Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients
Background
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are important primary care providers in rural communities. These safety net programs are similar in that they both are located in areas with inadequate access to health care services. In addition, RHCs and FQHCs are federally-designated entities reimbursed by Medicare based on all-inclusive per visit payments rather than the Medicare Physician Fee Schedule used for most other primary care providers. Required services differ, however, despite the similar missions of the programs. For example, in addition to primary care provided in both settings, FQHCs are required to provide, either on-site or by arrangement, many other health care services such as pharmacy, dental care, and case management, and RHCs are not. RHCs must be located in non-urbanized areas, while FQHCs may operate in urban areas as well.1 Because they are similar in mission but may be different in practice, understanding their respective Medicare patient profiles is important. Using data extracted from 2009 Medicare outpatient provider claims, we looked at the location of clinics, the number of beneficiaries served, and the number of and cost per claim for each type of rural safety net clinic. We further examined characteristics of Medicare beneficiaries comparing their age, the health problems for which they sought care, and the distance they travelled to obtain care. In most analyses, values for urban beneficiaries are also provided for comparison. It is important to emphasize that the information provided here is for Medicare beneficiaries and does not consider the total population of patients served by each type of clinic. This findings brief is the third in a series on RHCs which draws on a large, national dataset that includes claims data on the approximately 90% of RHCs that billed Medicare in 2009. Other findings briefs in this series profile in greater detail RHCs’ Medicare billing and reimbursement, the distribution and characteristics of individual clinics,2 and the characteristics of Medicare beneficiaries served by RHCs.3