Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics

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OVERVIEW

In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. With over 3,900 certified sites located across the county, RHCs are an important component of the rural health care infrastructure.1 RHCs can be private/for-profit or non-profit. Some operate as independent medical practices, while others are part of a hospital-owned system or other health care organization (“provider based”). RHCs receive cost-based reimbursement, subject to tests of reasonableness, for primary care services provided to Medicare beneficiaries. This Findings Brief is the second in a series on RHCs which draws on a large, national secondary dataset that includes data on all RHCs that bill Medicare.2 Using data extracted from 2009 Medicare outpatient provider claims, this Findings Brief presents a summary of the geographic distribution and clinic-level characteristics of RHCs, as well as an overview of the Medicare beneficiaries they served.

KEY FINDINGS

  • RHCs billing Medicare in 2009 were almost evenly divided between independent RHCs (1,799) and provider-based RHCs (1,695).
  • In 2009, the average independent RHC treated 547 Medicare beneficiaries and filed 2,481 claims. The average provider-based RHC of a hospital with 49 or fewer beds saw 520 beneficiaries and had 2,215 claims, as compared to 531 beneficiaries and 2,113 claims for clinics of hospitals with 50 or more beds. Although number of patients and total charges were not statistically different by RHC type, independent RHCs had more claims and received lower payments per claim than provider-based RHCs.
  • Median RHC visits per Medicare beneficiary seen was 3.0 (mean = 4.8) in 2009.
  • The median distance an RHC’s Medicare patient traveled one-way (beneficiary address ZIP centroid to RHC ZIP centroid) was 6.2 miles. Medicare patients seen at RHCs in the Mountain (12.5 miles) and Pacific (7.0 miles) Census Divisions had the longest median travel distance.
  • Medicare patients seen at RHCs in 2009 were primarily female (58%) and white (91%).