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Suggested Citation:"Front Matter." 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.
×

GEOGRAPHIC ADJUSTMENT

IN MEDICARE PAYMENT

Phase II: Implications for Access, Quality, and Efficiency

Committee on Geographic Adjustment Factors in Medicare Payment

Board on Health Care Services

Margaret Edmunds, Frank A. Sloan, and A. Bruce Steinwald, Editors

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." 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.
×

THE NATIONAL ACADEMIES PRESS     500 Fifth Street, NW     Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. HHS P23320042509XI, Task Order No. HHS P23337012T between the National Academy of Sciences and the Centers for Medicare & Medicaid Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee on Geographic Adjustment Factors in Medicare Payment.

Geographic adjustment in Medicare payment. Phase II, Implications for access, quality, and efficiency / Committee on Geographic Adjustment Factors in Medicare Payment, Board on Health Care Services ; Margaret Edmunds and Frank A. Sloan, and A. Bruce Steinwald, editors.

      p. ; cm.

Implications for access, quality, and efficiency

Includes bibliographical references and index.

ISBN 978-0-309-25798-5 (pbk.) — ISBN 978-0-309-25799-2 (pdf)

I. Edmunds, Margaret. II. Sloan, Frank A. III. Steinwald, Bruce. IV. Title.

V. Title: Implications for access, quality, and efficiency.

[DNLM: 1. Medicare Part A—economics. 2. Medicare Part B—economics. 3. Fee-for-Service Plans—organization & administration—United States. 4. Professional Practice Location—economics—United States. WT 31]

368.4’20140973—dc23

2012040470

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Suggested citation: IOM (Institute of Medicine). 2012. Geographic adjustment in Medicare payment: Phase II: Implications for access, quality, and efficiency. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." 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.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

image

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." 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.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." 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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COMMITTEE ON GEOGRAPHIC ADJUSTMENT FACTORS IN MEDICARE PAYMENT

FRANK A. SLOAN (Chair), J. Alexander McMahon Professor of Health Policy and Management, Professor of Economics, Center for Health Policy, Duke University, Durham, NC

M. ROY WILSON (Vice-Chair), Chancellor Emeritus, University of Colorado Denver

JON B. CHRISTIANSON, Professor and James A. Hamilton Chair in Health Policy and Management, University of Minnesota School of Public Health, Minneapolis

STUART GUTERMAN, Vice President, Payment and System Reform, The Commonwealth Fund, Washington, DC

CARLOS R. JAÉN, Chair of Family and Community Medicine and Dr. John M. Smith, Jr. Endowed Professor, University of Texas Health Science Center at San Antonio

JACK KALBFLEISCH, Professor of Biostatistics and Statistics and Director, Kidney Epidemiology and Cost Center, University of Michigan School of Public Health, Ann Arbor

MARILYN MOON, Senior Vice President and Director, Health, American Institutes of Research, Washington, DC

CATHRYN NATION, Associate Vice President, Division of Health Sciences and Services, University of California Office of the President, Oakland

JOANNE M. POHL, Professor Emerita, Division of Health Promotion and Risk Reduction, University of Michigan School of Nursing, Ann Arbor

THOMAS C. RICKETTS III, Managing Director, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill

JANE E. SISK, Institute of Medicine Scholar-in-Residence, and Former Director, Division of Health Care Statistics, Centers for Disease Control and Prevention, National Center for Health Statistics, Washington, DC

A. BRUCE STEINWALD, Independent Consultant, Washington, DC

DAVID VLAHOV, Dean and Professor, School of Nursing, University of California, San Francisco

BARBARA O. WYNN, Senior Policy Analyst, RAND Corporation, Arlington, VA

ALAN M. ZASLAVSKY, Professor, Health Care Policy (Statistics), Harvard Medical School, Boston, MA

STEPHEN ZUCKERMAN, Senior Fellow, Health Policy Center, The Urban Institute, Washington, DC

