Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care
Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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State Innovation Model Testing Awards from the Centers for Medicare & Medicaid Services Innovation Center: Highlighting Rural Focus
Summarizes the activities and accomplishments of rural-specific State Innovation Models (SIM) in 11 states: Arkansas, Colorado, Idaho, Iowa, Maine, Michigan, Minnesota, New York, Ohio, Oregon, and Vermont. Describes the SIM initiative, which began in 2012 to support states committed to designing and testing strategies for payment model and delivery system reform.
Date: 06/2022
Type: Document
Sponsoring organization: Rural Health Value
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Summarizes the activities and accomplishments of rural-specific State Innovation Models (SIM) in 11 states: Arkansas, Colorado, Idaho, Iowa, Maine, Michigan, Minnesota, New York, Ohio, Oregon, and Vermont. Describes the SIM initiative, which began in 2012 to support states committed to designing and testing strategies for payment model and delivery system reform.
Date: 06/2022
Type: Document
Sponsoring organization: Rural Health Value
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Let's Get a Good Deal on Health Care
Explains the challenges rural hospitals face with current payment systems and the potential that value-based payment holds for meeting rural communities' needs.
Author(s): A. Clinton MacKinney
Citation: Rural Monitor
Date: 05/2022
Type: Document
Sponsoring organization: Rural Health Information Hub
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Explains the challenges rural hospitals face with current payment systems and the potential that value-based payment holds for meeting rural communities' needs.
Author(s): A. Clinton MacKinney
Citation: Rural Monitor
Date: 05/2022
Type: Document
Sponsoring organization: Rural Health Information Hub
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The Role of Social Determinants of Health in Value-Based Payment Models During COVID-19: An Evolving Rural Perspective
Recording of an April 2022 webinar discussing how some rural health providers address social determinants of health in their communities and mitigate hardships associated with COVID-19. Highlights strategies using value-based payment models and collaboration with community partners. Transcript is available in the video description.
Additional links: Presentation Slides
Author(s): Alana Knudson
Date: 04/2022
Type: Video/Multimedia
Sponsoring organizations: National Rural Health Resource Center, NORC Walsh Center for Rural Health Analysis
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Recording of an April 2022 webinar discussing how some rural health providers address social determinants of health in their communities and mitigate hardships associated with COVID-19. Highlights strategies using value-based payment models and collaboration with community partners. Transcript is available in the video description.
Additional links: Presentation Slides
Author(s): Alana Knudson
Date: 04/2022
Type: Video/Multimedia
Sponsoring organizations: National Rural Health Resource Center, NORC Walsh Center for Rural Health Analysis
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Medicare's Prospective Payment System for Inpatient Psychiatric Facilities at 15 Years
Examine how Medicare enrollees' use of inpatient psychiatric facility (IPF) services and the characteristics of IPFs have changed since the introduction of the IPF-PPS in 2005. Explores whether there have been changes in events that occur before or after IPF stays that may indicate potential changes in the quality of services. Includes information on per diem costs for rural IPFs compared to urban facilities.
Date: 04/2022
Type: Document
Sponsoring organizations: Medicare Payment Advisory Commission, Urban Institute
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Examine how Medicare enrollees' use of inpatient psychiatric facility (IPF) services and the characteristics of IPFs have changed since the introduction of the IPF-PPS in 2005. Explores whether there have been changes in events that occur before or after IPF stays that may indicate potential changes in the quality of services. Includes information on per diem costs for rural IPFs compared to urban facilities.
Date: 04/2022
Type: Document
Sponsoring organizations: Medicare Payment Advisory Commission, Urban Institute
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Medicaid Coverage of Community Health Worker Services
Provides an overview of types of community health workers (CHWs) and the services they provide. Summarizes studies examining the effects of CHW programs on health outcomes and costs. Discusses state approaches to covering CHW services through Medicaid, including the services covered, regulatory authorities used to provide Medicaid payment, the populations served, and training and certification requirements.
Date: 04/2022
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Provides an overview of types of community health workers (CHWs) and the services they provide. Summarizes studies examining the effects of CHW programs on health outcomes and costs. Discusses state approaches to covering CHW services through Medicaid, including the services covered, regulatory authorities used to provide Medicaid payment, the populations served, and training and certification requirements.
Date: 04/2022
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Environmental Scan on Issues Related to the Development of Population-Based Total Cost of Care (TCOC) Models in the Broader Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)
Presents results of an environmental scan regarding population-based total cost of care (TCOC) payment models and the role these models can play in optimizing health care delivery and value-based transformation in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs). Provides an overview of TCOC payment models, relevant performance and outcome measures used in reporting and evaluation, findings from research related to population-based models and programs that seek to reduce TCOC, barriers and challenges related to implementing population-based TCOC models, and opportunities for improving and optimizing efforts to develop and implement these models. Highlights rural considerations and examples throughout.
Date: 03/2022
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan regarding population-based total cost of care (TCOC) payment models and the role these models can play in optimizing health care delivery and value-based transformation in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs). Provides an overview of TCOC payment models, relevant performance and outcome measures used in reporting and evaluation, findings from research related to population-based models and programs that seek to reduce TCOC, barriers and challenges related to implementing population-based TCOC models, and opportunities for improving and optimizing efforts to develop and implement these models. Highlights rural considerations and examples throughout.
Date: 03/2022
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Medicare: Information on Geographic Adjustments to Physician Payments for Physicians' Time, Skills, and Effort
Provides an overview of the work geographic practice cost indices (GPCI), which the Centers for Medicare & Medicaid Services uses to adjust Medicare physician payments to account for differences in the costs of providing care across various geographic locations. Examines the extent to which the work GPCI accounts for geographic variation in physician earnings and how Medicare payments could change under potential modifications to the work GPCI.
Additional links: Full Report
Date: 02/2022
Type: Document
Sponsoring organization: Government Accountability Office
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Provides an overview of the work geographic practice cost indices (GPCI), which the Centers for Medicare & Medicaid Services uses to adjust Medicare physician payments to account for differences in the costs of providing care across various geographic locations. Examines the extent to which the work GPCI accounts for geographic variation in physician earnings and how Medicare payments could change under potential modifications to the work GPCI.
Additional links: Full Report
Date: 02/2022
Type: Document
Sponsoring organization: Government Accountability Office
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Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than at Wholly Owned Settings
Provides an overview of the Medicare diagnosis-related group (DRG) window policy. Examines how much Medicare and Medicare beneficiaries paid affiliated settings, including Critical Access Hospitals, for admission-related outpatient services in 2019 that would have otherwise been covered by the DRG policy at wholly-owned hospitals. Offers recommendations to the Centers for Medicare & Medicaid Services (CMS) for updating the DRG policy.
Date: 12/2021
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Provides an overview of the Medicare diagnosis-related group (DRG) window policy. Examines how much Medicare and Medicare beneficiaries paid affiliated settings, including Critical Access Hospitals, for admission-related outpatient services in 2019 that would have otherwise been covered by the DRG policy at wholly-owned hospitals. Offers recommendations to the Centers for Medicare & Medicaid Services (CMS) for updating the DRG policy.
Date: 12/2021
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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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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Additional resources are available related to this guide. See the full list of resources by topic for:
- Accountable Care Organizations
- Care coordination
- Health insurance
- Healthcare business and finance
- Medicaid
- Medicare
- Policy
- Reimbursement and payment models
- Service delivery models
Last Updated: 7/22/2024