Rural Health
Resources by Topic: Reimbursement and payment models
Understanding the Rural Swing Bed: More than Just a Reimbursement Policy
Provides an overview of the swing bed program and its role as a patient-centric post-acute care solution that helps rural hospitals serve their communities. Discusses the impact of the program, reimbursement, quality measures, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 08/2021
Sponsoring organization: Rural Health Information Hub
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Provides an overview of the swing bed program and its role as a patient-centric post-acute care solution that helps rural hospitals serve their communities. Discusses the impact of the program, reimbursement, quality measures, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 08/2021
Sponsoring organization: Rural Health Information Hub
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Diabetes-Related Inpatient Stays, 2018
Brief examining nonmaternal inpatient stays related to type 1 and type 2 diabetes based on 2018 National Inpatient Sample (NIS) data. Presents distribution of inpatient stays by age, sex, insurance status, income, race and ethnicity, and metro and rural location.
Author(s): Kathryn R. Fingar, Lawrence D. Reid
Date: 07/2021
Sponsoring organizations: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project
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Brief examining nonmaternal inpatient stays related to type 1 and type 2 diabetes based on 2018 National Inpatient Sample (NIS) data. Presents distribution of inpatient stays by age, sex, insurance status, income, race and ethnicity, and metro and rural location.
Author(s): Kathryn R. Fingar, Lawrence D. Reid
Date: 07/2021
Sponsoring organizations: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project
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Evaluation of the State Innovation Models (SIM) Initiative Round 2: Model Test Final Report
Final report on the Round 2 State Innovation Models (SIM) program across eleven participating states - Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee, and Washington. Discusses the adoption of delivery models and payment reforms related to value-based payment (VBP) and alternative payment models (APMs). Examines whether the implementation efforts and healthcare delivery system reforms impacted the quality of care, health outcomes, population health, and spending.
Additional links: Appendix, Findings at a Glance
Date: 06/2021
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Final report on the Round 2 State Innovation Models (SIM) program across eleven participating states - Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee, and Washington. Discusses the adoption of delivery models and payment reforms related to value-based payment (VBP) and alternative payment models (APMs). Examines whether the implementation efforts and healthcare delivery system reforms impacted the quality of care, health outcomes, population health, and spending.
Additional links: Appendix, Findings at a Glance
Date: 06/2021
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Basics of Value-based Care and Payment
Slides presented to the Rural Healthcare Provider Transition Project (RHPTP) providing an overview of value-based care and payment models. Includes examples of rural providers addressing patient social needs, tackling local health issues, and aligning services with community needs.
Author(s): Jennifer P. Lundblad
Date: 06/2021
Sponsoring organization: Rural Health Value
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Slides presented to the Rural Healthcare Provider Transition Project (RHPTP) providing an overview of value-based care and payment models. Includes examples of rural providers addressing patient social needs, tackling local health issues, and aligning services with community needs.
Author(s): Jennifer P. Lundblad
Date: 06/2021
Sponsoring organization: Rural Health Value
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MedPAC Comment on CMS's Proposed Rule on the Hospital Inpatient PPS and the Long-term Care Hospital PPS for FY 2022
Comments on a May 10, 2021, Federal Register proposed rule revising the hospital inpatient and long-term care hospital (LTCH) prospective payment systems. Discusses proposals on rate-setting in both the hospital and LTCH prospective payment systems, the use of "market-based" data to set Medicare severity–diagnosis related group (MS–DRG) relative weights, and changes to rural reclassification cancellation requirements for hospitals.
Date: 06/2021
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on a May 10, 2021, Federal Register proposed rule revising the hospital inpatient and long-term care hospital (LTCH) prospective payment systems. Discusses proposals on rate-setting in both the hospital and LTCH prospective payment systems, the use of "market-based" data to set Medicare severity–diagnosis related group (MS–DRG) relative weights, and changes to rural reclassification cancellation requirements for hospitals.
Date: 06/2021
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2021
Evaluates Medicare payment issues and offers recommendations to the U.S. Congress. Chapter 5 presents an interim report on Medicare beneficiaries' access to care in rural areas. Also includes chapters on Medicare Advantage benchmark policy, alternative payment models, private equity and Medicare, the skilled nursing facility value-based purchasing program, indirect medical education payments, Medicare coverage of vaccines, separately payable drugs in the hospital outpatient prospective payment system, clinical laboratory fee schedule payment rates, and the relationship between clinician services and other Medicare services.
