Rural Health
Resources by Topic: Reimbursement and payment models
Lessons Learned from Efforts to Support Vulnerable Critical Access and Other Rural Hospitals
Provides an overview of state and federal programs, demonstrations, and models designed to support Critical Access Hospitals (CAHs) and other rural hospitals. Describes challenges facing CAHs and rural hospitals, including chronic workforce shortages, high operating and staffing costs, inadequate reimbursement, operational and regulatory issues, and the diverse demographics of rural communities. Discusses lessons learned, the new for a new rural hospital model, and next steps.
Author(s): John Gale, Celia Jewell, Karen Pearson
Date: 02/2024
Type: Document
Sponsoring organization: Flex Monitoring Team
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Provides an overview of state and federal programs, demonstrations, and models designed to support Critical Access Hospitals (CAHs) and other rural hospitals. Describes challenges facing CAHs and rural hospitals, including chronic workforce shortages, high operating and staffing costs, inadequate reimbursement, operational and regulatory issues, and the diverse demographics of rural communities. Discusses lessons learned, the new for a new rural hospital model, and next steps.
Author(s): John Gale, Celia Jewell, Karen Pearson
Date: 02/2024
Type: Document
Sponsoring organization: Flex Monitoring Team
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Unrelenting Pressure Pushes Rural Safety Net Crisis Into Uncharted Territory
Examines financial and operational metrics for rural hospitals. Discusses the growth of Medicare Advantage (MA) enrollment in rural communities between 2019 and 2023, the impact of MA on rural hospital reimbursement, how the Rural Emergency Hospital (REH) designation can provide a path forward for some rural facilities, and the discontinuation of obstetrics and chemotherapy services at rural hospitals since 2011. Includes the percentage of rural hospitals in each state vulnerable to closure and nine factors significantly associated with rural hospital vulnerability.
Date: 02/2024
Type: Document
Sponsoring organization: Chartis Center for Rural Health
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Examines financial and operational metrics for rural hospitals. Discusses the growth of Medicare Advantage (MA) enrollment in rural communities between 2019 and 2023, the impact of MA on rural hospital reimbursement, how the Rural Emergency Hospital (REH) designation can provide a path forward for some rural facilities, and the discontinuation of obstetrics and chemotherapy services at rural hospitals since 2011. Includes the percentage of rural hospitals in each state vulnerable to closure and nine factors significantly associated with rural hospital vulnerability.
Date: 02/2024
Type: Document
Sponsoring organization: Chartis Center for Rural Health
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Chartis Center for Rural Health Research & Resources for the 2024 National Rural Health Association's Rural Health Policy Institute Conference
Offers research and analysis of the stability of the rural healthcare safety net. Includes Unrelenting Pressure Pushes Rural Safety Net Crisis into Uncharted Territory, Rural America's OB Deserts Widen in Fallout From Pandemic, and presentation slides on this report from the 2024 National Rural Health Association Policy Institute. Provides links to national and state data tables showing the financial impact of federal policies on rural hospitals.
Date: 02/2024
Type: Website
Sponsoring organization: Chartis Center for Rural Health
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Offers research and analysis of the stability of the rural healthcare safety net. Includes Unrelenting Pressure Pushes Rural Safety Net Crisis into Uncharted Territory, Rural America's OB Deserts Widen in Fallout From Pandemic, and presentation slides on this report from the 2024 National Rural Health Association Policy Institute. Provides links to national and state data tables showing the financial impact of federal policies on rural hospitals.
Date: 02/2024
Type: Website
Sponsoring organization: Chartis Center for Rural Health
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State Medicaid & CHIP Telehealth Toolkit
Toolkit to support state policymakers in expanding the use of telehealth to deliver Medicaid and Children's Health Insurance Program (CHIP) services. Provides information on telehealth flexibilities under Medicaid and CHIP; billing best practices; strategies for telehealth in value-based care; best practices from states during the COVID-19 public health emergency; strategies to promote the delivery of accessible and culturally competent care via telehealth; evaluation strategies to understand how telehealth affects quality, outcomes, and cost, and more. Offers state policy and operational considerations; information about common telehealth modalities; frequently asked questions for states to consider as they explore whether to expand the use of telehealth; Medicaid managed care and fee-for-service state checklists; and other planning tools. Includes information about using telehealth to deliver services to medically underserved and rural communities, American Indian and Alaska Native individuals, individuals with disabilities, older adults, and other specific populations.
