Rural Health
Resources by Topic: Reimbursement and payment models
Optimizing Population-Based Total Cost of Care (PB-TCOC) Models in the Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)
Report from the Physician-Focused Payment Model Technical Advisory Committee (PTAC) summarizing findings on population-based total cost of care (PB-TCOC) payment models and the role these models can play in optimizing health care delivery and value-based transformation in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs). Provides an overview of key issues relating to PB-TCOC models and value-based care transformation. Identifies areas where additional research is needed and some potential next steps. Includes rural references throughout.
Date: 03/2023
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Report from the Physician-Focused Payment Model Technical Advisory Committee (PTAC) summarizing findings on population-based total cost of care (PB-TCOC) payment models and the role these models can play in optimizing health care delivery and value-based transformation in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs). Provides an overview of key issues relating to PB-TCOC models and value-based care transformation. Identifies areas where additional research is needed and some potential next steps. Includes rural references throughout.
Date: 03/2023
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Can Community Paramedicine Improve Health Outcomes in Rural America?
Profiles three community paramedicine programs that serve rural communities in the Midwest, Maine, and Pennsylvania. Describes how community paramedicine can help fill gaps in care in rural communities and improve health outcomes. Identifies challenges to the growth of rural community paramedicine programs, including funding, payment, and workforce.
Author(s): Vida Foubister
Date: 03/2023
Type: Document
Sponsoring organization: Commonwealth Fund
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Profiles three community paramedicine programs that serve rural communities in the Midwest, Maine, and Pennsylvania. Describes how community paramedicine can help fill gaps in care in rural communities and improve health outcomes. Identifies challenges to the growth of rural community paramedicine programs, including funding, payment, and workforce.
Author(s): Vida Foubister
Date: 03/2023
Type: Document
Sponsoring organization: Commonwealth Fund
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California Federally Qualified Health Center Alternative Payment Model Implementation Guide
Provides an overview on how the California Federally Qualified Health Center Alternative Payment Model (FQHC APM) may impact FQHCs and how facilities can prepare for the transition. Discusses the financial impact of the FQHC APM and assists facilities and staff in setting priorities, determining staffing needs, understanding necessary data collection, building staff competencies, and more.
Author(s): Greg Howe, Karla Silverman, Rob Houston
Date: 03/2023
Type: Document
Sponsoring organizations: California Health Care Foundation, Center for Health Care Strategies
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Provides an overview on how the California Federally Qualified Health Center Alternative Payment Model (FQHC APM) may impact FQHCs and how facilities can prepare for the transition. Discusses the financial impact of the FQHC APM and assists facilities and staff in setting priorities, determining staffing needs, understanding necessary data collection, building staff competencies, and more.
Author(s): Greg Howe, Karla Silverman, Rob Houston
Date: 03/2023
Type: Document
Sponsoring organizations: California Health Care Foundation, Center for Health Care Strategies
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Financial Risk Acceptance among Rural Health Care Providers Participating in the Quality Payment Program
Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Merit-Based Incentive Payment System (MIPS): Participating in the Improvement Activities Performance Category in the 2023 Performance Year - Traditional MIPS
Provides details on how to participate in the performance improvement part of the Merit-Based Incentive Payment System (MIPS), one of two tracks under the Medicare Quality Payment Program. Identifies differences for small practices and clinicians located in a rural or Health Professional Shortage Area.
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides details on how to participate in the performance improvement part of the Merit-Based Incentive Payment System (MIPS), one of two tracks under the Medicare Quality Payment Program. Identifies differences for small practices and clinicians located in a rural or Health Professional Shortage Area.
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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MedPAC Report to the Congress: Medicare Payment Policy, 2023
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for healthcare facilities and services; Medicare Advantage (MA), including a mandated report comparing per enrollee spending in the MA program with that of traditional fee-for-service (FFS) Medicare; and Medicare Part D.
Date: 03/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for healthcare facilities and services; Medicare Advantage (MA), including a mandated report comparing per enrollee spending in the MA program with that of traditional fee-for-service (FFS) Medicare; and Medicare Part D.
Date: 03/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress on Medicaid and CHIP, March 2023
Reports on four aspects of Medicaid: 1) collecting and reporting Medicaid race and ethnicity data, 2) increasing the transparency and improving the collection of nursing facility payment data, 3) strengthening evidence under Medicaid drug coverage, and 4) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 4 examines the relationship between disproportionate share hospital (DSH) allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the amounts and sources of hospitals' uncompensated care costs. Table 4-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2023
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Reports on four aspects of Medicaid: 1) collecting and reporting Medicaid race and ethnicity data, 2) increasing the transparency and improving the collection of nursing facility payment data, 3) strengthening evidence under Medicaid drug coverage, and 4) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 4 examines the relationship between disproportionate share hospital (DSH) allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the amounts and sources of hospitals' uncompensated care costs. Table 4-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2023
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Use of Telemedicine among Office-Based Physicians, 2021
Details the usage of telemedicine by physicians who are office-based, self-employed or employed by a health system, including their specialty, participation in payment models, satisfaction with telemedicine, and continued use post-pandemic. Provides data on rural and urban physician use of telemedicine tools and platforms integrated with electronic health records (EHR).
Author(s): Yuriy Pylypchuk, Wesley Barker
Citation: ONC Data Brief, 65
Date: 03/2023
Type: Document
Sponsoring organization: Office of the National Coordinator for Health Information Technology
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Details the usage of telemedicine by physicians who are office-based, self-employed or employed by a health system, including their specialty, participation in payment models, satisfaction with telemedicine, and continued use post-pandemic. Provides data on rural and urban physician use of telemedicine tools and platforms integrated with electronic health records (EHR).
Author(s): Yuriy Pylypchuk, Wesley Barker
Citation: ONC Data Brief, 65
Date: 03/2023
Type: Document
Sponsoring organization: Office of the National Coordinator for Health Information Technology
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RHCs & the Medicare Shared Savings Program - What You Need to Know
Recording of a March 7, 2023, webinar providing an overview of the transition to value-based care, Accountable Care Organizations, and the Medicare Shared Savings Program. Discusses considerations for Rural Health Clinic participation in the Shared Savings Program. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides, Transcript
Date: 03/2023
Type: Video/Multimedia
Sponsoring organization: National Association of Rural Health Clinics
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Recording of a March 7, 2023, webinar providing an overview of the transition to value-based care, Accountable Care Organizations, and the Medicare Shared Savings Program. Discusses considerations for Rural Health Clinic participation in the Shared Savings Program. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides, Transcript
Date: 03/2023
Type: Video/Multimedia
Sponsoring organization: National Association of Rural Health Clinics
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Rural Track Program Funding: An Erosion in Definitions of Rural Places Requires New Action
Policy position paper discussing graduate medical education (GME) in rural areas. Discusses policy changes to rural hospital classification and the impact of these changes on rural GME and rural training track programs.
Date: 03/2023
Type: Document
Sponsoring organization: National Rural Health Association
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Policy position paper discussing graduate medical education (GME) in rural areas. Discusses policy changes to rural hospital classification and the impact of these changes on rural GME and rural training track programs.
Date: 03/2023
Type: Document
Sponsoring organization: National Rural Health Association
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