Additional links: Executive Summary
Date: 06/2021
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and offers recommendations to the U.S. Congress. Chapter 5 presents an interim report on Medicare beneficiaries' access to care in rural areas. Also includes chapters on Medicare Advantage benchmark policy, alternative payment models, private equity and Medicare, the skilled nursing facility value-based purchasing program, indirect medical education payments, Medicare coverage of vaccines, separately payable drugs in the hospital outpatient prospective payment system, clinical laboratory fee schedule payment rates, and the relationship between clinician services and other Medicare services.
Additional links: Executive Summary
Date: 06/2021
Sponsoring organization: Medicare Payment Advisory Commission
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Mid-Level Leaders and the Transition to Value Video Series
A 6-part video series on healthcare leadership for mid-level Critical Access Hospital (CAH) leaders. Provides information and strategies on leading a team through the shift to value-based payment with training modules on strategic and systems thinking, collaborative and change leadership, healthcare finance, and talent development.
Additional links: Action Plan, Discussion Questions and Recommended Activities, Resource Guide
Date: 05/2021
Sponsoring organizations: National Rural Health Resource Center, Technical Assistance and Services Center
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A 6-part video series on healthcare leadership for mid-level Critical Access Hospital (CAH) leaders. Provides information and strategies on leading a team through the shift to value-based payment with training modules on strategic and systems thinking, collaborative and change leadership, healthcare finance, and talent development.
Additional links: Action Plan, Discussion Questions and Recommended Activities, Resource Guide
Date: 05/2021
Sponsoring organizations: National Rural Health Resource Center, Technical Assistance and Services Center
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AHA Future of Rural Health Care Task Force: Final Recommendations
Presents the recommendations of the American Hospital Association Future of Rural Health Care Task Force, including innovation-based solutions and promising practices. Solutions include public-private funding changes for core services, flexible rural hospital infrastructure funding programs, creating a rural design center, and supporting grant writing services. Explores promising rural initiatives such as telemedicine, strategic partnerships, maternal health efforts, broadband investment, and rural philanthropy.
Date: 05/2021
Sponsoring organization: American Hospital Association
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Presents the recommendations of the American Hospital Association Future of Rural Health Care Task Force, including innovation-based solutions and promising practices. Solutions include public-private funding changes for core services, flexible rural hospital infrastructure funding programs, creating a rural design center, and supporting grant writing services. Explores promising rural initiatives such as telemedicine, strategic partnerships, maternal health efforts, broadband investment, and rural philanthropy.
Date: 05/2021
Sponsoring organization: American Hospital Association
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April 2021 MACPAC Meeting Transcript
Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) April 2021 meeting. Covers the review of draft chapters and recommendations regarding high-cost specialty drugs, improving integration through dual-eligible special needs plans (D-SNPs), access to mental health services for adults, access to behavioral health services for children and adolescents, electronic health records as a tool for behavioral health services integration, and the non-emergency medical transportation benefit. Also details lessons from states on rebalancing, ensuring quality in Medicaid and CHIP, and what states are learning from the expanded use of telehealth.
Date: 04/2021
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) April 2021 meeting. Covers the review of draft chapters and recommendations regarding high-cost specialty drugs, improving integration through dual-eligible special needs plans (D-SNPs), access to mental health services for adults, access to behavioral health services for children and adolescents, electronic health records as a tool for behavioral health services integration, and the non-emergency medical transportation benefit. Also details lessons from states on rebalancing, ensuring quality in Medicaid and CHIP, and what states are learning from the expanded use of telehealth.
Date: 04/2021
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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April 2021 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2021 meeting. Covers Medicare's skilled nursing facility value-based purchasing program and proposed replacement, streamlining CMS's portfolio of alternative payment models, rebalancing the Medicare Advantage benchmark policy, revising Medicare's indirect medical education payments to better reflect teaching hospital costs, Medicare vaccine coverage and payment, and improving Medicare's policies for separately payable drugs in the hospital outpatient prospective payment system. Includes a discussion of training rural physicians, among other rural references.
Date: 04/2021
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2021 meeting. Covers Medicare's skilled nursing facility value-based purchasing program and proposed replacement, streamlining CMS's portfolio of alternative payment models, rebalancing the Medicare Advantage benchmark policy, revising Medicare's indirect medical education payments to better reflect teaching hospital costs, Medicare vaccine coverage and payment, and improving Medicare's policies for separately payable drugs in the hospital outpatient prospective payment system. Includes a discussion of training rural physicians, among other rural references.
Date: 04/2021
Sponsoring organization: Medicare Payment Advisory Commission
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