Serving rural Medicare beneficiaries

required that the Commission report on: • rural Medicare beneficiaries' access to care, • rural providers' quality of care, • special rural Medicare payments, and • the adequacy of Medicare payments to rural providers. In addition to the findings presented on each of the four topics, this report presents a set of principles designed to guide expectations and policies with respect to rural access, quality, and payments for all sectors. By consistently following this set of principles, Medicare policy can be refined to more efficiently provide access to high-quality care for rural beneficiaries. In brief, with respect to access, we find large differences in health care service use across regions but little difference between rural and urban beneficiaries' service use within regions. Rural service use is high in regions where urban use is high, and it is low in regions where urban use is low. Beneficiary satisfaction with access is also similar in rural and urban areas. With respect to quality of care, quality is similar for most types of providers in rural and urban areas; however, rural hospitals tend to have below average rankings on mortality and some process measures. Beneficiaries' satisfaction with quality of care is similar in rural and urban areas. With respect to payment, In this chapter • Background information on rural Medicare beneficiaries • Access to health services by rural Medicare beneficiaries • Rural volumes of care are similar to urban volumes of care, but large regional differences exist • Quality of care in rural areas • Payment adequacy and special rural payment adjustments rural Medicare payments are adequate, in part due to implementation of certain increases in rural hospital payments that followed from recommendations in the Commission's 2001 report on rural health care. Because of higher prospective payment rates and enactment of the critical access hospital (CAH) program, the number of rural hospital closures has declined dramatically in recent years. However, some rural special payments go beyond the Commission's recommendations and are not consistent with the set of payment principles we establish in this paper. Our evaluation of rural health care in America started with a multimethod approach to data collection. We made several site visits to gain the perspectives of Medicare beneficiaries and individuals who deliver health care in several rural areas. We examined information from a series of beneficiary surveys, including the Commission's national telephone survey of Medicare beneficiaries, the Medicare Current …