Optimizing Population-Based Total Cost of Care (PB-TCOC) Models in the Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)
Report from the Physician-Focused Payment Model Technical Advisory Committee (PTAC) summarizing findings on population-based total cost of care (PB-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 key issues relating to PB-TCOC models and value-based care transformation. Identifies areas where additional research is needed and some potential next steps. Includes rural references throughout.
Date: 03/2023
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Merit-based Incentive Payment System (MIPS): Eligibility and Participation in the 2023 Performance Year - Traditional MIPS
Provides an overview of the Merit-Based Incentive Payment System (MIPS) eligibility criteria. Addresses calculation of the low-volume threshold exclusion at the individual and group levels, opt-in and voluntary reporting options, and the impact of special status designations such as rural and small practices.
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicaid/CHIP Coverage by School Districts, 2016-2020
Provides data on the percent of children covered by Medicaid/CHIP by school district, with separate, searchable lists for each state.
Date: 03/2023
Type: Website
Sponsoring organization: Georgetown University Health Policy Institute
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Financial Burden of Medical Care Among Veterans Aged 25–64, by Health Insurance Coverage: United States, 2019–2021
Examines financial burden for medical care among veterans aged 25–64 for those with VA health care alone and combined with different types of health insurance coverage. Table 1 includes data on VA health care and health insurance coverage for those in metropolitan and nonmetro areas.
Author(s): Robin A. Cohen, Peter Boersma
Date: 03/2023
Type: Document
Sponsoring organization: National Center for Health Statistics
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Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for the Unwinding of the Pandemic-Era Continuous Enrollment Provision
Provides a detailed overview of state policies related to Medicaid and the Children's Health Insurance Program (CHIP). Covers policies related to eligibility, enrollment, and renewal. Includes information on how states are preparing for the lifting of the continuous enrollment provision. Includes data tables on state Medicaid and CHIP policies.
Date: 03/2023
Type: Document
Sponsoring organization: Kaiser Family Foundation
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Financial Risk Acceptance among Rural Health Care Providers Participating in the Quality Payment Program
Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Merit-Based Incentive Payment System (MIPS): Participating in the Improvement Activities Performance Category in the 2023 Performance Year - Traditional MIPS
Provides details on how to participate in the performance improvement part of the Merit-Based Incentive Payment System (MIPS), one of two tracks under the Medicare Quality Payment Program. Identifies differences for small practices and clinicians located in a rural or Health Professional Shortage Area.
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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MedPAC Report to the Congress: Medicare Payment Policy: Home Health Care Services: Chapter 8
Discusses payment adequacy for home health care services and information on supplemental payments for home health services provided in low-use rural areas. Features statistics on Medicare margins for home health agencies between 2019-2021 with breakdowns by urban and rural areas and the number of home health periods provided to rural beneficiaries by state Review Choice Demonstration status in 2021.
Date: 03/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Hospice Services: Chapter 10
Discusses payment adequacy for hospice and palliative support services. Includes statistics with breakdowns by urban and rural locations and demographics on Medicare decedents who used hospice during 2010 and between 2017-2021. Compares the actual hospice utilization rates in micropolitan, rural adjacent, rural nonadjacent, and frontier areas to urban hospice utilization rates. Presents data on costs by day, aggregate margins, and the aggregate cap by urban and rural status.
Date: 03/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy, 2023
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for healthcare facilities and services; Medicare Advantage (MA), including a mandated report comparing per enrollee spending in the MA program with that of traditional fee-for-service (FFS) Medicare; and Medicare Part D.
Date: 03/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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