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Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
×

Index

[Page numbers followed by b, f, n, or t, refer to boxed text, figures, footnotes, or tables, respectively.]

A

Access to care

cost of care as barrier to, 54

current system performance, 5–6, 7, 53–54, 61, 82, 91

definition and measures of, 17b, 51, 52t, 58–59

delivery system reforms to improve, 114–117

determinants of, 18, 19, 99, 132

disparities in, 57, 129–130

expected outcomes of Phase I recommendations, 2–3, 6, 61–62, 136–137

geographic adjustment and, 2–3, 5–6, 7, 14, 49, 51, 61–62, 82–83, 136

in Health Professional Shortage Areas, 40, 55

health workforce supply and distribution as factor in, 17, 18, 54–55, 66–67, 136

locating new physician as indicator of, 54

Medicare fee schedule as factor in, 126–127

Medicare physician participation rates and, 56–57

Medicare policies for maintaining, 92–96, 93–94t, 119

in metropolitan and nonmetropolitan areas, 55–56, 82

opportunities to improve, 8, 65, 74–82

patient travel distance as measure of, 65, 66, 99

payment policy as factor in, 18

physician payment policies and, 91

quality of care and, 59

recommendations for improving, 9–10, 11, 137–138, 140–141

study goals, 2b, 14–15, 15b, 51

underserved and vulnerable populations, 6, 7, 53, 55–56, 57–58, 82, 83, 129–130, 136–137

See also Specialty medicine, access to

Accountable care organizations, 114–116, 131

Advance payment accountable care organizations, 115–116

Advanced practice nurses, 65, 72, 81

Affordable Care Act, 39, 56b, 98, 117, 119, 127

Affordable Health Care for America Act, 1, 14

Agency for Healthcare Research and Quality (AHRQ), 6, 58

Alaska, 5, 37, 38–39, 47, 48–49b, 57, 73

Alien physician program, 111–112

American Recovery and Reinvestment Act, 79

Area Health Education Centers, 97

Area Resource File, 152–154

B

Balanced Budget Act, 139

Benefits in provider compensation, 24n, 146, 148–150, 149t

Bureau of Labor Statistics

employee benefits data, 24n

hospital wage index based on data from, 4

Occupational Employment Statistics, 66

in simulations of Phase I recommendations, 4, 27, 28f, 30–31, 49, 146–148

Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
×

C

California, 46–47, 74

Centers for Medicare & Medicaid Services, 1, 14, 92

Chronic care patients, 6, 19, 76–77

Community health centers, 96–97

Commuting between market areas, 4–5, 27, 29b, 33b, 34n, 37, 37n, 45–46, 47, 49, 50, 150–152. See also Smoothing labor market borders and payment areas

Comprehensive Primary Care Initiative, 117

Congress, recommendations for, 10–11, 139–140

Conrad-30 Programs, 111

Consumer Assessment of Healthcare Providers and Systems, 6, 51, 59–62, 136

Consumer satisfaction, 59–62, 60t, 100

Coordination of care, 7, 11, 19, 59, 114, 115, 117, 119

Core-based statistical areas

mapping Bureau of Labor Statistics data to, 146–147

outcomes of simulations based on Phase I recommendations, 4, 34, 37–38, 45–46, 50

smoothing methodology, 150–152, 151t

Cost of care

as barrier to access, 54

benefits of telehealth services, 81

care transitions, 117

geographic variation in practice input costs, 104, 107

health care labor markets as factor in, 18

hospital readmissions, 101

Medicare reimbursement reform initiatives, 131–132

Critical access hospitals, 10, 92–94, 92n, 139

Cross-subsidization, 23, 23n

D

Data sources

for commuting-based smoothing, 29b

for computation of hospital wage index in Phase I simulations, 155–156

for computation of physician payments in Phase I simulations, 159

for construction of geographic practice cost indexes, 34n, 35b

for construction of hospital wage index, 32b

on effectiveness of programs to improve access to care, 11, 140–141

Health Professional Shortage Areas, 3, 40

impact of Bureau of Labor Statistics data on Phase I simulations, 4, 27, 28f, 30–31, 49

