Rural Health
Resources by Topic: Reimbursement and payment models
FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule – CMS-1808-F
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2023
Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Describes changes in the quality of care during the first four years of the demonstration for states with available quality measures, as well as quality bonus payments states made to CCBHCs based on quality measure performance. Builds on findings on demonstration implementation, quality improvement, and costs outlined in previous evaluation reports, focusing on data collected since spring 2022.
Date: 07/2024
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica, RAND Corporation
view details
Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Describes changes in the quality of care during the first four years of the demonstration for states with available quality measures, as well as quality bonus payments states made to CCBHCs based on quality measure performance. Builds on findings on demonstration implementation, quality improvement, and costs outlined in previous evaluation reports, focusing on data collected since spring 2022.
Date: 07/2024
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica, RAND Corporation
view details
Rural Community Health Worker Programs: Proving Value and Finding Sustainability
Features four rural healthcare organizations describing the impact of their community health worker (CHW) programs and strategies for sustaining them. Discusses CHW roles, activities, reimbursement options, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 07/2024
Sponsoring organization: Rural Health Information Hub
view details
Features four rural healthcare organizations describing the impact of their community health worker (CHW) programs and strategies for sustaining them. Discusses CHW roles, activities, reimbursement options, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 07/2024
Sponsoring organization: Rural Health Information Hub
view details
The Low-Volume Hospital Adjustment Before and During COVID-19
Describes characteristics of rural low-volume hospitals (LVHs) between April 2018 and March 2022. Compares the characteristics and profitability of rural LVHs with other rural prospective payment system (PPS) hospitals before and during the COVID-19 pandemic. Presents data on LVH profitability margins with and without the LVH payment adjustment.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George Pink
Date: 07/2024
Sponsoring organization: North Carolina Rural Health Research Program
view details
Describes characteristics of rural low-volume hospitals (LVHs) between April 2018 and March 2022. Compares the characteristics and profitability of rural LVHs with other rural prospective payment system (PPS) hospitals before and during the COVID-19 pandemic. Presents data on LVH profitability margins with and without the LVH payment adjustment.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George Pink
Date: 07/2024
Sponsoring organization: North Carolina Rural Health Research Program
view details
Why Primary Care Practitioners Aren't Joining Value-Based Payment Models: Reasons and Potential Solutions
Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Sponsoring organization: Commonwealth Fund
view details
Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Sponsoring organization: Commonwealth Fund
view details
MedPAC Data Book: Health Care Spending and the Medicare Program, 2024
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures.
Date: 07/2024
Sponsoring organization: Medicare Payment Advisory Commission
view details
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures.
Date: 07/2024
Sponsoring organization: Medicare Payment Advisory Commission
view details
Positioning Telehealth Policy to Ensure High-Quality, Cost-Effective Care
Presents policy recommendations and suggestions to guide policymakers when considering the future of telehealth. Analyzes peer-reviewed research; government reports; and findings from interviews with payers, providers, provider associations, federal agencies, consumer advocates, technology leaders, policy experts, and other stakeholders. Includes rural references and considerations throughout.
Author(s): Maya Sandalow, Julia Harris, Mikayla Curtis, Marilyn Werber Serafini
Date: 07/2024
Sponsoring organization: Bipartisan Policy Center
view details
Presents policy recommendations and suggestions to guide policymakers when considering the future of telehealth. Analyzes peer-reviewed research; government reports; and findings from interviews with payers, providers, provider associations, federal agencies, consumer advocates, technology leaders, policy experts, and other stakeholders. Includes rural references and considerations throughout.
Author(s): Maya Sandalow, Julia Harris, Mikayla Curtis, Marilyn Werber Serafini
Date: 07/2024
Sponsoring organization: Bipartisan Policy Center
view details
How Payment Caps Can Reduce Hospital Prices and Spending: Lessons from the Oregon State Employee Plan
Report discusses how policy changes to state employee insurance plans affected healthcare costs in Oregon. Details Oregon's plan to place payment caps tied to Medicare reimbursement rates and exceptions for rural and Critical Access Hospitals.
Author(s): Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan
Date: 07/2024
Sponsoring organization: Milbank Memorial Fund
view details
Report discusses how policy changes to state employee insurance plans affected healthcare costs in Oregon. Details Oregon's plan to place payment caps tied to Medicare reimbursement rates and exceptions for rural and Critical Access Hospitals.
Author(s): Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan
Date: 07/2024
Sponsoring organization: Milbank Memorial Fund
view details
Disruptors, Essential Services, and Reflections on a Career in Rural Health, with John Supplitt
An episode of the Exploring Rural Health podcast featuring John Supplitt, Senior Director of Rural Health Services for the American Hospital Association. Focuses on the importance of maintaining rural essential services, along with insights from Supplitt's long career in rural health.
Date: 07/2024
Sponsoring organization: Rural Health Information Hub
view details
An episode of the Exploring Rural Health podcast featuring John Supplitt, Senior Director of Rural Health Services for the American Hospital Association. Focuses on the importance of maintaining rural essential services, along with insights from Supplitt's long career in rural health.
Date: 07/2024
Sponsoring organization: Rural Health Information Hub
view details
Report to the Secretary of Health and Human Services: Encouraging Rural Participation in Population-Based Total Cost of Care (PB-TCOC) Models
Summarizes findings from the Physician-Focused Payment Model Technical Advisory Committee's (PTAC) review of information on best practices for addressing rural health challenges and encouraging rural participation in value-based care and PB-TCOC models. Describes the importance of addressing challenges affecting patients and providers in rural communities, developing financial incentives and glide paths to encourage rural participation in value-based care, and measuring and incentivizing value-based care and social determinants of health for patients in rural areas. Identifies areas where areas where additional research is needed, considerations for policymakers, and potential next steps.
Date: 06/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
view details
Summarizes findings from the Physician-Focused Payment Model Technical Advisory Committee's (PTAC) review of information on best practices for addressing rural health challenges and encouraging rural participation in value-based care and PB-TCOC models. Describes the importance of addressing challenges affecting patients and providers in rural communities, developing financial incentives and glide paths to encourage rural participation in value-based care, and measuring and incentivizing value-based care and social determinants of health for patients in rural areas. Identifies areas where areas where additional research is needed, considerations for policymakers, and potential next steps.
Date: 06/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
view details