Rural Health
Resources by Topic: Reimbursement and payment models
Telehealth: Use in Medicare and Medicaid
Discusses the extent to which telehealth is used by Medicare and Medicaid, the factors affecting the use of telehealth in Medicare, and how emerging payment and delivery models could affect future telehealth use. Includes rural-specific information throughout with particular attention paid to the role of rural healthcare facilities as originating sites.
Additional links: Full Report
Date: 07/2017
Type: Document
Sponsoring organization: Government Accountability Office
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Discusses the extent to which telehealth is used by Medicare and Medicaid, the factors affecting the use of telehealth in Medicare, and how emerging payment and delivery models could affect future telehealth use. Includes rural-specific information throughout with particular attention paid to the role of rural healthcare facilities as originating sites.
Additional links: Full Report
Date: 07/2017
Type: Document
Sponsoring organization: Government Accountability Office
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Changes in Hospital Quality Associated with Hospital Value-Based Purchasing
Examines whether quality improved more in acute care hospitals exposed to Medicare's Hospital Value-Based Purchasing (HVBP) program. Uses Critical Access Hospitals as a comparison for clinical process, patient experience, and mortality measures.
Author(s): Andrew M. Ryan, Sam Krinsky, Kristen A. Maurer, Justin B. Dimick
Citation: New England Journal of Medicine, 376(24), 2358-2366
Date: 06/2017
Type: Document
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Examines whether quality improved more in acute care hospitals exposed to Medicare's Hospital Value-Based Purchasing (HVBP) program. Uses Critical Access Hospitals as a comparison for clinical process, patient experience, and mortality measures.
Author(s): Andrew M. Ryan, Sam Krinsky, Kristen A. Maurer, Justin B. Dimick
Citation: New England Journal of Medicine, 376(24), 2358-2366
Date: 06/2017
Type: Document
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Development and Deployment of Community Health Workers in Delaware
A guide for establishing a Community Health Worker program in the state of Delaware. Includes information about certification requirements and reimbursement mechanisms, along with model programs from other states.
Date: 06/2017
Type: Document
Sponsoring organizations: Delaware Center for Health Innovation, Delaware Health and Social Services
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A guide for establishing a Community Health Worker program in the state of Delaware. Includes information about certification requirements and reimbursement mechanisms, along with model programs from other states.
Date: 06/2017
Type: Document
Sponsoring organizations: Delaware Center for Health Innovation, Delaware Health and Social Services
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Hospital Value-Based Purchasing: CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses
Examines the scoring methodology used by the Hospital Value-Based Purchasing (HVBP) program, which measures quality and efficiency within multiple hospital types including small, rural, and safety-net hospitals. Addresses differences in how safety net, small rural, and small urban hospitals performed, how payment adjustments changed for them over time, and the impact of an efficiency score on payment adjustments. Supports revising the methodology to apply the standards more evenly.
Additional links: Full Report
Date: 06/2017
Type: Document
Sponsoring organization: Government Accountability Office
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Examines the scoring methodology used by the Hospital Value-Based Purchasing (HVBP) program, which measures quality and efficiency within multiple hospital types including small, rural, and safety-net hospitals. Addresses differences in how safety net, small rural, and small urban hospitals performed, how payment adjustments changed for them over time, and the impact of an efficiency score on payment adjustments. Supports revising the methodology to apply the standards more evenly.
Additional links: Full Report
Date: 06/2017
Type: Document
Sponsoring organization: Government Accountability Office
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2017
Includes chapters on implementing a unified payment system for post-acute care, Part B drug payment policies, the redesign of the Merit-Based Incentive Payment System (MIPS) and other alternative payment models, drug and device manufacturer payments to physicians and teaching hospitals, stand-alone emergency departments, and skilled nursing facility use. Rural hospitals and rural patient populations are discussed throughout the report.
Date: 06/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Includes chapters on implementing a unified payment system for post-acute care, Part B drug payment policies, the redesign of the Merit-Based Incentive Payment System (MIPS) and other alternative payment models, drug and device manufacturer payments to physicians and teaching hospitals, stand-alone emergency departments, and skilled nursing facility use. Rural hospitals and rural patient populations are discussed throughout the report.
Date: 06/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Factors Affecting States' Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk?
