Rural Health
Resources by Topic: Medicare
CMS Office of Minority Health: Health Equity Data Book
Provides data on disparities in participation in Centers for Medicare & Medicaid Services (CMS) programs, including data on demographics of covered individuals, chronic conditions, behavioral health conditions, and social determinants of health. Contains rural data for select programs.
Date: 12/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides data on disparities in participation in Centers for Medicare & Medicaid Services (CMS) programs, including data on demographics of covered individuals, chronic conditions, behavioral health conditions, and social determinants of health. Contains rural data for select programs.
Date: 12/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Could save Billions with Comparable Access for Enrollees If Critical Access Hospital Payments for Swing-Bed Services Were Similar to Those of the Fee-for-Service Prospective Payment System
Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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December 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; and Mandated Report on Rural Emergency Hospitals - Presentation Slides, Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services - Presentation Slides
Date: 12/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; and Mandated Report on Rural Emergency Hospitals - Presentation Slides, Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services - Presentation Slides
Date: 12/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Estimating the Effects of the Medicare $2 Drug List on Part D Enrollees
Discusses the Medicare $2 Drug List (M2DL) Model, which would allow Medicare Part D enrollees to purchase monthly drugs for $2 or less. Provides projected financial impact of the model, such as out of pocket (OOP) costs for individual drugs as well as OOP changes for enrollees, with breakdowns by demographic variables, including urban, rural-micropolitan, rural-other, or unclassified location.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Discusses the Medicare $2 Drug List (M2DL) Model, which would allow Medicare Part D enrollees to purchase monthly drugs for $2 or less. Provides projected financial impact of the model, such as out of pocket (OOP) costs for individual drugs as well as OOP changes for enrollees, with breakdowns by demographic variables, including urban, rural-micropolitan, rural-other, or unclassified location.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Hospital Margins Rebounded in 2023, But Rural Hospitals and Those With High Medicaid Shares Were Struggling More Than Others
Examines hospital margins for non-federal general short-term hospitals in the U.S. from 2018 through 2023, with a focus on operating margins. Analyzes RAND Hospital Data to explore the extent to which hospitals profited or lost money on patient care and other operating activities. Discusses differences in operating margins by hospital characteristics, including hospital ownership type, commercial share, size, rural or urban location, and Medicare rural payment designation.
Date: 12/2024
Sponsoring organization: KFF
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Examines hospital margins for non-federal general short-term hospitals in the U.S. from 2018 through 2023, with a focus on operating margins. Analyzes RAND Hospital Data to explore the extent to which hospitals profited or lost money on patient care and other operating activities. Discusses differences in operating margins by hospital characteristics, including hospital ownership type, commercial share, size, rural or urban location, and Medicare rural payment designation.
Date: 12/2024
Sponsoring organization: KFF
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Critical Access Hospital Financial Sustainability Guide
Provides guidance and assistance to state Medicare Rural Hospital Flexibility (Flex) Program personnel, leaders of Critical Access Hospitals (CAHs), and others helping CAHs manage long-term financial stability. Presents potential interventions CAHs may use to address ongoing and systemic financial challenges in rural healthcare.
Date: 12/2024
Sponsoring organizations: EideBailly, National Rural Health Resource Center
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Provides guidance and assistance to state Medicare Rural Hospital Flexibility (Flex) Program personnel, leaders of Critical Access Hospitals (CAHs), and others helping CAHs manage long-term financial stability. Presents potential interventions CAHs may use to address ongoing and systemic financial challenges in rural healthcare.
Date: 12/2024
Sponsoring organizations: EideBailly, National Rural Health Resource Center
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Center for Medicare and Medicaid Innovation: 2024 Report to Congress
Reports to Congress on payment and service delivery models and initiatives tested or announced by the Center for Medicare and Medicaid Innovation between October 2022 and September 2024. Includes summaries and updates on multiple rural-relevant models and initiatives, including the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the Transforming Maternal Health Model, the Pennsylvania Rural Health Model (PARHM), the Vermont All-Payer Accountable Care Organization Model, and more.
Date: 12/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
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Reports to Congress on payment and service delivery models and initiatives tested or announced by the Center for Medicare and Medicaid Innovation between October 2022 and September 2024. Includes summaries and updates on multiple rural-relevant models and initiatives, including the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the Transforming Maternal Health Model, the Pennsylvania Rural Health Model (PARHM), the Vermont All-Payer Accountable Care Organization Model, and more.
Date: 12/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
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Calendar Year (CY) 2015 Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) Updates: Payment Rate Increases for RHCs and FQHCs Billing Under the All-Inclusive Rate System (AIR), and Urban and Rural Designations for FQHCs Billing Under the AIR
Provides updates for RHCs and FQHCs that are submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.
Date: 12/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides updates for RHCs and FQHCs that are submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.
Date: 12/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Primary Care Collaborative 2024 Evidence Report: An Evaluation of Primary Care in Medicare Accountable Care Organizations
Examines the role of primary care in Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP), and includes 3 case studies of MSSP ACOs that are primary care centric. Explores how the performance of ACOs may be affected by serving beneficiaries with high economic and social need. Mentions rural throughout.
Author(s): Ann Greiner, David Muhlestein, Ann Kempski, Melissa K. Fillippi, Alison N. Huffstetler
Date: 11/2024
Sponsoring organizations: Primary Care Collaborative, Robert Graham Center, Simple Healthcare
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Examines the role of primary care in Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP), and includes 3 case studies of MSSP ACOs that are primary care centric. Explores how the performance of ACOs may be affected by serving beneficiaries with high economic and social need. Mentions rural throughout.
Author(s): Ann Greiner, David Muhlestein, Ann Kempski, Melissa K. Fillippi, Alison N. Huffstetler
Date: 11/2024
Sponsoring organizations: Primary Care Collaborative, Robert Graham Center, Simple Healthcare
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Federally Qualified Health Centers and Performance of Medicare Accountable Care Organizations
Explores the association between participation of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in Medicare Shared Savings Program Accountable Care Organizations (ACOs) with ACOs' beneficiary characteristics, utilization, expenditure, and quality. Features statistics including estimated changes in Medicare Shared Savings Program ACO-assigned beneficiaries, utilization, and expenditure, with breakdowns by FQHC and RHC visits and other types of visits.
Author(s): Kun Li, Yucheng Hou, Frank McStay, Jonathan Gonzalez-Smith, Robert S. Saunders
Citation: JAMA Network Open, 7(11), e2445536
Date: 11/2024
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Explores the association between participation of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in Medicare Shared Savings Program Accountable Care Organizations (ACOs) with ACOs' beneficiary characteristics, utilization, expenditure, and quality. Features statistics including estimated changes in Medicare Shared Savings Program ACO-assigned beneficiaries, utilization, and expenditure, with breakdowns by FQHC and RHC visits and other types of visits.
Author(s): Kun Li, Yucheng Hou, Frank McStay, Jonathan Gonzalez-Smith, Robert S. Saunders
Citation: JAMA Network Open, 7(11), e2445536
Date: 11/2024
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