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Rural Health
Resources by Topic: Reimbursement and payment models

Rural Health Care Costs: Are They Higher and Why Might They Differ from Urban Health Care Costs?
Explores issues surrounding healthcare costs and investigates differences between rural and urban expenditures. Includes statistics on Medicare fee-for-service expenditures in 2014 with breakdowns by metropolitan and non-metropolitan status.
Author(s): Dunc Williams, Mark Holmes
Location: North Carolina Medical Journal, 79(1), 51-55
Date: 01/2018
Type: Document
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2018 OPPS Medicare Part B Payment Impact Analysis
Examines how changes to the CY 2018 Medicare Outpatient Prospective Payment System (OPPS) will impact hospitals' net Part B payments. Discusses the payment reduction for drugs purchased through the 340B Program and how the reduction will affect rural and urban hospitals. Includes a state-by-state analysis of aggregate impacts.
Date: 01/2018
Type: Document
Sponsoring organization: Avalere
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Rural Innovation Profile: Affiliation Partners Sought to Prepare Small Hospital for Value-Based Care
Details how Grinnell Regional Medical Center (GRMC) in Grinnell, Iowa, followed a robust due diligence process to seek affiliation partners and prepare for participation in risk-based reimbursement models. GRMC is a 49-bed private, non-profit medical center that serves six rural counties in Iowa.
Date: 01/2018
Type: Document
Sponsoring organization: Rural Health Value
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Taking Stock: Policy Opportunities for Advancing Rural Health
Examines the progress of health system transformation and discusses the challenges that remain for rural people, places, and providers. Organized around seven main topics: Medicare, Medicaid and CHIP, insurance coverage and affordability, quality, healthcare finance and system transformation, workforce, and population health. Provides background information on each topic and shares policy suggestions for addressing each topic's most pressing issues.
Author(s): Keith J. Mueller, Charles Alfero, Andrew F. Coburn, et al.
Date: 01/2018
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States
Examines the current state of rural healthcare in seven states - Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming - and uses the findings to determine the impact of existing federal policies, understand ongoing healthcare challenges, and identify opportunities for improvement in rural healthcare access and delivery. Recommends the following actions to improve rural healthcare: rightsizing healthcare services to fit community need, creating rural funding mechanisms, building and supporting the primary care physician workforce, and expanding telemedicine services. Analysis is based on interviews with over 90 national thought leaders and key stakeholders.
Additional links: Infographic, Summary – Rural Health Care: Lessons Learned
Date: 01/2018
Type: Document
Sponsoring organization: Bipartisan Policy Center
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State Innovation Models (SIM) Round 2: Model Test Annual Report One
First annual report describing the design and progress of the Round 2 State Innovation Models (SIM) program across eleven participating states - Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee, and Washington. Includes information about the program's organization, data and methods, and implementation activities. Also shares highlights from each state's site visits.
Date: 12/2017
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Medicare Learning Network: Ambulance Fee Schedule
Provides an overview of the Medicare Part B ambulance transport benefit, and briefly explains payment and rate setting provisions affecting rural providers.
Date: 12/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicaid Payment Policy for Federally Qualified Health Centers
Describes the role of Federally Qualified Health Centers (FQHCs) in Medicaid, and highlights current policy issues related to Medicaid FQHC payment. Also discusses the Medicaid FQHC prospective payment system (PPS), alternative payment methodologies, how FQHCs participate in managed care networks, and states' desire for increased flexibility in setting FQHC payment rates.
Date: 12/2017
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Rural-Urban Enrollment in Part D Prescription Drug Plans: June 2017 Update
Updates prior policy briefs and shows state-to-state variation in stand-alone prescription drug plans and Medicare Advantage with Prescription Drug plans. Features statistics with breakdowns by rural and urban enrollment in 2008 and 2017.
Author(s): Paula Weigel, Fred Ullrich, Keith Mueller
Date: 12/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Learning Network: Health Professional Shortage Area Physician Bonus Program
Provides an overview of the Health Professional Shortage Area (HPSA) Physician Bonus Program and explains how bonus payments are calculated and paid. Includes information related to Critical Access Hospitals (CAHs) as well as primary care and mental health HPSAs.
Date: 12/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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