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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Can Community Paramedicine Improve Health Outcomes in Rural America?
Profiles three community paramedicine programs that serve rural communities in the Midwest, Maine, and Pennsylvania. Describes how community paramedicine can help fill gaps in care in rural communities and improve health outcomes. Identifies challenges to the growth of rural community paramedicine programs, including funding, payment, and workforce.
Author(s): Vida Foubister
Date: 03/2023
Type: Document
Sponsoring organization: Commonwealth Fund
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California Federally Qualified Health Center Alternative Payment Model Implementation Guide
Provides an overview on how the California Federally Qualified Health Center Alternative Payment Model (FQHC APM) may impact FQHCs and how facilities can prepare for the transition. Discusses the financial impact of the FQHC APM and assists facilities and staff in setting priorities, determining staffing needs, understanding necessary data collection, building staff competencies, and more.
Author(s): Greg Howe, Karla Silverman, Rob Houston
Date: 03/2023
Type: Document
Sponsoring organizations: California Health Care Foundation, Center for Health Care Strategies
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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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Report to Congress on Medicaid and CHIP, March 2023
Reports on four aspects of Medicaid: 1) collecting and reporting Medicaid race and ethnicity data, 2) increasing the transparency and improving the collection of nursing facility payment data, 3) strengthening evidence under Medicaid drug coverage, and 4) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 4 examines the relationship between disproportionate share hospital (DSH) allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the amounts and sources of hospitals' uncompensated care costs. Table 4-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2023
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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