Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
The Pennsylvania Rural Health Model (PARHM): Third Annual Evaluation Report
Evaluates the third performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2021. Includes three case studies discussing three themes: the recruitment and retention of system-affiliated hospitals, engagement and coordination with community organizations and providers, and exploring service line changes.
Additional links: Appendix, Findings at a Glance
Date: 09/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the third performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2021. Includes three case studies discussing three themes: the recruitment and retention of system-affiliated hospitals, engagement and coordination with community organizations and providers, and exploring service line changes.
Additional links: Appendix, Findings at a Glance
Date: 09/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Rural Health Value Summit: Driving Value Through Community-Based Partnerships
Provides an overview of a June 2023 summit regarding the intersection of rural providers and communities, value-based care and payment models, and social determinants of health (SDOH). Describes the efforts of Arkansas, Michigan, Oregon, and South Carolina communities that had representatives at the summit. Discusses opportunities for policymakers, payers, and health system leaders to build and support infrastructure to address social determinants of health in rural communities and offers possible next steps.
Date: 09/2023
Type: Document
Sponsoring organization: Rural Health Value
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Provides an overview of a June 2023 summit regarding the intersection of rural providers and communities, value-based care and payment models, and social determinants of health (SDOH). Describes the efforts of Arkansas, Michigan, Oregon, and South Carolina communities that had representatives at the summit. Discusses opportunities for policymakers, payers, and health system leaders to build and support infrastructure to address social determinants of health in rural communities and offers possible next steps.
Date: 09/2023
Type: Document
Sponsoring organization: Rural Health Value
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A Consensus Panel Approach to Estimating the Start-Up and Annual Service Costs for Rural Ambulance Agencies
Policy brief exploring the costs of running ambulance services for 3 population-based service tiers. Establishes a minimum access standard for ambulances servicing a 25-minute travel time from the ambulance station, and enables policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services. Features statistics on number of calls, population ranges of service areas, and fixed, depreciation, variable, and administrative costs.
Author(s): Yvonne Jonk, Gary Wingrove, Nikiah Nudell, Kevin McGinnis
Date: 08/2023
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Policy brief exploring the costs of running ambulance services for 3 population-based service tiers. Establishes a minimum access standard for ambulances servicing a 25-minute travel time from the ambulance station, and enables policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services. Features statistics on number of calls, population ranges of service areas, and fixed, depreciation, variable, and administrative costs.
Author(s): Yvonne Jonk, Gary Wingrove, Nikiah Nudell, Kevin McGinnis
Date: 08/2023
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Policy brief identifying penetration rates, number of plans, and enrollment patterns and trends in Medicare Advantage participation in metropolitan and nonmetropolitan counties from 2017-2022. Features statistics with breakdowns by year and metropolitan, micropolitan, and noncore areas.
Author(s): Dan Shane, Ufuoma Ejughemre, Fred Ullrich, Keith Mueller
Date: 08/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Policy brief identifying penetration rates, number of plans, and enrollment patterns and trends in Medicare Advantage participation in metropolitan and nonmetropolitan counties from 2017-2022. Features statistics with breakdowns by year and metropolitan, micropolitan, and noncore areas.
Author(s): Dan Shane, Ufuoma Ejughemre, Fred Ullrich, Keith Mueller
Date: 08/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Merit-Based Incentive Payment System (MIPS): 2024 Payment Year - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2024. Describes how 2022 MIPS scores relate to 2024 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 08/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2024. Describes how 2022 MIPS scores relate to 2024 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 08/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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COVID-19 Impact on Dental Service Delivery, Financing, Regulation, and Education Systems: An Environmental Scan
Describes the immediate and longer-term impacts of the COVID-19 pandemic on dental care delivery, regulation, education, and finance. Mentions rural throughout.
Author(s): Margaret Langelier, Aubri Kottek, Theekshana Fernando, et al.
Date: 07/2023
Type: Document
Sponsoring organization: Oral Health Workforce Research Center
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Describes the immediate and longer-term impacts of the COVID-19 pandemic on dental care delivery, regulation, education, and finance. Mentions rural throughout.
Author(s): Margaret Langelier, Aubri Kottek, Theekshana Fernando, et al.