Date: 02/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Toolkit to support state policymakers in expanding the use of telehealth to deliver Medicaid and Children's Health Insurance Program (CHIP) services. Provides information on telehealth flexibilities under Medicaid and CHIP; billing best practices; strategies for telehealth in value-based care; best practices from states during the COVID-19 public health emergency; strategies to promote the delivery of accessible and culturally competent care via telehealth; evaluation strategies to understand how telehealth affects quality, outcomes, and cost, and more. Offers state policy and operational considerations; information about common telehealth modalities; frequently asked questions for states to consider as they explore whether to expand the use of telehealth; Medicaid managed care and fee-for-service state checklists; and other planning tools. Includes information about using telehealth to deliver services to medically underserved and rural communities, American Indian and Alaska Native individuals, individuals with disabilities, older adults, and other specific populations.
Date: 02/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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2024 Rural Advocacy Agenda
Outlines the American Hospital Association's federal policy priorities for rural hospitals in 2024. Offers recommendations in the areas of commercial insurer accountability, flexible payment options, reimbursement, workforce, and the 340B program.
Date: 02/2024
Type: Document
Sponsoring organization: American Hospital Association
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Outlines the American Hospital Association's federal policy priorities for rural hospitals in 2024. Offers recommendations in the areas of commercial insurer accountability, flexible payment options, reimbursement, workforce, and the 340B program.
Date: 02/2024
Type: Document
Sponsoring organization: American Hospital Association
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Bridging The Home-Based Primary Care Gap In Rural Areas
Discusses challenges with offering home-based primary care (HBPC) in rural communities for older adults and people with disabilities, notably workforce shortages, insufficient infrastructure, and funding. Offers HBPC redesign suggestions with these challenges in mind, discussing community health workers, technology and telehealth, leveraging community resources and partnerships, training, scope of practice laws, payment models, and infrastructure investments.
Author(s): Ginny Rogers, Montgomery Smith, Jonathan Gonzalez-Smith, Robert S. Saunders
Citation: Health Affairs Forefront
Date: 02/2024
Type: Document
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Discusses challenges with offering home-based primary care (HBPC) in rural communities for older adults and people with disabilities, notably workforce shortages, insufficient infrastructure, and funding. Offers HBPC redesign suggestions with these challenges in mind, discussing community health workers, technology and telehealth, leveraging community resources and partnerships, training, scope of practice laws, payment models, and infrastructure investments.
Author(s): Ginny Rogers, Montgomery Smith, Jonathan Gonzalez-Smith, Robert S. Saunders
Citation: Health Affairs Forefront
Date: 02/2024
Type: Document
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2024 MIPS Eligibility Decision Tree
Presents information to determine if providers are eligible to participate in the Merit-Based Incentive Payment System (MIPS) in the 2024 Performance Year. Includes information on the low-volume threshold criteria.
Date: 02/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Presents information to determine if providers are eligible to participate in the Merit-Based Incentive Payment System (MIPS) in the 2024 Performance Year. Includes information on the low-volume threshold criteria.
Date: 02/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Early Impacts of the Pennsylvania Rural Health Model on Potentially Avoidable Utilization
Assesses the impact of the Pennsylvania Rural Health Model (PARHM) on potentially avoidable utilization rates between 2016 and 2022 by comparing participating and non-participating hospitals. Discusses the potential impact of COVID-19 on results.
Author(s): Donald S. Bourne, Eric T. Roberts, Lindsay M. Sabik
Citation: Health Affairs Scholar, 2(2)
Date: 02/2024
Type: Document
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Assesses the impact of the Pennsylvania Rural Health Model (PARHM) on potentially avoidable utilization rates between 2016 and 2022 by comparing participating and non-participating hospitals. Discusses the potential impact of COVID-19 on results.
Author(s): Donald S. Bourne, Eric T. Roberts, Lindsay M. Sabik
Citation: Health Affairs Scholar, 2(2)
Date: 02/2024
Type: Document
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Merit-based Incentive Payment System (MIPS): 2024 MIPS Quick Start Guide for Small Practices
Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2024 performance year. Includes information on performance category redistribution policies for small practices.
Date: 02/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2024 performance year. Includes information on performance category redistribution policies for small practices.
Date: 02/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Critical Access Hospital Telehealth Guide
Provides practical guidance on implementing and sustaining telehealth in Critical Access Hospitals, to optimize healthcare delivery, expand access, enhance care coordination, and address health inequity. Focuses on Medicare outpatient telehealth services, but also includes information on Medicaid coverage and remote services that may not strictly be considered telehealth.
Date: 02/2024
Type: Document
Sponsoring organizations: National Rural Health Resource Center, Northwest Regional Telehealth Resource Center
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Provides practical guidance on implementing and sustaining telehealth in Critical Access Hospitals, to optimize healthcare delivery, expand access, enhance care coordination, and address health inequity. Focuses on Medicare outpatient telehealth services, but also includes information on Medicaid coverage and remote services that may not strictly be considered telehealth.
Date: 02/2024
Type: Document
Sponsoring organizations: National Rural Health Resource Center, Northwest Regional Telehealth Resource Center
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