Rural Health
Resources by Topic: Medicare
Medicare Accountable Care Organizations: Past Performance and Future Directions
Summarizes research findings about Medicare accountable care organizations (ACOs) from recent peer-reviewed journals, official evaluations of Medicare ACOs, and research organization reports. Describes characteristics of certain ACOs associated with greater savings and factors that limit ACOs' ability to achieve net budgetary savings for the Medicare program. Identifies policy approaches that could increase savings for Medicare through ACOs and the Medicare Shared Savings Program. Includes a brief discussion of challenges facing ACOs in rural and underserved areas.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Budget Office
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Summarizes research findings about Medicare accountable care organizations (ACOs) from recent peer-reviewed journals, official evaluations of Medicare ACOs, and research organization reports. Describes characteristics of certain ACOs associated with greater savings and factors that limit ACOs' ability to achieve net budgetary savings for the Medicare program. Identifies policy approaches that could increase savings for Medicare through ACOs and the Medicare Shared Savings Program. Includes a brief discussion of challenges facing ACOs in rural and underserved areas.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Budget Office
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Evaluation of the Maryland Total Cost of Care Model: Progress Report
Provides an overview of the Maryland Total Cost of Care Model and evaluates the first four years of the program, 2019-2022. Explores the effects of the model on Medicare spending; service use, including preventable hospital use; and healthcare quality measures. Estimates the potential impact of switching Maryland to the Medicare prospective payment system (PPS) on Medicare spending and service use, including implications for rural and safety net hospitals.
Additional links: Appendices, Findings at a Glance, Transformation Spotlight
Date: 04/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Provides an overview of the Maryland Total Cost of Care Model and evaluates the first four years of the program, 2019-2022. Explores the effects of the model on Medicare spending; service use, including preventable hospital use; and healthcare quality measures. Estimates the potential impact of switching Maryland to the Medicare prospective payment system (PPS) on Medicare spending and service use, including implications for rural and safety net hospitals.
Additional links: Appendices, Findings at a Glance, Transformation Spotlight
Date: 04/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Medicare Payment for Rural or Geographically Isolated Hospitals
Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Research Service
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Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Research Service
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Rural Emergency Hospital (REH) Model Frequently Asked Questions
Provides answers to frequently asked questions regarding the Rural Emergency Hospital (REH) designation. Covers general information, Conditions of Participation, and REH payment policies.
Date: 04/2024
Type: Document
Sponsoring organizations: Mathematica, Rural Health Redesign Center
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Provides answers to frequently asked questions regarding the Rural Emergency Hospital (REH) designation. Covers general information, Conditions of Participation, and REH payment policies.
Date: 04/2024
Type: Document
Sponsoring organizations: Mathematica, Rural Health Redesign Center
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Primary Care Spending in Medicare Fee-for-Service: An Illustrative Analysis Using Alternative Definitions of Primary Care
Discusses the importance of primary care to promote positive health outcomes and how reimbursement rates illustrate what healthcare areas are given priority. Utilizes Medicare fee-for-service data to estimate primary care spending and provides data breakdowns according to sex, race, age, insurance status, rural versus urban location, and more.
Date: 03/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Discusses the importance of primary care to promote positive health outcomes and how reimbursement rates illustrate what healthcare areas are given priority. Utilizes Medicare fee-for-service data to estimate primary care spending and provides data breakdowns according to sex, race, age, insurance status, rural versus urban location, and more.
Date: 03/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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A Lack of Behavioral Health Providers in Medicare and Medicaid Impedes Enrollees' Access to Care
Examines the availability of behavioral health providers who actively serve Medicare or Medicaid enrollees in 20 counties, 10 urban and 10 rural, across 10 states in 2021. Explores the extent to which traditional Medicare, Medicare Advantage, and Medicaid enrollees received behavioral health services and whether they used telehealth or in-person services. Offers recommendations to encourage more behavioral health providers to serve these enrollees and expand coverage to additional behavioral health provider types. Includes rural and urban comparisons throughout.
