Medicare Payment and Cost Sharing for Rural Beneficiaries at FQHCs and RHCs

Purpose: Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are similar in mission, services provided, and common patient diagnoses, but have different payment policies under Medicare. The purpose of this study is to investigate how Medicare payment and patient cost sharing differ among FQHCs and RHCs. Methods: The study included all 2014 claims generated at FQHCs and RHCs by rural Medicare beneficiaries. Multivariate linear regression was used to estimate the effect of facility type on Medicare payment and cost sharing, controlling for various facility, geographic, and community factors.Findings: The average Medicare payment across all FQHCs and RHCs was $119 per claim. Compared to rural FQHCs, Medicare payment per claim was $39.95 higher at provider-based RHCs with ≤ 49 beds, $11.83 lower at provider-based RHCs with ≥ 50 beds, and $22.32 lower at independent RHCs. The average cost sharing across all FQHCs and RHCs was $32 per claim. Compared to rural FQHCs, cost sharing per claim was $18.59 higher at provider-based RHCs with ≥ 50 beds, $15.03 higher at provider-based RHCs with ≤ 49 beds, and $12.96 higher at independent RHCs.Conclusion: Medicare payment and patient cost sharing differed significantly among types of FQHCs and RHCs. The results suggest that there may be a need to assess 1) whether the exemption from the Medicare payment limit for provider-based RHCs with ≤ 49 beds is achieving the policy objective, and 2) whether rural Medicare beneficiaries without access to a rural FQHC are disadvantaged (due to higher cost sharing amounts).Bachelor of Science in Public Healt