quality of care, 6, 59–61

recommendations for health workforce data collection, 10–11, 139–141

recommendations from Phase I report, 1, 13, 24

study goals, 1

use of core-based statistical areas, 4, 34

on workforce supply and distribution, 7, 65–66, 118–119

Delivery of care

characteristics of well-functioning system, 52–53

determinants of quality in, 18, 19

health care labor markets as factor in, 18

reform initiatives to improve access and quality, 114–117, 131–132

study goals, 2b, 15b, 18

See also Access to care

Department of Health and Human Services, 1, 13, 103, 129–130

Disabilities, current Medicare coverage, 1, 13

Disparities

in access to care, 57, 129–130

in metropolitan and nonmetropolitan areas, 55–56, 63

in quality of care, 82, 102, 106

E

Electronic health records, 103–104

Emergency Health Personnel Act, 108

F

Florida, 45

Frontier states, 4, 5, 23n, 30, 31, 33b, 38–39, 43–44, 132

Future of Nursing, The, 82, 138–139

G

Geographic adjustment, generally

current Medicare system, 1, 13

effects on health care access and quality, 2–3, 5–6, 7, 14, 49, 51, 61–62, 82–83, 84, 104, 119, 125, 136

expected outcomes of Phase I recommendations, 2–5, 19–20

Medicare adjustments for hospitals in isolated areas, 92–96

Medicare fee schedule before, 126–127

recommendations from Phase I report, 24, 25b

study goals, 1, 13–14, 19

terminology, 15–17, 16b, 17b

value-based reimbursement and, 131–132

See also Geographic adjustment factors; Geographic practice cost indexes; Hospital wage index

Geographic adjustment factors

definition and computation, 35b

Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
×

effects on health workforce supply and distribution, 91–92

methodology for analysis of payment rate mediation of quality of care, 175–178, 181t

outcomes of simulations based on Phase I recommendations, 2–5, 6, 9, 19–20, 48–49b, 61–62, 168t

study goals, 2b, 14–15, 15b, 135

value-based reimbursement and, 131–132

See also Geographic adjustment, generally; Geographic practice cost indexes; Hospital wage index

Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, 1, 2–5, 13, 14, 135. See also Simulation of Phase I recommendations

Geographic practice cost indexes (GPCIs)

accuracy, 24

benefits index, 148–150, 149t

as budget-neutral in simulations, 24, 161–163

computation of, 34n, 35b, 44

effects of removing index floors, 38–39

effects on health care access and quality, 61

function, 35b

methodology for analysis of payment rate mediation of quality of care, 175–178, 181t

outcomes of simulations based on Phase I recommendations, 4–5, 23–27, 26f, 31–47, 36f, 50, 61–62, 125–126, 167f, 169–171t, 172t

payment areas, in simulation of Phase I recommendations, 150, 151t

in Phase I simulation methodology, 146, 159–160, 161

proxy professions in calculation of, 34n, 44

recommendations from Phase I report, 24, 25b, 26t

in shortage areas, 39–44, 41–44

smoothing adjustments, 37, 37n, 50

statewide versus nonstatewide payment localities, 37–38, 45

H

H-1B visa, 111

Health Care Workforce Commission, 118–119

Health Information Technology for Economic and Clinical Health, 104, 104n

Health Professional Shortage Areas

application, 39–40, 55, 83–84, 97

beneficiary population, 40–42, 41t, 55, 56f, 58f, 64, 84

definition, 3, 3n, 16–17, 17b, 55, 56b

determinants of practitioner location decisions, 64

health care access and quality in, 61

mapping methodology for Phase I simulations, 152–155, 156f, 156t, 157t

methodology for analysis of payment rate mediation of quality of care in, 175–178, 179t, 181t

methodology for designating, 56b

outcomes of simulations based on Phase I recommendations, 2–4, 5, 9, 20, 39–44, 41t, 50, 62, 125–126, 136–137, 170t

