Rural Health
Resources by Topic: Reimbursement and payment models
Improving Health in Rural Communities: FY 2021 Year in Review
Provides an overview of Centers for Medicaid and Medicare Services (CMS) programs and activities that have affected rural health and healthcare in fiscal year 2021. Focuses on 10 priority areas: COVID-19, Federally-facilitated and State Marketplaces; Medicare payment and policy; practitioner workforce; Medicaid and Children's Health Insurance Program (CHIP) enrollment, payment, and policy; long-term services and supports; maternal health; mental health and substance use disorders; models and demonstrations, and quality and equity.
Date: 11/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Centers for Medicaid and Medicare Services (CMS) programs and activities that have affected rural health and healthcare in fiscal year 2021. Focuses on 10 priority areas: COVID-19, Federally-facilitated and State Marketplaces; Medicare payment and policy; practitioner workforce; Medicaid and Children's Health Insurance Program (CHIP) enrollment, payment, and policy; long-term services and supports; maternal health; mental health and substance use disorders; models and demonstrations, and quality and equity.
Date: 11/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare: Information on the Transition to Alternative Payment Models by Providers in Rural, Health Professional Shortage, or Underserved Areas
Describes the participation of providers in rural and health professional shortage areas in Advanced APMs from 2017 through 2019. Discusses challenges providers in rural, shortage, and underserved areas face in transitioning to APMs, as well as actions CMS takes to help these providers transition to APMs. Includes data by practice and provider type.
Additional links: Full Report
Date: 11/2021
Type: Document
Sponsoring organization: Government Accountability Office
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Describes the participation of providers in rural and health professional shortage areas in Advanced APMs from 2017 through 2019. Discusses challenges providers in rural, shortage, and underserved areas face in transitioning to APMs, as well as actions CMS takes to help these providers transition to APMs. Includes data by practice and provider type.
Additional links: Full Report
Date: 11/2021
Type: Document
Sponsoring organization: Government Accountability Office
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Using CPT Charges as an Economic Proxy for Telehealth and Non-telehealth Emergency Department Utilization
Explores the characteristics of a dataset comprising rural hospitals' reported Current Procedural Terminology (CPT) codes and associated charges for a sample of telehealth and non-telehealth emergency department (ED) visits. Features statistics including number of ED cases and controls selected by diagnosis, and demographics on select ED samples with breakdowns by 4 CPT codes.
Author(s): Marcia M. Ward, Knute D. Carter, Fred Ullrich, Kimberly A. S. Merchant
Date: 11/2021
Type: Document
Sponsoring organization: Rural Telehealth Research Center
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Explores the characteristics of a dataset comprising rural hospitals' reported Current Procedural Terminology (CPT) codes and associated charges for a sample of telehealth and non-telehealth emergency department (ED) visits. Features statistics including number of ED cases and controls selected by diagnosis, and demographics on select ED samples with breakdowns by 4 CPT codes.
Author(s): Marcia M. Ward, Knute D. Carter, Fred Ullrich, Kimberly A. S. Merchant
Date: 11/2021
Type: Document
Sponsoring organization: Rural Telehealth Research Center
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Rural Emergency Hospital: Policy Brief and Recommendations to the Secretary
Describes the development of the Rural Emergency Hospital (REH) designation in response to rural hospital closures and issues accessing emergency care. Lists statutory requirements for hospitals wishing to become an REH, and offers policy recommendations related to participation conditions, quality reporting, reimbursement, and emergency medical transfer agreement.
Date: 10/2021
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Describes the development of the Rural Emergency Hospital (REH) designation in response to rural hospital closures and issues accessing emergency care. Lists statutory requirements for hospitals wishing to become an REH, and offers policy recommendations related to participation conditions, quality reporting, reimbursement, and emergency medical transfer agreement.
Date: 10/2021
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Rural Nevada EMS Capacity Assessment
Presents results of a 2020 survey of 36 rural EMS agencies, addressing transporting patients, funding and billing, workforce and recruitment issues, health information technology, and more.
Author(s): Laima Etchegoyhen, John Packham, Tabor Griswold, Jeannine Warner
Date: 10/2021
Type: Document
Sponsoring organization: Nevada Health Workforce Research Center
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Presents results of a 2020 survey of 36 rural EMS agencies, addressing transporting patients, funding and billing, workforce and recruitment issues, health information technology, and more.
Author(s): Laima Etchegoyhen, John Packham, Tabor Griswold, Jeannine Warner
Date: 10/2021
Type: Document
Sponsoring organization: Nevada Health Workforce Research Center
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2021 CMS Hospital Quality Star Ratings of Rural Hospitals
Results of a study comparing the 2021 Centers for Medicare & Medicaid Services (CMS) Hospital Quality Star Rating results for rural and urban hospitals, comparing the 2021 and 2016 results for rural hospitals, and identifying implications for the usefulness of these ratings for rural hospitals. Features statistics including percentages of hospitals by Star Ratings with breakdowns by urban or rural location, and numbers of unrated rural hospitals by Medicare payment classification, net patient revenue, and census region.