Additional links: Report Highlights
Date: 03/2024
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Examines the availability of behavioral health providers who actively serve Medicare or Medicaid enrollees in 20 counties, 10 urban and 10 rural, across 10 states in 2021. Explores the extent to which traditional Medicare, Medicare Advantage, and Medicaid enrollees received behavioral health services and whether they used telehealth or in-person services. Offers recommendations to encourage more behavioral health providers to serve these enrollees and expand coverage to additional behavioral health provider types. Includes rural and urban comparisons throughout.
Additional links: Report Highlights
Date: 03/2024
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Environmental Scan on Developing and Implementing Performance Measures for Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan regarding the development and implementation of population-based total cost of care (PB-TCOC) payment models. Describes types of performance measures used in value-based payment models and pay-for-reporting programs, data sources used for constructing performance measures, features of PB-TCOC models, challenges in developing and implementing performance measures and opportunities for Alternative Payment Models (APMs) and PB-TCOC models to address these challenges, trends in existing performance measures across several Center for Medicare and Medicaid Innovation (CMMI) models and Medicare value-based care programs, and more. Includes rural references and considerations throughout.
Date: 03/2024
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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Presents results of an environmental scan regarding the development and implementation of population-based total cost of care (PB-TCOC) payment models. Describes types of performance measures used in value-based payment models and pay-for-reporting programs, data sources used for constructing performance measures, features of PB-TCOC models, challenges in developing and implementing performance measures and opportunities for Alternative Payment Models (APMs) and PB-TCOC models to address these challenges, trends in existing performance measures across several Center for Medicare and Medicaid Innovation (CMMI) models and Medicare value-based care programs, and more. Includes rural references and considerations throughout.
Date: 03/2024
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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March 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2024 meeting. Covers proposed approaches and research topics related to evaluating rural hospital and clinician payment policies, an assessment of the completeness of Medicare Advantage (MA) encounter data and other sources of information about MA enrollees' healthcare utilization, a preliminary analysis of MA quality, the Acute Hospital Care at Home program, and Medicare inpatient psychiatric service trends and issues.
Additional links: Rural Hospital and Clinician Payment Policy: A Workplan for 2024–2025 - Presentation Slides
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2024 meeting. Covers proposed approaches and research topics related to evaluating rural hospital and clinician payment policies, an assessment of the completeness of Medicare Advantage (MA) encounter data and other sources of information about MA enrollees' healthcare utilization, a preliminary analysis of MA quality, the Acute Hospital Care at Home program, and Medicare inpatient psychiatric service trends and issues.
Additional links: Rural Hospital and Clinician Payment Policy: A Workplan for 2024–2025 - Presentation Slides
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Mandated Report: Rural Emergency Hospitals: Chapter 15
Provides an overview of the Rural Emergency Hospital (REH) designation. Discusses the evolution of Medicare's support for rural hospitals through payment policies and the impact of declining inpatient volumes on rural hospitals' financial sustainability. Describes the characteristics of hospitals that converted to REH status in 2023, the first year of the designation.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Provides an overview of the Rural Emergency Hospital (REH) designation. Discusses the evolution of Medicare's support for rural hospitals through payment policies and the impact of declining inpatient volumes on rural hospitals' financial sustainability. Describes the characteristics of hospitals that converted to REH status in 2023, the first year of the designation.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Skilled Nursing Facility Services: Chapter 6
Discusses payment adequacy for skilled nursing facility (SNF) services. Features statistics on SNF care provided by rural hospitals and Critical Access Hospitals (CAHs) via swing beds and Medicare margins for urban and rural freestanding SNFs in 2022.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Discusses payment adequacy for skilled nursing facility (SNF) services. Features statistics on SNF care provided by rural hospitals and Critical Access Hospitals (CAHs) via swing beds and Medicare margins for urban and rural freestanding SNFs in 2022.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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