primary care bonus payment program in, 97–98, 119

shortcoming of, as data source, 3, 40

Surgical Incentive Payment, 98

See also Primary care bonus payment program

Health Resources and Services Administration, 92, 127

Health workforce supply and distribution

access to care and, 17, 18, 54–55, 66–67, 136

commuting between market areas, 4–5, 27, 29b

current programs to improve, 11, 119, 140–141

current status, 6–7, 64, 65f, 66–67, 91, 98–99

data sources, 7, 10, 65–66, 118, 119, 139–140

determinants of practitioner location decisions, 54–55, 64, 104–107

effects of geographic adjustment factors, 91–92

effects of Medicare’s national fee schedule, 126–127

expected outcomes of Phase I recommendations, 82–83

geographic distribution, 66, 67–74, 68f, 69f, 70f, 72f, 74f, 75f, 77f, 82

Medicare participation and, 6–7, 19

national targets, 117

need for government entity to oversee, 10–11, 118–119, 139–140

outcomes of programs and policies to improve, 7, 107–114, 136

policy considerations affecting, 117–118

practitioner population included in assessment of, 16, 17b

programs to encourage clinical practice in underserved areas, 96–100, 107–114

projections, 64, 66

quality of care and, 66–67, 136

recommendations for improving, 10–11, 139–141

research needs, 99–100, 113–114

scope of practice issues and, 8, 10, 81–82

strategies for improving, 8, 64, 65, 92

study goals, 2b, 14–15, 15b, 18, 19

telehealth credentialing, 80

HITECH Act, 104, 104n

Hospital Compare, 102

Hospital Consumer Assessment of Healthcare Providers and Systems, 100

Hospital Inpatient Quality Reporting Program, 100

Hospital readmissions, 78, 100–102

Hospital wage index

accuracy, 24

benefits index, 148–150, 149t

Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
×

as budget-neutral in simulations, 24, 161–163

computation of, 32–33b, 155–158, 160–161

fixed-weight index, 147–148, 148f

function, 32b

hospitals with special payment status, 10, 30–31, 32t, 33t, 139

location-based adjustments for special groups of hospitals, 10

outcomes of simulations based on Phase I recommendations, 4, 19–20, 23–31, 26f, 28f, 34t, 44–47, 48–50, 136

in Phase I simulation methodology, 146

recommendations from Phase I report, 24, 25b, 26t

year-to-year changes, 34t

Household income, 39, 171t

I

Idaho, 101

Illinois, 101

Immigration law, 111–112

Inpatient Prospective Payment System

hospitals with special payment status, 30–31, 32t, 33t, 139

impact of Phase I recommendations, 25, 27, 28f, 163–167f

Medicare adjustments for hospitals in isolated areas, 94–95

International medical students, 111–112

J

J-1 waiver program, 111–112

L

Labor markets

computation of geographic practice cost indexes, 35b

computation of hospital wage index, 32–33b

definition, 16b

statewide versus nonstatewide payment localities, 37–38

See also Health workforce supply and distribution; Smoothing labor market borders and payment areas

Licensure, professional, 8, 64–65, 71, 81–82, 107, 138

Loan forgiveness programs, 107, 108, 110–111, 113–114, 119

Louisiana, 101

Low-volume hospitals, 10, 92, 95, 96, 139

Lugar hospitals, 30

M

Maine, 56

Massachusetts, 46, 47, 56

Medical home concept, 114

Medicare

chronic conditions among beneficiaries of, 6, 19, 76–77

consumer satisfaction, 59–62, 60t, 100

coverage, 1, 13, 56–57

current access to care for beneficiaries of, 5–6, 7, 53–54, 82, 91

current health care workforce, 64

current quality of care in, 58–63

current spending, 1, 13, 78

delivery system reforms to promote access and quality, 114–117

fee setting policies, 126–127

geographic distribution of beneficiaries, 6n

influence on health workforce supply and distribution, 114, 126, 136

Part B services, 42, 54, 56–57, 82, 97–98

policies to maintain access to care, 92–96, 93–94t, 119

practitioner population, 6–7, 19, 57

programs to improve quality of care, 119 100–104

projected growth, 81

recommendations for improving access to services, 9–10, 137–139

reimbursement for nonphysician health professionals, 117–118

reimbursement reforms to improve access and quality, 91, 131–132

shared savings program, 115

subsidization of graduate medical education, 127–129

supplemental coverage, 54

telehealth services coverage, 78t, 79–81

See also Simulation of Phase I recommendations

Medicare Advantage, 54n

Medicare Cost Reports, 32b

Medicare-dependent hospitals, 10, 31, 92, 95, 139

Medicare Improvements for Patients and Providers Act, 6, 102

Medicare Modernization Act, 95

Medicare Payment Advisory Commission (MedPAC), 53–54, 127

Medigap, 54n

Metropolitan and nonmetropolitan areas

access to care, 55–56, 82

determinants of practitioner location decisions, 104–107

effects of Medicare’s national fee schedule on physician location decisions, 127

Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
×

in frontier states, 30

health workforce distribution, 64, 66, 67–69, 69f

methodology for analysis of payment rate mediation of quality of care, 175–178, 180t