Author(s): Laura Bozovich, Randall John, Kristie Thompson, George H. Pink
Date: 10/2021
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Results of a study comparing the 2021 Centers for Medicare & Medicaid Services (CMS) Hospital Quality Star Rating results for rural and urban hospitals, comparing the 2021 and 2016 results for rural hospitals, and identifying implications for the usefulness of these ratings for rural hospitals. Features statistics including percentages of hospitals by Star Ratings with breakdowns by urban or rural location, and numbers of unrated rural hospitals by Medicare payment classification, net patient revenue, and census region.
Author(s): Laura Bozovich, Randall John, Kristie Thompson, George H. Pink
Date: 10/2021
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Driving Health System Transformation - A Strategy for the CMS Innovation Center's Second Decade
White paper describing the new vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center) for the next 10 years that seeks to achieve equitable health outcomes through the provision of high-quality, affordable, person-centered care. Shares beneficiary and healthcare provider goals for each strategic objective in Table 2. Strategic objectives include: driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve healthcare system transformation. Includes discussion on models focused on improving rural health and ways of increasing participation in those models for rural and underserved populations.
Additional links: At a Glance
Date: 10/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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White paper describing the new vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center) for the next 10 years that seeks to achieve equitable health outcomes through the provision of high-quality, affordable, person-centered care. Shares beneficiary and healthcare provider goals for each strategic objective in Table 2. Strategic objectives include: driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve healthcare system transformation. Includes discussion on models focused on improving rural health and ways of increasing participation in those models for rural and underserved populations.
Additional links: At a Glance
Date: 10/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare: Provider Performance and Experiences Under the Merit-Based Incentive Payment System
Examines Centers for Medicare and Medicaid Services (CMS) data on Merit-Based Incentive Payment System (MIPS) performance category scores, final scores, and payment adjustments from performance years 2017 through 2019. Summarizes interviews with 11 stakeholder groups and identifies strengths and challenges of the MIPS program. Presents data on MIPS performance scores and related payment adjustments by practice size, geographic location, method of participation, and specialty.
Additional links: Full Report
Date: 10/2021
Type: Document
Sponsoring organization: Government Accountability Office
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Examines Centers for Medicare and Medicaid Services (CMS) data on Merit-Based Incentive Payment System (MIPS) performance category scores, final scores, and payment adjustments from performance years 2017 through 2019. Summarizes interviews with 11 stakeholder groups and identifies strengths and challenges of the MIPS program. Presents data on MIPS performance scores and related payment adjustments by practice size, geographic location, method of participation, and specialty.
Additional links: Full Report
Date: 10/2021
Type: Document
Sponsoring organization: Government Accountability Office
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Who Will Answer the Call? An Abstract of Challenges Facing Michigan's Rural EMS Agencies
Provides an overview of challenges experienced by Michigan's rural emergency medical services (EMS) agencies, such as reimbursement, access to care, recruitment and retention, workforce shortages and training, and more.
Date: 09/2021
Type: Document
Sponsoring organization: Rural Subcommittee of the EMS Coordinating Committee
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Provides an overview of challenges experienced by Michigan's rural emergency medical services (EMS) agencies, such as reimbursement, access to care, recruitment and retention, workforce shortages and training, and more.
Date: 09/2021
Type: Document
Sponsoring organization: Rural Subcommittee of the EMS Coordinating Committee
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Addressing Health-Related Social Needs to Improve Rural Health: Ideas to Action
Identifies strategies for building community and regional systems of care to better address the social needs of patients and inform the design of community-level rural health transformation initiatives, pilots, or demonstrations in rural Maine. Examines existing literature and evidence from similar initiatives in Vermont, Idaho, and Oregon, and highlights key observations. Describes key components of a demonstration designed to build, implement, and test strategies for aligning health, social service, and other systems to address in order to advance whole-person care.
Author(s): Andrew F. Coburn, Deborah A. Deatrick
Date: 09/2021
Type: Document
Sponsoring organizations: Maine Rural Health Action Network, New England Rural Health Association
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Identifies strategies for building community and regional systems of care to better address the social needs of patients and inform the design of community-level rural health transformation initiatives, pilots, or demonstrations in rural Maine. Examines existing literature and evidence from similar initiatives in Vermont, Idaho, and Oregon, and highlights key observations. Describes key components of a demonstration designed to build, implement, and test strategies for aligning health, social service, and other systems to address in order to advance whole-person care.
Author(s): Andrew F. Coburn, Deborah A. Deatrick
Date: 09/2021
Type: Document
Sponsoring organizations: Maine Rural Health Action Network, New England Rural Health Association
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