Healthcare in Tooele County brings in a fair sum of Medicare payments, but lags significantly behind more urban Utah counties, according to numbers released this month from the Medicare Part B claims database.
Local doctors received roughly $2.79 million in reimbursements from Medicare Part B, essentially a federally-run medical insurance program for the elderly, those with disabilities, and those with chronic conditions such as permanent kidney failure.
The program is intended to offset the high costs of medical care for these populations. But analyses by the New York Times, the Associated Press, and other media organizations have found that reimbursements from the program are not distributed equally among the nation’s doctors — or their patients.
The database, which is hosted by the New York Times, lists the 2012 Medicare Part B reimbursements received by more than 800,000 nation-wide medical providers. The database includes details on what providers received for check-ups, tests, treatments and procedures, but patient’s names and specific details are omitted.
Providers who received reimbursements for less than 11 procedures were also omitted from the database to protect patient privacy.
Tooele’s county-wide $2.79 million Medicare reimbursement is relatively high for a rural Utah county. Payments in Box Elder County, which is generally considered the most demographically similar to Tooele, totaled $2.05 million.
In smaller, more rural counties, the difference is even greater — Iron County brought in just under $1 million in Medicare payments, and Summit County less than half a million.
But Tooele received significantly fewer Medicare reimbursements than even the smallest urban counties. Cache County’s reimbursements totaled nearly $9.22 million, and Washington County brought in $32.87 million.
Though population and the number of available health care providers contributed to the difference, Michelle McOmbre, CEO for the Utah Medical Association, said there were also numerous other factors at play.
“I don’t think the numbers tell the full story,” she said. “The problem is, we don’t know all the factors [that go in to determining a Medicare payment]. Even we don’t have all the tools needed to break down the data.”
Given what factors are known about Medicare reimbursement — such as population size and age, the cost of different kinds of medical care and various prescriptions, and other considerations — McOmbre said the different reimbursement totals across rural and urban areas are realities of the modern health care system.
Population is by far the most obvious factor, McOmbre said. But the data shows that the correlation between county population and the county’s reimbursement total is not direct. That is, urban counties did not receive more Medicare reimbursements simply because their larger population base resulted in more patients for urban health care providers.
When averaged across the county’s population as of the 2010 U.S. Census, Tooele County medical providers received the equivalent of $47.84 per Tooele County resident. On the other hand, Washington County medical providers received the equivalent of $237.98 per resident, and Cache County received $81.82 per resident.
At the other end of the spectrum, Summit County received $13.21 per resident, and Iron County received $21.64 per resident. Box Elder, Tooele’s closest analog, received $41.10 per resident.
Commuting for health care is one of the largest factors responsible for that difference, McOmbre said, especially in a community like Tooele, which, because of its proximity to Salt Lake, is not as self-contained as communities in Cache or Washington counties.
In her experience, she said, people will commute for care if they believe a provider within 100 miles of their home is more desirable than local providers. This disrupts the balance of reimbursements across counties, because Tooele County residents may commute to become Salt Lake County patients, thereby bringing in Medicare reimbursements in urban, rather than rural, areas.
Additionally, rural areas tend to have fewer providers, and less specialized providers, than urban areas, where the larger population base allows for a greater number and diversity of health care facilities, McOmbre said. The lower number of providers in rural areas not only decreases the amount of Medicare funding that may come in to an area, but may also impact the number of patients who can be served locally.
When rural practices’ more meager resources become spread too thin, she said Medicare patients were among the first to be told the practice could not take on any new customers.
“The thing I will say, in general, about rural areas is that there does tend to be fewer providers,” said McOmbre. “There are things that are being worked on, but in general they tend to have fewer providers.”
The availability of different types of specialists was also a key factor, McOmbre said, because both larger and more specialized facilities have different kinds of costs and bill Medicare in different ways.
The impact of specialized care was visible within the released Medicare data, where the most highly-reimbursed medical specialties were notably absent from rural areas. For example, the most highly-reimbursed provider in Tooele, an internist, received roughly $309,000 from Medicare in 2012. But the most reimbursed providers in Washington County — most of them radiation oncologists — each received more than $1 million from Medicare.
Specialists, as well as doctors at large facilities rated to admit more critical patients, tend to receive more reimbursement from Medicare on account of the increased expenses necessary to their services, said Scott Horne, manager of health policy and information systems for the Utah Department of Health.
“The assumption is, the rural doctors are seeing a less complex patient,” he said “That wouldn’t be atypical, to see dollars go the way of doctors who treat more complex patients.”
However, when you take into account the added expenses of treating more complex medical needs, “it’s not really a big win,” Horne said.
Both Horne and McOmbre said the additional expenses that come with specialized medical care were a significant barrier that prevented these practices from operating in rural areas, where the smaller population base does not support more costly medical services.
“It’s hard for these rural areas,” said Horne. “These physicians, they’re hard to afford, because you don’t get that patient load.”