outcomes of simulations based on Phase I recommendations, 4, 5, 27, 34–37, 38f, 39, 41–42, 44–47, 49, 50, 136, 163f, 165t, 167f, 169t, 170t

primary care billings, 127, 128f

quality of care variation between and within, 6, 63–64, 180t, 181t

statewide versus nonstatewide payment localities, 37

study goals, 2b, 15b, 18

workforce distribution and supply in, 6, 7, 15b

See also Rural areas

Micropolitan areas, 56, 63

Minnesota, 45, 56

N

National Health Care Workforce Commission, 10, 11, 139–140

National Health Disparities Report, 59

National Health Quality Report, 59

National Health Service Corps, 11, 108–110, 113, 127, 136, 140–141

National Healthcare Quality Report, 102

National Impact Assessment of Medicare Quality Measures, 103

National Institute for Minority Health and Health Disparities, 130

National Institutes of Health, 130

National Quality Strategy, 102–104

National Strategy for Quality Improvement in Health Care, 103

New England City and Town Areas, 146–147

New Hampshire, 73

New Jersey, 77–78, 101

North Dakota, 42, 43f

Nurse practitioners

current and projected supply, 66

in delivery system reforms to promote access and quality, 114, 115, 116

health care delivery role, 71, 84

Medicare payment policy, 117–118

minority population utilization of, 129

recommendations for scope of practice, 10, 138–139

scope of practice issues, 8, 10, 81–82, 83b

supply and geographic distribution, 71–73, 74f, 75f

training, 71

O

Ohio, 46

Oregon, 101

P

Patient Protection and Affordable Care Act. See Affordable Care Act

Payment policy

effectiveness of current programs to encourage practice in underserved areas, 107–114

effects on health care access and quality, 6, 8, 11, 18, 91

evidence of overpayment or underpayment, 23

to improve quality of care, 100–102, 116–117

influence on practitioner location decisions, 105–107

loan forgiveness programs, 107, 108, 110–111, 113–114

Medicare reimbursement reforms to improve access and quality, 131

Medicare’s fee setting policies, 126–127

methodology for analysis of payment rate mediation of quality of care, 175–178

programs to encourage clinical practice in underserved areas, 3–4, 96–98

recommendations from Phase I report, 24, 25b, 26t

reimbursement for nonphysician health professionals, 117–118

study goals, 2b, 8, 15b, 18, 19

value-based purchasing, 116–117, 131

See also Geographic adjustment, generally; Geographic practice cost indexes; Hospital wage index; Primary care bonus payment program

Pennsylvania, 47

Phase I. See Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy

Physician assistants, 66, 71, 73–74, 76f, 77f, 82, 114, 116, 117–118, 129

Physician Compare, 102

Physician education and training

influence on practice location decisions, 107–108, 112–113

shortcomings of data on, 118

subsidization of graduate medical education, 112–113, 126, 127–129

Physician Quality Reporting System, 102

Pioneer accountable care organizations, 115

Policy adjustments

cross-subsidization, 23, 23n

definition, 16b

recommendations from Phase I report, 24

rural floor adjustments as, 30

in simulations of Phase I recommendations, 4, 20, 24, 48

Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
×

Population health

effect of provider payment policies on, 92

racial and ethnic disparities, 126, 129–130

study goals, 2b, 14–15, 15b

Premier Hospital Quality Incentive Program, 103b

Primary care

in community health centers, 96–97

coordination of care in, 117

definition, 17, 17b, 53

influences on physicians’ career decisions, 107–108

outcomes of Phase I simulations by county percent of primary care relative value units, 172t

physician caseloads, 99

physician supply and geographic distribution, 7, 58f, 67–69, 70f, 73t, 99

practitioner earnings in, 106b

recommendations for improving access to, 9–10, 137–139

reimbursement for nonphysician health professionals, 117–118

scope of practice regulations, 10, 81–82, 84, 138–139

in a well-functioning health care system, 52–53, 84

Primary care bonus payment program

bonus, 42, 97–98

disbursement methodology, 39–41

disbursements to date, 98

effectiveness, 98, 119, 127

eligibility of health professionals for, 3–4, 16, 17, 98

geographic distribution, 40–42

to offset geographic practice cost index reductions, 42–43

recommendations for, 9, 137

See also Health Professional Shortage Areas

Public Health Service Act, 11, 107n, 127, 140

Puerto Rico, 47, 48b, 49b

Q

Quality of care

access to care and, 59

in community health centers, 96–97

current data collection and dissemination, 6

current system performance, 6, 58–64, 60t, 82

definition and measures of, 17b, 19, 20t, 51–52, 52t, 59–60, 100

delivery system reforms to improve, 114–117

determinants of, 132

effectiveness of incentive payment programs, 103b, 119

effects of geographic adjustment, 2–3, 6, 7, 14, 51, 61–62, 82–83, 84, 104, 119, 125, 136

