Rural Health
Resources by Topic: Reimbursement and payment models
Alternative Payment Models in the Quality Payment Program as of December 2023
A set of three tables that list brief information about Alternative Payment Models (APMs) that the Centers for Medicare and Medicaid Services (CMS) operates or has announced, as of December 2023. Identifies Advanced APMs, Merit Based Incentive Program (MIPs) APMs, and Other Payer Advanced APMs, which include Medicaid Other Payer Advanced APMs, Medicare Health Plan Payment Arrangements, and commercial payment arrangements.
Date: 12/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
A set of three tables that list brief information about Alternative Payment Models (APMs) that the Centers for Medicare and Medicaid Services (CMS) operates or has announced, as of December 2023. Identifies Advanced APMs, Merit Based Incentive Program (MIPs) APMs, and Other Payer Advanced APMs, which include Medicaid Other Payer Advanced APMs, Medicare Health Plan Payment Arrangements, and commercial payment arrangements.
Date: 12/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Independent Evaluation of Comprehensive Primary Care Plus (CPC+): Final Annual Report
Reports on the Comprehensive Primary Care Plus (CPC+) model, a CMS primary care payment and delivery reform effort that ran from 2017-2021. Outlines key findings from the model, including CPC+ supports to practices, care delivery changes made by practices, impacts on outcomes for Medicare fee-for-service beneficiaries, and implications for primary care models. Describes the experiences of payers, practices, health IT vendors, and patients. Includes rural references throughout.
Additional links: Appendices to the Final Report, Volume 1, Appendices to the Final Report, Volume 2, Findings at a Glance
Date: 12/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
view details
Reports on the Comprehensive Primary Care Plus (CPC+) model, a CMS primary care payment and delivery reform effort that ran from 2017-2021. Outlines key findings from the model, including CPC+ supports to practices, care delivery changes made by practices, impacts on outcomes for Medicare fee-for-service beneficiaries, and implications for primary care models. Describes the experiences of payers, practices, health IT vendors, and patients. Includes rural references throughout.
Additional links: Appendices to the Final Report, Volume 1, Appendices to the Final Report, Volume 2, Findings at a Glance
Date: 12/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
view details
CMS Final Rules Overview - Impact for RHCs Beginning January 1, 2024
Recording of a December 11, 2023, webinar providing an overview of telehealth payment rates for Rural Health Clinics (RHCs) and other regulatory updates and potential changes for 2024. Covers new billable providers for RHCs, changes to care management services and billing, telehealth regulations, intensive outpatient program (IOP) services, and more. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides
Date: 12/2023
Type: Video/Multimedia
Sponsoring organization: National Association of Rural Health Clinics
view details
Recording of a December 11, 2023, webinar providing an overview of telehealth payment rates for Rural Health Clinics (RHCs) and other regulatory updates and potential changes for 2024. Covers new billable providers for RHCs, changes to care management services and billing, telehealth regulations, intensive outpatient program (IOP) services, and more. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides
Date: 12/2023
Type: Video/Multimedia
Sponsoring organization: National Association of Rural Health Clinics
view details
Advancing Value-Based Payment Policies Relevant to Rural Areas – Continued Challenges and New Opportunities
Discusses lessons from the recent public health emergency, rising health care costs, improved quality measurement, and innovative technologies on the transition from volume-based payment to value-based payment. Outlines potential policy opportunities for the Centers for Medicare & Medicaid Services (CMS) Innovation Center model design and CMS program inclusion to expand rural-appropriate opportunities to participate in the transition to value-based care. Builds on the 2020 publication How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report.
Date: 12/2023
Type: Document
Sponsoring organization: Rural Health Value
view details
Discusses lessons from the recent public health emergency, rising health care costs, improved quality measurement, and innovative technologies on the transition from volume-based payment to value-based payment. Outlines potential policy opportunities for the Centers for Medicare & Medicaid Services (CMS) Innovation Center model design and CMS program inclusion to expand rural-appropriate opportunities to participate in the transition to value-based care. Builds on the 2020 publication How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report.
Date: 12/2023
Type: Document
Sponsoring organization: Rural Health Value
view details
Participation in a Medicare Advanced Primary Care Model and the Delivery of High-Value Services
Examines if participation in the Comprehensive Primary Care Plus Initiative (CPC+) impacted the high-value services delivered by primary care providers. Utilizes multiple national data sets to estimate the association of CPC+ and services such as annual wellness visits (AWVs), advance care planning (ACP), flu shots, tobacco prevention counseling, and depression screening. Provides data on intervention groups and comparison groups by patient demographics as well as provider demographics, specialty, and location, including urban, large rural, small rural, and isolated rural.