Date: 07/2023
Type: Document
Sponsoring organization: Oral Health Workforce Research Center
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Building On CMS's Accountable Care Vision To Improve Care For Medicare Beneficiaries
Describes progress the Centers for Medicare & Medicaid Services (CMS) has made to date in its accountable care strategy. Outlines areas that CMS is exploring to accelerate the growth of and access to accountable care organizations (ACOs) that can support improved care and quality for beneficiaries, especially those in rural and underserved areas. Covers aligning the testing of ACO models and features with the Shared Savings Program (SSP), growth in the SSP, and using ACOs to reach more underserved populations and promote health equity.
Author(s): Purva Rawal, Douglas Jacobs, Elizabeth Fowler, Meena Seshamani
Citation: Health Affairs Forefront
Date: 07/2023
Type: Document
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Describes progress the Centers for Medicare & Medicaid Services (CMS) has made to date in its accountable care strategy. Outlines areas that CMS is exploring to accelerate the growth of and access to accountable care organizations (ACOs) that can support improved care and quality for beneficiaries, especially those in rural and underserved areas. Covers aligning the testing of ACO models and features with the Shared Savings Program (SSP), growth in the SSP, and using ACOs to reach more underserved populations and promote health equity.
Author(s): Purva Rawal, Douglas Jacobs, Elizabeth Fowler, Meena Seshamani
Citation: Health Affairs Forefront
Date: 07/2023
Type: Document
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A Rural Accountable Care Organization's Journey
Profiles South East Rural Physicians Alliance Accountable Care Organization (SERPA‐ACO), a physician‐led ACO consisting of 16 Nebraska clinics - 13 of which are rural. Describes various value-based payment models SERPA-ACO clinics participated in and activities the clinics use to succeed in these models. Includes recommendations for primary care clinics considering joining an ACO.
Date: 06/2023
Type: Document
Sponsoring organization: Rural Health Value
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Profiles South East Rural Physicians Alliance Accountable Care Organization (SERPA‐ACO), a physician‐led ACO consisting of 16 Nebraska clinics - 13 of which are rural. Describes various value-based payment models SERPA-ACO clinics participated in and activities the clinics use to succeed in these models. Includes recommendations for primary care clinics considering joining an ACO.
Date: 06/2023
Type: Document
Sponsoring organization: Rural Health Value
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Updated Simulation of a Prospective Payment System for Post-Acute Care
Updates a potential unified post-acute care (PAC) prospective payment system (PPS) and estimates the impact of a PAC PPS on providers and Medicare beneficiaries. Presents data comparing the estimated costs payments to actual payments by rurality and region.
Author(s): Doug Wissoker, Bowen Garrett
Date: 06/2023
Type: Document
Sponsoring organizations: Medicare Payment Advisory Commission, Urban Institute
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Updates a potential unified post-acute care (PAC) prospective payment system (PPS) and estimates the impact of a PAC PPS on providers and Medicare beneficiaries. Presents data comparing the estimated costs payments to actual payments by rurality and region.
Author(s): Doug Wissoker, Bowen Garrett
Date: 06/2023
Type: Document
Sponsoring organizations: Medicare Payment Advisory Commission, Urban Institute
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2023
Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Chapter 7 presents a report on the use, payment, and quality of telehealth services that Medicare pays for separately under the physician fee schedule (PFS). Also includes chapters on the cost of drugs covered under Medicare Part B, postsale rebates for prescription drugs in Medicare Part D, standardized benefits in Medicare Advantage plans, future directions for Medicare Advantage payment policy, disparities in outcomes for beneficiaries with different social risks, Medicare behavioral health services, the alignment of fee-for-service payment rates across ambulatory settings, and the evaluation of a post-acute care prospective payment system prototype.
Date: 06/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Chapter 7 presents a report on the use, payment, and quality of telehealth services that Medicare pays for separately under the physician fee schedule (PFS). Also includes chapters on the cost of drugs covered under Medicare Part B, postsale rebates for prescription drugs in Medicare Part D, standardized benefits in Medicare Advantage plans, future directions for Medicare Advantage payment policy, disparities in outcomes for beneficiaries with different social risks, Medicare behavioral health services, the alignment of fee-for-service payment rates across ambulatory settings, and the evaluation of a post-acute care prospective payment system prototype.
Date: 06/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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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: 11/4/2024