expected outcomes of Phase I recommendations, 2–3, 6, 61–62, 125

in Health Professional Shortage Areas, 179t, 181t

health workforce supply and, 66–67, 136

hospital readmission rates, 78, 100–102

methodology for analysis of payment rate effects, 175–178

in metropolitan and nonmetropolitan areas, 6, 63–64, 180t, 181t

National Quality Strategy, 102–104

physician payment policy to improve, 102

regional variation in, 62–63

strategies for improving, 8, 100–104

study goals, 2b, 14–15, 15b, 51

underserved populations, 63, 82

value-based purchasing, 116–117

R

Racial and ethnic minorities

access to care, 2–3, 6, 53, 55–56, 57–58, 82, 83, 129

hospital readmission rates, 101–102

outcomes of Phase I recommendations for, 2–3, 129, 136–137, 171t

population health research, 126, 129–130

quality of care received by, 63, 82, 83

strategies to reduce health care disparities, 129–130, 130b

study goals, 2–3

utilization of nonphysician health professionals, 129

Recommendations

commuter smoothing, 29b

from Geographic Adjustment in Medicare Payment: Phase I, 1, 2–5, 13, 24, 25b, 135

hospitals with special payment status, 10, 139

to improve access to care, 9–10, 11, 137–139, 140–141

to improve workforce supply and distribution, 10–11, 139–140

See also Simulation of Phase I recommendations

Recruitment and retention of health care workforce

future challenges, 64

study goals, 2b, 15b

in underserved areas, effectiveness of programs to improve, 11, 107–114, 140–141

Registered nurses, 70, 72f

Relative value units, 4, 25–26, 35b, 127, 128f, 150

Rent costs, 24n, 35b, 145

Resource-based Relative Value Scale, 127

Rhode Island, 56

Rural areas

determinants of practitioner location decisions, 104–105, 107–108, 112

distribution of Medicare beneficiaries, 18n

health workforce supply, 64, 67, 68–69, 71, 73

Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
×

hospitals with special payment status, 10, 30–31, 33t, 139

Medicare payment policies for hospitals serving, 92–94

outcomes of programs to encourage practice in, 107–114

outcomes of simulations based on Phase I recommendations, 4–5, 27, 38, 38f, 39, 132, 171t

population distribution, 68

recommendations for improving access to care in, 9–10, 137–139

scope of practice issues for health care workforce in, 82

See also Metropolitan and nonmetropolitan areas

Rural floor adjustment, 4, 23n, 29–30, 33b, 45, 46–47, 49

Rural Health Care Pilot Program, 78–79

Rural referral centers, 4, 31, 49, 92, 95, 96

recommendations for, 10, 139

Rural–Urban Continuum Code, 39, 60–61, 62, 153, 176, 177, 178, 180t, 181t, 182t

S

Scope of practice issues, 8, 81–82, 83b, 138–139

Screening, 77–78

Shared savings, 115, 131

Shortage areas. See Health Professional Shortage Areas

Simulation of Phase I recommendations

access to care, 2–3, 6, 82–83, 136–137

aggregate geographic adjustment factors changes, 168t

budget neutrality in, 24, 161–163, 162t

distribution of effects across payment areas, 26–27

effects in counties by percent of primary care relative value units, 172t

examples of provider impact, 44–47

hospital adjustment status effects, 166t

hospital payment computations, 146, 155–158, 160–161

hospital payment outcomes, 4, 19–20, 23–31, 26f, 28f, 48–50, 125, 136

hospital size effects, 167t

hospitals with special payment status, 30–31, 32t, 33t

impact of Bureau of Labor Statistics data, 4, 27, 28f, 30–31, 49

Inpatient Prospective Payment System outcomes, 25, 27, 28f, 163–167f

key findings, 48–50

mapping of Health Professional Shortage Areas, 152–155, 156f, 156t, 157t

methodology, 23, 145–163

outcomes by household income, 171t

outcomes for frontier states, 4, 5, 38–39, 132

outcomes for racial and ethnic minorities, 2–3, 129, 136–137, 171t

outcomes in metropolitan and nonmetropolitan areas, 4–5, 27, 34–37, 38f, 39, 49, 50, 132, 136, 163f, 165t, 167f

