Rural Health Research Gateway

A. Clinton MacKinney, MD, MS

Phone: 320.363.8150
E-mail: clintmack@cloudnet.com

Center for Rural Health Policy Analysis
RUPRI (see also University of Nebraska RUPRI)

Completed Projects

Rural-Urban Physician Payment Differences Across the Nation: Methodological Changes, Lead researcher
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicare, Physicians, Workforce
This project will simulate the effects of changes to the methodologies used to calculate the three geographic practice cost indices (GPCIs) currently used to adjust physician payment across the 89 Medicare payment areas in the U.S. and territories. Changes to the payment formula will be analyzed to determine potential impact on payment across areas and revenues for rural physician practices.

Publications

  • Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
    Author(s): Anthony Wellever, Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health care financing, Legislation and regulation, Medicare Prospective Payment System (PPS), Medicare Wage Index
    Date: 08 / 2000
    This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
  • Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
    Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Legislation and regulation, Medicare, Pharmacy and prescription drugs
    Date: 01 / 2003
    This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
  • Care Across the Continuum: Access to Health Care Services in Rural America
    Author(s): Keith J. Mueller, A. Clinton MacKinney
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topic: Health services
    Citation: Journal of Rural Health, 22(1), 43-49
    Date: 2006
    Proposes a continuum of care that serves as a framework with which to assess public and private policies designed to ensure that rural residents receive appropriate health care services, in a timely manner, and in a place that optimizes care effectiveness. Community leaders and policymakers can use this health care continuum as a design framework to help reduce system complexity and implement a patient- and community-focused, rather than provider-focused, health care system. The article is divided into 3 sections: 1) basic principles that determine services to be included in the continuum and how success in providing those services is judged; 2) definition of the continuum and its basic stages based on the health systems research literature; 3) applications of the continuum and policy implications of the framework.
  • Care Across the Continuum: Access to Health Care Services in Rural America
    Author(s): Keith J. Mueller, A. Clinton MacKinney
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topic: Health services
    Report Number: Working Policy Paper P2003-10
    Date: 12 / 2003
    Proposes that a continuum of care serve as the framework with which to consider rural health care policies, focusing on people and on places where people live rather than on the wants of providers and constituencies. The continuum of care describes the breadth of health care services in seven stages, from personal behavior to palliative care. The framework helps establish which health care services should be provided locally and which provided at a distance, emphasizing seamless linkages between all stages of the continuum.
  • Comments on the June 2001 Report of the Medicare Payment Advisory Commission: Medicare in Rural America
    Author(s): Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health policy, Medicare
    Date: 09 / 2001
    Comments on and critiques the findings in MedPAC's Medicare in Rural America. The authors believe that while the MedPAC report helps set a framework for analysis, it is not a definitive treatise on the role of Medicare in rural health. Among its findings: most of MedPAC's recommendations would have positive impacts on health care for rural beneficiaries, others would do no harm, others could be strengthened, and a few, particularly those relating to access to services, "suffer from disparities and weaknesses." Report produced by the RUPRI Rural Health Panel.
  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Author(s): Andrew F. Coburn, Erika C. Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
    Date: 08 / 2000
    The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    Author(s): Andrew F. Coburn, Erika Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Legislation and regulation, Pharmacy and prescription drugs
    Date: 06 / 2000
    This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Medicare Physician Payment
    Author(s): A. Clinton MacKinney, Michael D. Shambaugh-Miller, Keith Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Date: 01 / 2003
    Resource-Based Relative Value Scale (RBRVS) has replaced the 25 year-old Medicare CPR charge system.
  • Medicare Physician Payment Policy and the Rural Perspective (Final Report)
    Author(s): A. Clinton MacKinney, Keith J. Mueller, Timothy D. McBride
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topic: Medicare
    Date: 11 / 2008
    During the past six years, the RUPRI Center has examined the effects of Medicare payment changes on rural physician practice revenue. Despite the apparently tenuous association between Medicare physician payment policy and physician practice decision making, we infer that changes to practice revenue potentially affect physician decisions regarding rural practice. This report presents the results of the RUPRI Center's work and provides a framework for understanding this continuing policy question.
  • Medicare Physician Payment: Impacts of Changes on Rural Physicians
    Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Report Number: Rural Policy Brief Vol. 11, No. 2 (PB2006-2 )
    Date: 09 / 2006
    Overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Discusses the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense and the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
  • Medicare Physician Payment: Practice Expense
    Author(s): A. Clinton MacKinney, Timothy D. McBride, Michael D. Shambaugh-Miller, Keith J. Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Report Number: Rural Policy Brief Vol. 8, No. 9 (PB2003-9)
    Date: 10 / 2003
    Examines the physician practice expense component of Medicare payment, which proportionately results in greater geographic physician payment variation than does the physician work payment. The practice expense adjustment methodology warrants careful validation to demonstrate that the index measures actual geographic practice cost differences. A complete understanding of the reasons for different payments will inform both physicians who want to know why the same procedure results in less reimbursement in one place than it does in another and policymakers who want to address that concern.
  • Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
    Author(s): Andrew F. Coburn, Charles W. Fluharty, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health policy, Medicare
    Report Number: Special Monograph
    Date: 02 / 2001
    Provides a framework to help shape proposals to redesign Medicare to the benefit of rural beneficiaries and providers. Chapters focus on equity, quality, choice, access, and cost. Each chapter outlines the current situation, analyzes the implications of various approaches to changing the program, and makes recommendations for developing a Medicare program of greatest benefit to rural residents. Report produced by the RUPRI Rural Health Panel.
  • Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
    Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health policy, Medicare
    Date: 08 / 2000
    With this paper, the RUPRI Rural Health Panel is presenting a well-defined framework for what should be included in any discussion of Medicare policies.
  • Rural Assessment of Leading Proposals to Redesign the Medicare Program
    Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Health policy, Medicare
    Date: 05 / 2000
    This Policy Paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" (S. 1895, introduced by Senator Breaux and others) and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed, specifically how they affect rural Medicare beneficiaries and rural providers of health care services. Report produced by the RUPRI Rural Health Panel.
  • Rural Physicians' Acceptance Of New Medicare Patients
    Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride, Jane L. Meza, Liyan Xu
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Report Number: Rural Policy Brief Vol. 9, No. 5 (PB2004-5 )
    Date: 08 / 2004
    Findings from analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians indicate that: 1) The trend among all physicians is to not accept new Medicare patients, 2) The percentage of physicians in both urban and rural areas who are accepting new Medicare patients is declining, 3) Physicians practicing in rural areas not adjacent to urban areas are the most likely to accept new Medicare patients, and 4) Findings also indicate that the negative implications of not taking the necessary steps to reverse the small but important decline in physician willingness to take new Medicare patients may be most serious in rural communities.
  • Rural Primary Care Physician Payment 2006–2009: What a Difference Three Years Doesn’t Make
    Author(s): A. Clinton MacKinney, Keith J. Mueller, Mary Charlton
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Report Number: 2009-12
    Date: 11 / 2009
    The analysis in this brief shows the impact of Medicare's Evaluation and Management (E&M) service valuation adjustment (implemented January 1, 2007) on two prototypical primary care practices--one providing only E&M services and the other providing a mix of procedures and E&M services.
  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary K. Wakefield
    Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
    Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs
    Citation: Journal of Rural Health, 21(3), 194-197
    Date: 2005
    The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that congressional staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects.

This web site includes content provided by and adapted from the Maine Rural Health Research Center, University of Southern Maine under a Cooperative Agreement with the University of North Dakota.