Examines 30 key factors that contribute to state-by-state differences in Medicaid per enrollee spending including rural population, and uses the factors to rank and identify which states are at greatest risk if federal Medicaid cuts or caps are enacted. Presents findings across five main areas: Medicaid policy, demographics, health status, available tax revenue and state budget choices, and healthcare markets.
Author(s): Robin Rudowitz, Allison Valentine, Petry Ubri, Julia Zur
Date: 06/2017
Type: Document
Sponsoring organization: KFF
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Examines 30 key factors that contribute to state-by-state differences in Medicaid per enrollee spending including rural population, and uses the factors to rank and identify which states are at greatest risk if federal Medicaid cuts or caps are enacted. Presents findings across five main areas: Medicaid policy, demographics, health status, available tax revenue and state budget choices, and healthcare markets.
Author(s): Robin Rudowitz, Allison Valentine, Petry Ubri, Julia Zur
Date: 06/2017
Type: Document
Sponsoring organization: KFF
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Federal Health Centers: An Overview
Explains the Federal Health Center program, with information relating to the statutory authority, program requirements, funding, location, patient populations, health outcomes, and more. Also discusses the Federally Qualified Health Center (FQHC) designation, and how this designation affects Medicare and Medicaid payment levels.
Date: 05/2017
Type: Document
Sponsoring organization: Congressional Research Service
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Explains the Federal Health Center program, with information relating to the statutory authority, program requirements, funding, location, patient populations, health outcomes, and more. Also discusses the Federally Qualified Health Center (FQHC) designation, and how this designation affects Medicare and Medicaid payment levels.
Date: 05/2017
Type: Document
Sponsoring organization: Congressional Research Service
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Public and Individual Health Insurance Trends in Rural Minnesota: Enrollment During Implementation of the Affordable Care Act
Report focuses on rural Minnesotans' enrollment in non-employer provided insurance coverage as impacted by the Affordable Care Act (ACA) since 2010. Includes a discussion of Medical Assistance and MinnesotaCare increases as well as the individual market. Data and statistics by county type (entirely rural, small town/rural mix, urban/small town/rural, entirely urban) also provided.
Date: 04/2017
Type: Document
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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Report focuses on rural Minnesotans' enrollment in non-employer provided insurance coverage as impacted by the Affordable Care Act (ACA) since 2010. Includes a discussion of Medical Assistance and MinnesotaCare increases as well as the individual market. Data and statistics by county type (entirely rural, small town/rural mix, urban/small town/rural, entirely urban) also provided.
Date: 04/2017
Type: Document
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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Finance in Rural and Urban Hospitals
Summary of the impact of the Affordable Care Act (ACA) on the insurance coverage rates and reimbursement methods in rural hospitals in Minnesota. Includes a discussion of public and private insurance programs, uncompensated care, and operating margins. Includes data and statistic comparisons for Critical Access Hospitals (CAHs), other rural hospitals, and urban hospitals.
Date: 04/2017
Type: Document
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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Summary of the impact of the Affordable Care Act (ACA) on the insurance coverage rates and reimbursement methods in rural hospitals in Minnesota. Includes a discussion of public and private insurance programs, uncompensated care, and operating margins. Includes data and statistic comparisons for Critical Access Hospitals (CAHs), other rural hospitals, and urban hospitals.
Date: 04/2017
Type: Document
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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Issues Confronting Rural Pharmacies after a Decade of Medicare Part D
Discusses the major challenges facing rural independent pharmacies, focusing on delayed maximum allowable cost (MAC) adjustments, and direct and indirect remuneration (DIR) fees. Other challenges include competition from mail order pharmacies, being a non-preferred pharmacy, and orderly succession planning. Also examines the implications for rural communities when independent pharmacies close.
Author(s): Abiodun Salako, Fred Ullrich, Keith Mueller
Date: 04/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Discusses the major challenges facing rural independent pharmacies, focusing on delayed maximum allowable cost (MAC) adjustments, and direct and indirect remuneration (DIR) fees. Other challenges include competition from mail order pharmacies, being a non-preferred pharmacy, and orderly succession planning. Also examines the implications for rural communities when independent pharmacies close.
Author(s): Abiodun Salako, Fred Ullrich, Keith Mueller
Date: 04/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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