outcomes in shortage areas, 2–4, 5, 9, 20, 39–44, 41t, 50, 62, 125–126, 132, 137

physician payment computations, 146, 159–160, 161

physician payment outcomes, 4–5, 23–27, 26f, 31–47, 36f, 50, 61–62, 125–126, 136, 167f, 169–171t, 172t

policy adjustments in, 4, 20, 24, 48

quality assurance and quality control in preparation of, 183–186, 186t

quality of care outcomes, 125

rural floor adjustments in, 4, 29–30, 46–47

scope of analysis, 24

smoothing labor market borders and payment areas in, 4–5, 27, 45–46, 47, 49, 50, 150–152, 151t, 152t, 153f, 154t

use of core-based statistical areas, 4, 34, 37–38, 45–46, 50

Smoothing labor market borders and payment areas

computation of geographic practice cost indexes, 34n, 37, 37n

computation of hospital wage index, 33b

methodology, 29b, 150–152, 151t, 152t, 153f, 154t, 157

outcomes of simulations based on Phase I recommendations, 4–5, 27–28, 37, 37n, 45–46, 47, 49, 50

recommendations, 29b

Social Security Act, 2b, 15b, 97

Sole community hospitals, 10, 31, 92, 94–95, 96, 139

Specialty medicine, access to

geographic variation in, 53–54, 66, 67, 99, 105, 114

for minority populations, 58, 82, 84

nurse practitioners and physician assistants and, 71, 72, 84

practitioner career decisions and, 104, 106b, 107–108, 112

recommendations for improving, 9–10, 137–138

telemedicine and, 75, 76, 84

trends, 69, 105

Subsidization of graduate medical education, 112–113, 126, 127–129

Surgeons, 69, 71f, 84, 98

Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
×

T

Telehealth technologies

credentialing of providers for, 80

current implementation, 8, 9–10, 74–75, 138

definition, 8, 9, 138

effectiveness, 8, 77–78

future prospects, 80–81

infrastructure, 78–79

Medicare payment provisions, 79–80, 81

recommendations for, 9–10, 84, 137–138

Transitional care, 114, 117

U

Underserved areas

influences on physicians’ career decisions, 107–108, 112–113

outcomes of programs to encourage clinical practice in, 7, 11, 108–114, 140–141

programs to encourage clinical practice in, 96–100

recommendations for improving access to care in, 9–10, 11, 137–138, 140–141

study goals, 135

underserved populations versus, 16–17

See also Health Professional Shortage Areas

Utah, 101

V

Value-based purchasing, 116–117, 131

Virginia, 47

W

Washington state, 74

West Virginia, 45

Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
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Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
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Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
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Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
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Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
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Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
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Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
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Suggested Citation:"Index." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase II: Implications for Access, Quality, and Efficiency. Washington, DC: The National Academies Press. doi: 10.17226/13420.
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Medicare, the world's single largest health insurance program, covers more than 47 million Americans. Although it is a national program, it adjusts payments to hospitals and health care practitioners according to the geographic location in which they provide service, acknowledging that the cost of doing business varies around the country. Under the adjustment systems, payments in high-cost areas are increased relative to the national average, and payments in low-cost areas are reduced.

In July 2010, the Department of Health and Human Services, which oversees Medicare, commissioned the IOM to conduct a two-part study to recommend corrections of inaccuracies and inequities in geographic adjustments to Medicare payments. The first report examined the data sources and methods used to adjust payments, and recommended a number of changes.

Geographic Adjustment in Medicare Payment - Phase II:Implications for Access, Quality, and Efficiency applies the first report's recommendations in order to determine their potential effect on Medicare payments to hospitals and clinical practitioners. This report also offers recommendations to improve access to efficient and appropriate levels of care. Geographic Adjustment in Medicare Payment - Phase II:Implications for Access, Quality, and Efficiency expresses the importance of ensuring the availability of a sufficient health care workforce to serve all beneficiaries, regardless of where they live.

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