Author(s): Fang He, Angela Gasdaska, Lindsay White, Yan Tang, Chris Beadles
Citation: Health Services Research, 58(6), 1266-1291
Date: 12/2023
Type: Document
view details
Examines if participation in the Comprehensive Primary Care Plus Initiative (CPC+) impacted the high-value services delivered by primary care providers. Utilizes multiple national data sets to estimate the association of CPC+ and services such as annual wellness visits (AWVs), advance care planning (ACP), flu shots, tobacco prevention counseling, and depression screening. Provides data on intervention groups and comparison groups by patient demographics as well as provider demographics, specialty, and location, including urban, large rural, small rural, and isolated rural.
Author(s): Fang He, Angela Gasdaska, Lindsay White, Yan Tang, Chris Beadles
Citation: Health Services Research, 58(6), 1266-1291
Date: 12/2023
Type: Document
view details
Medicare Advantage in Rural Areas: Implications for Hospital Sustainability
Explores the relationship between Medicare Advantage (MA) penetration levels in rural areas and acute care hospital financial distress and closure between 2008 and 2019. Analyzes data from Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 14 states to describe rural acute care hospitals with low and high MA penetration.
Author(s): Rachel Mosher Henke, Kathryn R. Fingar, Lan Liang, H. Joanna Jiang
Citation: American Journal of Managed Care, 29(11), 594–600
Date: 11/2023
Type: Document
view details
Explores the relationship between Medicare Advantage (MA) penetration levels in rural areas and acute care hospital financial distress and closure between 2008 and 2019. Analyzes data from Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 14 states to describe rural acute care hospitals with low and high MA penetration.
Author(s): Rachel Mosher Henke, Kathryn R. Fingar, Lan Liang, H. Joanna Jiang
Citation: American Journal of Managed Care, 29(11), 594–600
Date: 11/2023
Type: Document
view details
Beyond the Waiting Room: The State of Dental Care Access in West Virginia
Discusses dental care access in West Virginia, highlighting workforce shortages and underserved populations including rural residents. Offers policy recommendations to decrease disparities including interprofessional care, reimbursement structures, and more.
Date: 11/2023
Type: Document
Sponsoring organizations: Harmony Health Foundation, West Virginia Oral Health Coalition
view details
Discusses dental care access in West Virginia, highlighting workforce shortages and underserved populations including rural residents. Offers policy recommendations to decrease disparities including interprofessional care, reimbursement structures, and more.
Date: 11/2023
Type: Document
Sponsoring organizations: Harmony Health Foundation, West Virginia Oral Health Coalition
view details
Uncompensated Care is Highest for Rural Hospitals, Particularly in Non-Expansion States
Analyzes uncompensated care and hospital operating expense data to explore trends over time, the role of Medicaid expansion, and the impact on rural hospitals. Includes state-by-state comparisons as well as rural and urban comparisons.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George H. Pink
Citation: Medical Care Research and Review, 81(2), 164-170
Date: 11/2023
Type: Document
view details
Analyzes uncompensated care and hospital operating expense data to explore trends over time, the role of Medicaid expansion, and the impact on rural hospitals. Includes state-by-state comparisons as well as rural and urban comparisons.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George H. Pink
Citation: Medical Care Research and Review, 81(2), 164-170
Date: 11/2023
Type: Document
view details
Final Rule for CY 2024 Physician Fee Schedule: Fact Sheet
Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2024 as outlined in the final calendar year (CY) 2024 Physician Fee Schedule. Covers eligible services that can be delivered by telehealth, remote monitoring services, physician supervision, diabetes self-management training (DSMT), and more.
Date: 11/2023
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
view details
Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2024 as outlined in the final calendar year (CY) 2024 Physician Fee Schedule. Covers eligible services that can be delivered by telehealth, remote monitoring services, physician supervision, diabetes self-management training (DSMT), and more.
Date: 11/2023
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
view details
The Evolution of Rural Emergency Hospitals as a New Model of Care
Podcast episode with Laura Appel, executive vice president of the Michigan Health and Hospital Association, and Christina Campos, CEO at Guadalupe County Hospital. Discusses the Rural Emergency Hospital (REH) designation, the conversion process, meeting eligibility requirements, and the benefit of REHs to rural patients and communities.
Date: 11/2023
Type: Audio
Sponsoring organization: American Hospital Association
view details
Podcast episode with Laura Appel, executive vice president of the Michigan Health and Hospital Association, and Christina Campos, CEO at Guadalupe County Hospital. Discusses the Rural Emergency Hospital (REH) designation, the conversion process, meeting eligibility requirements, and the benefit of REHs to rural patients and communities.
Date: 11/2023
Type: Audio
Sponsoring organization: American Hospital Association
view details