for Primary Care Services to NonMetropolitan Beneficiaries as a Share of Total Physician Payments, by Physician
Specialty, Selected Years .................................................................................................. 131
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6.13 Distribution of Medicare Payments to NPPs for Services to Non-Metropolitan
Beneficiaries, by County Category and HPSA Designation, Selected Years.................... 132
7.1 Average AAPCC Capitation Rates, by Metropolitan, Non-Metropolitan, and Frontier
Counties, 1990, 1994 and 1997 ......................................................................................... 138
7.2 Average AAPCCs for Metropolitan, Non-Metropolitan, and Frontier Counties by
HHS Region, 1990 and 1997 ............................................................................................. 139
7.3 Average AAPCC Capitation Rates, by Metropolitan and Non-Metropolitan Health
Professional Shortage Areas, 1990, 1994, and 1997 ......................................................... 141
7.4 Part A Percentage Share of AAPCC Capitation Rates, by Metropolitan, NonMetropolitan, and Frontier Counties, 1990, 1994, and 1997............................................. 142
7.5 Part A Percentage Share of AAPCC Capitation Rates, by Metropolitan and NonMetropolitan Health Professional Shortage Areas, 1990, 1994, and 1997........................ 143
7.6 Volatility of AAPCC Capitation Rates, by Metropolitan, Non-Metropolitan, and
Frontier Counties, 1990 and 1995 ..................................................................................... 144
7.7 Volatility of 1995 AAPCC Capitation Rates for Frontier Counties, by Size of
Medicare Population.......................................................................................................... 145
7.8 Volatility of AAPCC Capitation Rates, by Metropolitan and Non-Metropolitan
Underserved Areas, 1990, 1993, and 1995........................................................................ 146
7.9 Estimation of Factors Associated with Levels of AAPCC Capitation Rates, 1997............. 148
7.10 Medicare Health Plan Enrollments for Metropolitan, Non-Metropolitan, and
Frontier Counties, 1993 and 1997 ..................................................................................... 150
7.11 Average 1997 AAPCC Rates for Metropolitan, Non-Metropolitan, and Frontier
Counties, by the Presence or Absence of a Medicare Health Plan.................................... 151
7.12 Distribution of Medicare Health Plans Serving Non-Metropolitan Counties, by
Percentage of Non-Metropolitan Plan Enrollees, 1993 and 1997 ..................................... 152
8.1 Average Total and Medicare Inpatient Payments per Non-Metropolitan Beneficiary,
Actual and Adjusted Amounts and Coefficients of Variation, Three-Year Average
and 1996–1998 .................................................................................................................. 157
8.2 Distribution of Non-Metropolitan Counties, by the Percentage of Medicare Inpatient
Stays at Hospitals with Special Payments, Three-Year Average 1996–1998 ................... 157
8.3 Distribution of Non-Metropolitan Counties, by Average Actual Payment per
Medicare Inpatient Stay for Total and Medicare Payments, Three-Year Average
1996–1998 ......................................................................................................................... 158
8.4 Distribution of Non-Metropolitan Counties, by Reduction in Payment per Medicare
Inpatient Stay with Special Payments Removed, Three-Year Average 1996–1998 ......... 158
8.5 Average Medicare Payments per Medicare Inpatient Stay, Before and After
Removing Special Payment Amounts, by Non-Metropolitan County Category,
Three-Year Average 1996–1998 ....................................................................................... 159
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8.6 Average Medicare Payments per Medicare Beneficiary, Before and After Removing
Special Payment Amounts, by Non-Metropolitan County Category, Three-Year
Average 1996–1998........................................................................................................... 160
8.7 Difference Between Actual and Adjusted Medicare Payments per Non-Metropolitan
Beneficiary, by Actual Payment Category, Three-Year Average 1996–1998 .................. 160
8.8 Average Total and Medicare Payments per Inpatient Stay, by Type of Hospital,
Three-Year Average 1996–1998 ....................................................................................... 161
8.9 Effects of Special Payments on Medicare Payments per Stay and per Capita for NonMetropolitan Beneficiaries, by Level of Special Payment Stays, Three-Year
Average 1996–1998........................................................................................................... 162
8.10 Effects of Special Payment Amounts on Medicare Payments per Inpatient Stay, for
All and Special Payment Stays, by Non-Metropolitan County Category, Three-Year
Average 1996–1998........................................................................................................... 163
8.11 Average Medicare Payments per Beneficiary to Special Payment Hospitals, by
Non-Metropolitan County Category, Three-Year Average 1996–1998............................ 163
8.12 Distribution of Non-Metropolitan Counties, by Actual Hospital Inpatient Payments
as a Percentage of Medicare Part A Payments per Beneficiary, Three-Year Average
1996–1998 ......................................................................................................................... 164
8.13 Distribution of Non-Metropolitan Counties, by Average Medicare Part A and
Hospital Inpatient Payments per Beneficiary, Actual and Adjusted Amounts, ThreeYear Average 1996–1998 .................................................................................................. 165
8.14 Average Medicare Part A Payments per Beneficiary, Actual and Without Special
Payments, by Non-Metropolitan County Category, All and Elderly Beneficiaries,
Three-Year Average 1996–1998 ....................................................................................... 165
A.1 Adjustments to Payments for Hospitals Serving a Disproportionate Share of LowIncome Patients.................................................................................................................. 187
B.1 Two Classification Methods for Metropolitan and Non-Metropolitan Counties ................ 190
B.2 Rural-Urban Commuting Area (RUCA) Codes .................................................................. 192
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