Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report
Summarizes a July 2020 virtual summit of rural participants in value‐based care (VBC) models and programs. Details six themes on VBC model design, implementation, and operation that can influence rural organization participation in VBC models. Provides recommendations for VBC model designers to improve rural healthcare provider participation and success in VBC models.
Author(s): Keith Mueller, Clint MacKinney, Jennifer Lundblad, Karla Weng
Date: 12/2020
Type: Document
Sponsoring organization: Rural Health Value
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Summarizes a July 2020 virtual summit of rural participants in value‐based care (VBC) models and programs. Details six themes on VBC model design, implementation, and operation that can influence rural organization participation in VBC models. Provides recommendations for VBC model designers to improve rural healthcare provider participation and success in VBC models.
Author(s): Keith Mueller, Clint MacKinney, Jennifer Lundblad, Karla Weng
Date: 12/2020
Type: Document
Sponsoring organization: Rural Health Value
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Evaluation of the Accountable Care Organization Investment Model: Final Report
Examines the ACO Investment Model (AIM) over three performance years. AIM tested the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. Reports on AIM results related to ACO formation, risk-taking, and sustainability, including the impact of rurality. Also discusses impacts on healthcare costs, utilization, and quality of care.
Additional links: Appendices, CMS Perspective Report, Findings at a Glance
Date: 09/2020
Type: Document
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Examines the ACO Investment Model (AIM) over three performance years. AIM tested the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. Reports on AIM results related to ACO formation, risk-taking, and sustainability, including the impact of rurality. Also discusses impacts on healthcare costs, utilization, and quality of care.
Additional links: Appendices, CMS Perspective Report, Findings at a Glance
Date: 09/2020
Type: Document
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Evaluation of the Health Care Innovation Awards, Round 2: Final Report
Summarizes the final evaluation results of 38 Health Care Innovation Awards Round Two projects. Discusses program impacts on healthcare service use and costs, factors associated with positive impacts, and awardees' experiences sustaining programs and implementing payment models after the end of the awards. Offers overall findings and awardee-specific evaluation reports. Includes some information on results for projects serving rural areas.
Additional links: Findings at a Glance
Date: 09/2020
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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Summarizes the final evaluation results of 38 Health Care Innovation Awards Round Two projects. Discusses program impacts on healthcare service use and costs, factors associated with positive impacts, and awardees' experiences sustaining programs and implementing payment models after the end of the awards. Offers overall findings and awardee-specific evaluation reports. Includes some information on results for projects serving rural areas.
Additional links: Findings at a Glance
Date: 09/2020
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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The Impact of Medicare's Rural Add-on Payments on Supply of Home Health Agencies Serving Rural Counties
Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
Type: Document
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Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
Type: Document
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Medicaid: State Views on Program Administration Challenges
Describes four federal Medicaid policies that pose barriers to effective program administration. Highlights the requirement for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) under the prospective payment system as a challenge for states. Identifies three issues for federal policymakers to consider when addressing these administrative challenges.
Additional links: Full Report
Date: 04/2020
Type: Document
Sponsoring organization: Government Accountability Office
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Describes four federal Medicaid policies that pose barriers to effective program administration. Highlights the requirement for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) under the prospective payment system as a challenge for states. Identifies three issues for federal policymakers to consider when addressing these administrative challenges.
Additional links: Full Report
Date: 04/2020
Type: Document
Sponsoring organization: Government Accountability Office
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Second Report to Congress: Social Risk Factors and Performance in Medicare's Value-Based Purchasing Programs
Analyzes the effect of individuals' social risk factors on quality measures, resource utilization, and other Medicare program measures using Medicare and non-Medicare data sources. Describes how Medicare value-based purchasing (VBP) programs impact providers who serve socially at-risk beneficiaries. Categorizes rurality as a social risk factor. Explores emerging trends among providers addressing social risk factors through cooperation with social services and community-based organizations. Offers policy recommendations for the U.S. Department of Health and Human Services to account for social risk factors in VBP programs and achieve better outcomes for those with social risk factors. Second of two reports required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. See the first report.