RTI International Consultants

WALTER ADAMACHE, Research Economist

JUSTINE L.E. ALLPRESS, Research Geospatial Programmer/Analyst

KATHLEEN DALTON, RTI Project Director, Senior Health Policy Analyst

GREGORY C. POPE, Program Director, Health Care Financing and Payment Program

ELIZABETH SEELEY, Health Economist

NATHAN WEST, Health Services Analyst

ALTON WRIGHT, Public Health Analyst

Suggested Citation:"Front Matter." 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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IHS Global Insight Consultants

TIM DALL, IHS Project Director, Managing Director

PAUL GALLO, Project Staff

MIKE STORM, Project Staff

Study Staff

MARGARET EDMUNDS, Study Director

KATHLEEN HADDAD, Senior Program Officer (August 2010 to November 2011)

JENSEN JOSE, Research Associate (December 2011 to March 2012)

SERINA S. RECKLING, Research Associate (September 2010 to November 2011)

SARA SPIZZIRRI, Research Assistant (August 2010 to March 2012)

JOI D. WASHINGTON, Research Assistant (August 2011 to January 2012)

ASHLEY McWILLIAMS, Senior Program Assistant (August 2010 to August 2011)

ROGER C. HERDMAN, Director, Board on Health Care Services

Suggested Citation:"Front Matter." 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.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Robert Berenson, The Urban Institute

Karen Heller, Greater New York Hospital Association

Keith J. Mueller, University of Iowa

Joseph Newhouse, Harvard University

Robert Phillips, Robert Graham Center for Policy Studies in Family Medicine and Primary Care

Douglas Reding, Marshfield Clinic

William Scanlon, Independent Consultant

Susan M. Skillman, University of Washington

George Stamas, Bureau of Labor Statistics

David Torchiana, Massachusetts General Physicians Organization

Lance A. Waller, Emory University, Rollins School of Public Health

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by

Page viii Cite
Suggested Citation:"Front Matter." 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.
×

Harold Sox, American College of Physicians, and Charles E. Phelps, Rochester University. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." 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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Acknowledgments

The Committee on Geographic Adjustment Factors in Medicare Payment and the Institute of Medicine (IOM) study staff would like to thank the many individuals and organizations who generously contributed their time, knowledge, and expertise to this Phase II report.

The following individuals shared their expertise through invited presentations at the public session in September 2011: Cindy Bagwell, Vice President for Talent Acquisition, Geisinger Health System, Danville, PA; Blair Childs, Senior Vice President, Premier, Inc.; James Dickson, CEO, Copper Queen Community Hospital, Bisbee, Arizona; Kathy Duckett, Director of Clinical Programs, Partners Home Care, Boston, MA; Jennifer Grebenschikoff, President, The Physician Executive Leadership Center, Tampa, FL; Mark Miller, Executive Director, MedPAC, Washington, DC; Rachel Morgan, National Conference of State Legislatures, Washington, DC; and Anne Rosewarne, President, Michigan Health Council, Okemos, MI.

Several others provided valuable information and technical assistance. Phil Doyle, Laurie Salmon, and George Stamas of the Bureau of Labor Statistics met with committee members and staff and provided statistical consultations and data for the committee’s consideration. Others were instrumental in identifying speakers for the public session and in providing materials and information for the committee’s consideration: Alex Calgano of the Massachusetts Medical Society; Linda Fishman, Don May, and Joanna Kim of the American Hospital Association; Atul Grover of the American Association of Medical Colleges; Elizabeth McNeil of the California Medical Association; Brent Miller of Marshfield Clinic; Mark Miller, Jeffrey Stensland, Kevin Hayes, Cristina Boccutti, and Arielle Mir of MedPAC; Robert Phillips, Director of the Robert Graham Center: Policy Studies in Family Medicine and Primary Care; Edward Salsberg of the Health Resources and Services Administration; and Jan Towers, Health Policy Director of the American Academy of Nurse Practitioners.

Several congressional staff members also provided valuable background information for the study. They include professional staff members Nick Bath of the Senate Health, Energy, Labor and Pensions Committee; Celina Cunningham, Office of Congressman Jay Inslee; Jennifer Friedman and Geoff Gerhardt of the House Committee on Ways and Means, Subcommittee on

Suggested Citation:"Front Matter." 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.
×

Health; Heather Gasper, Office of Congressman Michael E. Capuano; Mike Goodman, Office of Congressman Bruce Braley; Tim Gronniger, House Committee on Energy and Commerce; Jenn Holcomb, Office of Congresswoman Betty McCollum; John Laufer, Office of Congressman Pierluisi; and Travis Robey, Office of Congressman Ron Kind.

