Rural/Urban Disparities in the Utilization of Health and Behavioral Assessments/Interventions in the Fee-for-Service Medicare Population


It is recommended that primary care providers conduct Health and Behavioral Assessments and Interventions (HBAI) for many conditions, including poor diet, diabetes, obesity, cancer, and HIV. The benefits of HBAI in primary care can have a substantial impact on patient outcomes.

The objective of this study was to further investigate geographic disparities and identify the availability of HBAI services in rural and urban communities by examining fee-for service (FFS) Medicare beneficiaries. The 2012-2016 Medicare provider data were extracted, and Current Procedural Terminology codes were used to determine the number of hours of HBAI services provided, the number of healthcare providers administering the service, and the number of beneficiaries served by each provider. Provider services and beneficiaries were then aggregated at the county level. Rural-Urban Continuum Codes were used to assign counties to rural versus urban designations.

The findings suggest availability of HBAI services for FFS Medicare members is declining both in rural and urban settings, as fewer physicians are billing for HBAI and those who are bill fewer hours for fewer patients. This decline appears to be occurring more quickly in rural than urban areas. Services are concentrated around cities in the eastern U.S., and they are notably completely absent from several states in the Midwest. These findings suggest a significant difference between rural and urban availability of health and behavioral assessments and interventions, but they also show a decline in overall availability.

Rural and Underserved Health Research Center
Christian Rhudy, Eugene Shin, Jeffery Talbert