Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule – CMS-1808-F
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Low-Volume Hospital Adjustment Before and During COVID-19
Describes characteristics of rural low-volume hospitals (LVHs) between April 2018 and March 2022. Compares the characteristics and profitability of rural LVHs with other rural prospective payment system (PPS) hospitals before and during the COVID-19 pandemic. Presents data on LVH profitability margins with and without the LVH payment adjustment.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George Pink
Date: 07/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Describes characteristics of rural low-volume hospitals (LVHs) between April 2018 and March 2022. Compares the characteristics and profitability of rural LVHs with other rural prospective payment system (PPS) hospitals before and during the COVID-19 pandemic. Presents data on LVH profitability margins with and without the LVH payment adjustment.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George Pink
Date: 07/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Why Primary Care Practitioners Aren't Joining Value-Based Payment Models: Reasons and Potential Solutions
Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Type: Document
Sponsoring organization: Commonwealth Fund
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Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Type: Document
Sponsoring organization: Commonwealth Fund
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MedPAC Data Book: Health Care Spending and the Medicare Program, 2024
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures.
Date: 07/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures.
Date: 07/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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How Payment Caps Can Reduce Hospital Prices and Spending: Lessons from the Oregon State Employee Plan
Report discusses how policy changes to state employee insurance plans affected healthcare costs in Oregon. Details Oregon's plan to place payment caps tied to Medicare reimbursement rates and exceptions for rural and Critical Access Hospitals.
Author(s): Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan
Date: 07/2024
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Report discusses how policy changes to state employee insurance plans affected healthcare costs in Oregon. Details Oregon's plan to place payment caps tied to Medicare reimbursement rates and exceptions for rural and Critical Access Hospitals.
Author(s): Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan
Date: 07/2024
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Describes the estimated impact of three major Medicare home health payment policy changes - implementation of the Patient-Driven Groupings Model (PDGM), revisions to rural add-on payments, and the demonstration and nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) model - on home health agency (HHA) reimbursement for Medicare beneficiaries. Compares the estimated impact of these payment policy changes by HHA rural-serving status, U. S. Census Division, profit status, quality rating, and episode volume.
Author(s): Tracy M. Mroz, Lisa A. Garberson, C. Holly A. Andrilla, Davis G. Patterson
Date: 07/2024
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Describes the estimated impact of three major Medicare home health payment policy changes - implementation of the Patient-Driven Groupings Model (PDGM), revisions to rural add-on payments, and the demonstration and nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) model - on home health agency (HHA) reimbursement for Medicare beneficiaries. Compares the estimated impact of these payment policy changes by HHA rural-serving status, U. S. Census Division, profit status, quality rating, and episode volume.
Author(s): Tracy M. Mroz, Lisa A. Garberson, C. Holly A. Andrilla, Davis G. Patterson
Date: 07/2024
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Assessing Medicaid Payment Rates and Costs of Caring for the Medicaid Population Residing in Nursing Homes
Explores the relationship between Medicaid per diem payment rates to nursing homes and facilities' costs of providing care to Medicaid patients for facilities with a fiscal year ending on June 30, 2019. Examines the determinants of average cost and payment variations across each state. Presents data by facility-level characteristics, including ownership status, chain affiliation, rural or urban location, and more.
Date: 06/2024
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Miami University, RTI International, University of Massachusetts
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Explores the relationship between Medicaid per diem payment rates to nursing homes and facilities' costs of providing care to Medicaid patients for facilities with a fiscal year ending on June 30, 2019. Examines the determinants of average cost and payment variations across each state. Presents data by facility-level characteristics, including ownership status, chain affiliation, rural or urban location, and more.
Date: 06/2024
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Miami University, RTI International, University of Massachusetts
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Report to the Secretary of Health and Human Services: Encouraging Rural Participation in Population-Based Total Cost of Care (PB-TCOC) Models
Summarizes findings from the Physician-Focused Payment Model Technical Advisory Committee's (PTAC) review of information on best practices for addressing rural health challenges and encouraging rural participation in value-based care and PB-TCOC models. Describes the importance of addressing challenges affecting patients and providers in rural communities, developing financial incentives and glide paths to encourage rural participation in value-based care, and measuring and incentivizing value-based care and social determinants of health for patients in rural areas. Identifies areas where areas where additional research is needed, considerations for policymakers, and potential next steps.
Date: 06/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Summarizes findings from the Physician-Focused Payment Model Technical Advisory Committee's (PTAC) review of information on best practices for addressing rural health challenges and encouraging rural participation in value-based care and PB-TCOC models. Describes the importance of addressing challenges affecting patients and providers in rural communities, developing financial incentives and glide paths to encourage rural participation in value-based care, and measuring and incentivizing value-based care and social determinants of health for patients in rural areas. Identifies areas where areas where additional research is needed, considerations for policymakers, and potential next steps.
Date: 06/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Evaluation of the Vermont All-Payer Accountable Care Organization Model: 2018-2022 - Fourth Evaluation Report
Evaluates the first five performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Includes analyses of Medicare ACO subgroups and Medicaid spending, utilization, and quality of care trends. Outlines challenges and lessons learned.
Additional links: Findings at a Glance, Technical Appendices
Date: 06/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the first five performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Includes analyses of Medicare ACO subgroups and Medicaid spending, utilization, and quality of care trends. Outlines challenges and lessons learned.
Additional links: Findings at a Glance, Technical Appendices
Date: 06/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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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: 10/14/2024