The expertise of Jim Jensen, Executive Director of the Office of Congressional and Government Affairs, in facilitating communications with congressional staff and members is gratefully acknowledged.

Special thanks go to the staff at RTI International, whose statistical analyses and technical consultations were both integral and invaluable to the study: Kathleen Dalton, RTI Project Director; Greg Pope, Program Director; and team members Walter Adamache, Justine Allpress, Elizabeth Seeley, Nathan West, and Alton Wright.

Several members of the IOM staff offered their guidance and support to the study staff and committee, including Roger Herdman, Director of the Board on Health Care Services; Senior Program Officers Jill Eden, Robin Grant, and Cheryl Ulmer and Program Officers Meg McCoy and Rob Saunders. Assistance and project support from Chelsea Frakes, Jillian Laffrey, and Michael Park is also gratefully acknowledged. Harvey Fineberg, President, and Judith Salerno, the Leonard D. Schaeffer Executive Officer, also provided valuable advice at key stages of the study. The guidance of Porter Coggeshall, Executive Director of the Report Review Committee, was especially valuable throughout the report review process. The Study Director would like to thank Marton Cavani, Web Communications Manager; Laura Harbold DeStefano, Editorial Projects Manager; Diedtra Henderson, Office of Reports and Communications; Stephen Mautner, Executive Editor, The National Academies Press; Abbey Meltzer, Deputy Communications Director; Christine Stencel, Senior Media Relations Officer; and Lauren Tobias, Director of Communications, for their creative approaches to helping the staff plan for report dissemination.

The committee could not have accomplished its tasks without the leadership of the Study Director, Margo Edmunds, whose management skills and foresight were exemplary.

Finally, the committee and staff would like to thank the Centers for Medicare & Medicaid Services (CMS), whose funding made this study possible. We especially thank Jonathan Blum, Deputy CMS Administrator; Marc Hartstein, Acting Director, Hospital and Ambulatory Policy Group; and Judith Richter, Division of Acute Care.

Suggested Citation:"Front Matter." 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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Expanding Opportunities to Improve Access

Summary

Findings

References

4   PROGRAMS AND POLICIES TO IMPROVE ACCESS AND QUALITY OF CARE FOR BENEFICIARIES

Introduction

Medicare Payment Policies Intended to Maintain Access to Hospital Care

Programs That Encourage Clinical Practice in Underserved Areas

Current Programs to Improve Quality

Current Programs to Improve Workforce Supply and Access

Empirical Evidence on Effects of Public Policies to Improve Geographic Distribution of Health Care Practitioners

Delivery System Reform Initiatives to Promote Access and Quality of Care

Policy Considerations Affecting Workforce Distribution

Findings

References

5   OBSERVATIONS ON THE LARGER POLICY CONTEXT

Unintended Effects of Medicare Payment Policies

Disparities in Access to Care

Geographic Adjustment and Payment Reform

Conclusion

References

6   RECOMMENDATIONS

Conclusion

APPENDIXES

A-1  Technical Approach to Payment Simulations: IOM Committee Recommendations for Hospital Wage Index and Physician Geographic Adjustment Factors

A-2  Payment Simulations: Data Tables

B     Methods for the Analysis of Associations of Quality Measures with Payments in Chapter 3

C     Quality Assurance for RTI Payment Simulations

D     Public Session: Workforce, Access, and Innovation: Policy Levers for Geographic Adjustment in Medicare Payment

E      Exchange of Letters Between House of Representatives Quality Coalition and Committee Chair Frank Sloan

F      Committee and Staff Biographies

INDEX

Suggested Citation:"Front Matter." 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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Figures

2-1      Payment differences between IOM committee recommended adjusters and current CMS policy: Distribution across measures of service delivery