Additional links: Executive Summary
Date: 03/2020
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Analyzes the effect of individuals' social risk factors on quality measures, resource utilization, and other Medicare program measures using Medicare and non-Medicare data sources. Describes how Medicare value-based purchasing (VBP) programs impact providers who serve socially at-risk beneficiaries. Categorizes rurality as a social risk factor. Explores emerging trends among providers addressing social risk factors through cooperation with social services and community-based organizations. Offers policy recommendations for the U.S. Department of Health and Human Services to account for social risk factors in VBP programs and achieve better outcomes for those with social risk factors. Second of two reports required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. See the first report.
Additional links: Executive Summary
Date: 03/2020
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020
Updates a literature review on the impact of state Medicaid expansions on insurance coverage, access to care, and economic measures. Addresses the impact of Medicaid expansion on rural insurance rates and hospital finances.
Author(s): Madeline Guth, Rachel Garfield, Robin Rudowitz
Date: 03/2020
Type: Document
Sponsoring organization: KFF
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Updates a literature review on the impact of state Medicaid expansions on insurance coverage, access to care, and economic measures. Addresses the impact of Medicaid expansion on rural insurance rates and hospital finances.
Author(s): Madeline Guth, Rachel Garfield, Robin Rudowitz
Date: 03/2020
Type: Document
Sponsoring organization: KFF
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Medicare: Information on Medicare-Dependent Hospitals
Provides an overview of the Medicare-dependent hospital (MDH) program, how the MDH designation differs from other rural hospital designations, and how MDH hospitals have changed over time. Discusses the decrease in the number of MDHs over time. Examines a variety of operational and financial metrics across MDHs over time.
Additional links: Full Report
Date: 02/2020
Type: Document
Sponsoring organization: Government Accountability Office
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Provides an overview of the Medicare-dependent hospital (MDH) program, how the MDH designation differs from other rural hospital designations, and how MDH hospitals have changed over time. Discusses the decrease in the number of MDHs over time. Examines a variety of operational and financial metrics across MDHs over time.
Additional links: Full Report
Date: 02/2020
Type: Document
Sponsoring organization: Government Accountability Office
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Rural-Urban Differences in Hospital Payer Mix in 2017
Fact sheet reporting payer mix, which refers to the percentage of inpatient days paid by Medicare and Medicaid, by hospital location and Critical Access Hospital (CAH) status. Highlights key observations on data drawn from the 2017 American Hospital Association annual survey.
Date: 2020
Type: Document
Sponsoring organization: Rural and Minority Health Research Center (formerly the South Carolina Rural Health Research Center)
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Fact sheet reporting payer mix, which refers to the percentage of inpatient days paid by Medicare and Medicaid, by hospital location and Critical Access Hospital (CAH) status. Highlights key observations on data drawn from the 2017 American Hospital Association annual survey.
Date: 2020
Type: Document
Sponsoring organization: Rural and Minority Health Research Center (formerly the South Carolina Rural Health Research Center)
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Impact of the Medicare Disproportionate Share Hospital Payment Cap on Rural and Urban Hospitals
Describes the number and location of hospitals that qualify for Medicare Disproportionate Share Hospital (DSH) payments and meet the criteria for a 12% payment cap. Examines how the payment cap and lost revenue impacts urban and rural hospitals. Presents options to modify DSH payments to ease the financial strain on rural hospitals.
Author(s): Paula Weigel, Fred Ullrich, Keith J. Mueller
Date: 12/2019
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Describes the number and location of hospitals that qualify for Medicare Disproportionate Share Hospital (DSH) payments and meet the criteria for a 12% payment cap. Examines how the payment cap and lost revenue impacts urban and rural hospitals. Presents options to modify DSH payments to ease the financial strain on rural hospitals.
Author(s): Paula Weigel, Fred Ullrich, Keith J. Mueller
Date: 12/2019
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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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: 7/2/2024