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Rural Health Information Hub

Rural Health
Resources by Topic: Reimbursement and payment models

Tackling the Maternal and Infant Health Crisis: A Governor's Playbook
Provides an overview of maternal morbidity and mortality trends, including racial and geographic disparities, as well as the underlying causes of poor maternal health in the United States. Outlines 32 recommendations across five priority areas that can be implemented in coordination with critical stakeholders, such as industry and community leaders, community-based organizations, faith-based organizations, and people with lived experience. Priority 3 covers recommendations related to disparities affecting Black and American Indian/Alaska Native individuals. Includes rural references throughout.
Date: 07/2023
Sponsoring organizations: Afton Bloom, Boldly Go Philanthropy, National Governors Association
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Building On CMS's Accountable Care Vision To Improve Care For Medicare Beneficiaries
Describes progress the Centers for Medicare & Medicaid Services (CMS) has made to date in its accountable care strategy. Outlines areas that CMS is exploring to accelerate the growth of and access to accountable care organizations (ACOs) that can support improved care and quality for beneficiaries, especially those in rural and underserved areas. Covers aligning the testing of ACO models and features with the Shared Savings Program (SSP), growth in the SSP, and using ACOs to reach more underserved populations and promote health equity.
Author(s): Purva Rawal, Douglas Jacobs, Elizabeth Fowler, Meena Seshamani
Citation: Health Affairs Forefront
Date: 07/2023
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Rural Health Policy Landscape: Implications for Addressing Behavioral Health
Presentation slides from a July 22, 2023, presentation at the 48th Annual Rural Social Work Conference. Provides an overview of the federal, state, and commercial insurance policy landscapes regarding healthcare value and payment. Offers policy recommendations related to rural behavioral health.
Author(s): Keith J. Mueller
Date: 07/2023
Sponsoring organization: Rural Policy Research Institute
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Changes in Telehealth Experienced by Advanced Practice RNs During COVID-19
Summarizes 7,467 advanced practice RNs' national survey responses from June-September 2020 about the use of telehealth before and during the pandemic, and analyzes free-text comments about how the use of telehealth changed during the pandemic. Discusses challenges in rural areas, including provider shortages and lack of broadband access.
Author(s): Mavis N. Schorn, Carole R. Myers, Julie Barroso, et al.
Citation: Computers, Informatics, Nursing, 41(7), 507–513
Date: 07/2023
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Evaluation of the Vermont All-Payer Accountable Care Organization Model: Third Evaluation Report
Evaluates the first four and a half performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Describes trends in substance use disorder diagnosis and treatment for Medicaid members. Outlines challenges and lessons learned, as well as areas for future research.
Additional links: Findings at a Glance, Technical Appendices
Date: 07/2023
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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2021 Quality Payment Program Experience Report
Reports on the clinician experience for those participating in the Quality Payment Program in 2021. Presents data on Merit-based Incentive Payment System (MIPS) eligibility and participation rates for clinicians in small practices and rural areas, as well as their mean payment adjustment scores.
Date: 07/2023
Sponsoring organization: Centers for Medicare and Medicaid Services
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Delta Region Community Health Systems Development (DRCHSD) Program: Revenue Cycle Management Best Practices Guide
Offers rural hospital executives and management teams best practice concepts in revenue cycle management by assisting them in identifying performance improvement within their hospitals and departments. Provides State Offices of Rural Health (SORH) directors and Flex Program coordinators a better understanding of the revenue cycle best practices to help them design educational training programs to support rural hospital administrators with performance improvement.
Additional links: Check List
Date: 07/2023
Sponsoring organizations: BKD CPAs & Advisors, National Rural Health Resource Center
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Impact of Higher Payments for Rural Home Health Episodes on Rehospitalizations
Examines the impact of home health rural add-on payments on beneficiary outcomes, specifically on rehospitalizations. Uses Medicare data from 2007 to 2014 to compare rehospitalizations between rural and urban post-acute home health episodes before and after the implementation of the add-on payments in 2010. Discusses the implications of the findings on home health payment policy.
Author(s): Lacey Loomer, Momotazur Rahman, Tracy M. Mroz, Pedro L. Gozalo, Vincent Mor
Citation: Journal of Rural Health, 39(3), 604-610
Date: 06/2023
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A Rural Accountable Care Organization's Journey
Profiles South East Rural Physicians Alliance Accountable Care Organization (SERPA‐ACO), a physician‐led ACO consisting of 16 Nebraska clinics - 13 of which are rural. Describes various value-based payment models SERPA-ACO clinics participated in and activities the clinics use to succeed in these models. Includes recommendations for primary care clinics considering joining an ACO.
Date: 06/2023
Sponsoring organization: Rural Health Value
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A Path Forward: The Rural Healthcare System of the Future
Presentation slides that discuss federal and state healthcare policies, implementation of new models of care, and plans to transform patient modalities of care. Includes U.S. county-level map on the Medicare Shared Savings Program Accountable Care Organizations (ACO) assigned beneficiary population as well as county-level data on ACO attributed lives in Illinois and residents enrolled in Medicare advantage.
Author(s): Keith J. Mueller
Date: 06/2023
Sponsoring organizations: Iowa Department of Health Management and Policy, Rural Policy Research Institute
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