2-2       Distribution of payment effects of IOM committee recommendations on the hospital index

2-3       Distribution of payment effects of IOM committee recommendations on the GPCIs

2-4       Payment effects attributed to market redefinition, by county status and type of payment locality

2-5       Combined physician payment effects by Rural–Urban Continuum Code

2-6       Sample state map identifying payment impact and HPSA status by county

Tables

2-1       Summary of Institute of Medicine Committee Phase I Recommendations Included in the Payment Simulations

2-2       Differences in Payments by IPPS Hospital Reclassification

2-3       Differences in IPPS Payments by Special Rural Status

2-4       Percent Changes in the Medicare Hospital Wage Indexes: Year-to-Year Actual Changes Compared to Simulated Changes from IOM Committee Recommendations

2-5       Distribution of Counties and Beneficiaries Across Newly Constructed HPSA Categories

2-6       Combined Physician Payment Effects by Health Professional Shortage Area Status and Metropolitan Location

Chapter 3

Boxes

3-1       Health Professional Shortage Areas (HPSAs): History and Methodology

3-2       State Variations in Nurse Practitioners' Scope of Practice

Figures

3-1       County designations for nonmetropolitan primary care service shortage areas

3-2       HPSA county designations for metropolitan primary care service shortage areas

3-3       National occupational employment estimates, 2000–2010, for selected populations

3-4       Number of primary care professionals

3-5       Change in physicians per 100,000 population, 2004–2009

3-6       Distribution of primary care physicians among urban and nonurban areas

3-7       Change in primary care physicians per 100,000 population, 2004–2009

3-8       Change in general surgeons-to-population ratios

3-9       Registered nurses per 100,000 population, 2011

3-10     Rural per capita supply of nurse practitioners by state, 2010

Suggested Citation:"Front Matter." 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:"Front Matter." 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.
×

A-5       County Assignments by Region, Type of Payment Locality, and CBSA Market

A-6       County Smoothing Adjustments, by Type of Index

A-7       Commuter-based smoothing adjustments by Rural—Urban Continuum Code

A-8    IOM Committee’s Recommended Smoothing Adjustments Compared to Current Outmigration Adjustments Under “Section 505” and Related Reclassifications

A-9       Correlation of Adjusted ZIP Code-to-County Address Counts to Population and Beneficiary Statistics

A-10     Distribution of estimated proportion of county population in primary care shortage areas

A-11   Distribution of Counties, Part B Enrollees, and RVUs Billed by Primary Care Practitioners, by Revised HPSA County Status

A-12     Budget Neutrality Factors Imposed on IOM Committee Indexes

A-13     Distribution of payment impact across all IPPS hospitals

A-14     Estimated Change in IPPS Payments, Isolated by Type of IOM Committee Recommendation

A-15  Impact of IOM Committee Recommendations on IPPS Payment, by USDA Rural—Urban Continuum Code

A-16  Impact of IOM Committee Recommendations on IPPS Payment, by Census Division and Metropolitan Status

A-17   Impact of IOM Committee Recommendations on IPPS Payment, by Hospital Reclassification Status

A-18     Impact of IOM Committee Recommendations on IPPS Payment, by Special Rural Status

A-19     Impact of IOM Committee Recommendations on IPPS Payment, by Teaching and DSH Status

A-20     Impact of IOM Committee Recommendations on IPPS Payment, by Bed Size

A-21     Distribution of physician payment impact across all counties

A-22     Change in Aggregate Geographic Adjustment Factor, by Type of IOM Committee Recommendation

A-23     County Analysis of the Isolated Payment Effects from Redefining the GPCI Payment Areas

A-24   Physician Payment Impact of IOM Committee Recommendations, by USDA Rural—Urban Continuum Code

A-25   Physician Payment Impact of IOM Committee Recommendations, by Revised Health Professional Shortage Area Indicator

A-26    Physician Payment Impact of IOM Committee Recommendations, by County Ranking in Median Family Income

A-27     Physician Payment Impact of IOM Committee Recommendations, by County Ranking in Percent Non-White Population

A-28     Physician Payment Impact of IOM Committee Recommendations, by Rural County Population Density

A-29   Physician Payment Impact of IOM Committee Recommendations, by Percent of Total RVUs Accounted for by Primary Care Practitioners

A-30    Effect of Level of Physician Work GPCI on Estimated IOM Committee Payment Differences, for Counties Grouped by Revised Health Professional Shortage Area Indicators

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ACRONYMS

ACA Patient Protection and Affordable Care Act
ACS American Community Survey
AHEC Area Health Education Center
AHRQ Agency for Healthcare Research and Quality
AMA American Medical Association
ASC ambulatory surgical center

BLS

Bureau of Labor Statistics

BPC Bipartisan Policy Center

CAH

critical access hospital

CAHPS Consumer Assessments of Healthcare Providers and Systems
CBSA core-based statistical area
CHC community health center
CMI case-mix index
CMS Centers for Medicare & Medicaid Services
COGME Council on Graduate Medical Education
CPT Current Procedural Terminology
CRS Congressional Research Service
CSA combined statistical area
CTS Community Tracking Survey
CY calendar year

DoD

Department of Defense

DRG diagnosis-related group
DSH disproportionate share hospital
Suggested Citation:"Front Matter." 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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EHR electronic health record

FCC

Federal Communications Commission

FQHC Federally Qualified Health Center
FY fiscal year

GAF

geographic adjustment factor

GAO Government Accountability Office
GIS geographic information system
GME graduate medical education
GPCI geographic practice cost index
GSA General Services Administration

HCAHPS

Hospital Consumer Assessment of Healthcare Providers and Systems Survey

HCFA Health Care Financing Administration
HCPCS Healthcare Common Procedure Coding System
HHA home health agency
HHS Department of Health and Human Services
HIT health information technology
HITECH Health Information Technology for Economic and Clinical Health Act of 2009
HPSA Health Professional Shortage Area
HRR hospital referral region
HRSA Health Resources and Services Administration
HSA hospital service area
HSIP Healthcare Shortage Professional Area (HPSA) Surgical Incentive Payment
HUD Department of Housing and Urban Development
HWI hospital wage index

IME

indirect medical education

IMG international medical graduate
IOM Institute of Medicine
IPPS Inpatient Prospective Payment System
IRS Internal Revenue Service

KFF

Kaiser Family Foundation

LPN

licensed practical nurse

MDH

Medicare-dependent hospital

MedPAC Medicare Payment Advisory Commission
MEPS Medical Expenditure Panel Survey
MGCRB Medicare Geographic Classification Review Board
MGMA Medical Group Management Association
microSA micropolitan statistical areas
MIPPA Medicare Improvements for Patients and Providers Act
MMA Medicare Modernization Act of 2003
Suggested Citation:"Front Matter." 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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MP malpractice
MS-DRG Medicare severity diagnosis-related group
MSA metropolitan statistical area

NAICS

North American Industry Classification Systems

NCS National Compensation Survey
NHDR National Healthcare Disparities Report
NHQR National Healthcare Quality Report
NHSC National Health Service Corps
NP nurse practitioner
NPI National Provider Identifier

OBRA

Omnibus Budget Reconciliation Act of 1989

OES Occupational Employment Statistics
OIG Office of Inspector General
OMA occupational mix adjustment

PA

physician assistant

PCSA primary care service area
PE practice expense
PFS Physician Fee Schedule
PHS Public Health Service
PLI professional liability insurance
PPIS Physician Practice Information Survey
PPS prospective payment system
PQRS Physician Quality Reporting System
ProPAC Prospective Payment Advisory Commission

RBRVS

Resource-Based Relative Value Scale

RN registered nurse
RSE relative standard error
RRC rural referral center
RUCC Rural—Urban Continuum Code
RVU relative value unit

SCH

sole community hospital

SE standard error
SNF skilled nursing facility

UDS

Uniform Data Systems

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Suggested Citation:"Front Matter." 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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Page xvii Cite
Suggested Citation:"Front Matter." 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:"Front Matter." 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:"Front Matter." 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:"Front Matter." 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:"Front Matter." 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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Page xxii Cite
Suggested Citation:"Front Matter." 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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