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Resources by Topic: Reimbursement and payment models

Environmental Scan on Developing and Implementing Performance Measures for Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan regarding the development and implementation of population-based total cost of care (PB-TCOC) payment models. Describes types of performance measures used in value-based payment models and pay-for-reporting programs, data sources used for constructing performance measures, features of PB-TCOC models, challenges in developing and implementing performance measures and opportunities for Alternative Payment Models (APMs) and PB-TCOC models to address these challenges, trends in existing performance measures across several Center for Medicare and Medicaid Innovation (CMMI) models and Medicare value-based care programs, and more. Includes rural references and considerations throughout.
Date: 03/2024
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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March 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2024 meeting. Covers proposed approaches and research topics related to evaluating rural hospital and clinician payment policies, an assessment of the completeness of Medicare Advantage (MA) encounter data and other sources of information about MA enrollees' healthcare utilization, a preliminary analysis of MA quality, the Acute Hospital Care at Home program, and Medicare inpatient psychiatric service trends and issues.
Additional links: Rural Hospital and Clinician Payment Policy: A Workplan for 2024–2025 - Presentation Slides
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress on Medicaid and CHIP, March 2024
Reports on three aspects of Medicaid of interest to Congress: 1) improving the Medicaid beneficiary experience through Medical Care Advisory Committees (MCACs) and federal government actions to aid states, 2) increasing the transparency and improving the monitoring of the denials and appeals process in Medicaid managed care, and 3) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 3 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 3-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2024
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Mandated Report: Rural Emergency Hospitals: Chapter 15
Provides an overview of the Rural Emergency Hospital (REH) designation. Discusses the evolution of Medicare's support for rural hospitals through payment policies and the impact of declining inpatient volumes on rural hospitals' financial sustainability. Describes the characteristics of hospitals that converted to REH status in 2023, the first year of the designation.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Skilled Nursing Facility Services: Chapter 6
Discusses payment adequacy for skilled nursing facility (SNF) services. Features statistics on SNF care provided by rural hospitals and Critical Access Hospitals (CAHs) via swing beds and Medicare margins for urban and rural freestanding SNFs in 2022.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Home Health Care Services: Chapter 7
Discusses payment adequacy for home health care services. Features statistics on Medicare margins for home health agencies between 2019-2022 with breakdowns by urban and rural areas and the number of home health periods provided to rural beneficiaries.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy: Hospice Services: Chapter 9
Discusses payment adequacy for hospice and palliative support services. Includes data on average costs by day and aggregate margins by urban and rural status, as well as demographics on Medicare decedents who used hospice during 2010 and between 2018-2022. Compares the actual hospice utilization rates in micropolitan, rural adjacent, rural nonadjacent, and frontier areas to urban hospice utilization rates.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare Payment Policy, 2024
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 Medicare fee-for-service payment systems, Medicare Advantage (MA), and Medicare Part D. Includes two mandated reports on special needs plans for beneficiaries dually eligible for Medicare and Medicaid and the Rural Emergency Hospital (REH) designation.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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COVID-19 Affected Rural and Urban Hospital Uncompensated Care
Offers data comparing the impact of COVID-19 on uncompensated hospital care on rural and urban facilities using Medicare Cost Report data for acute care hospitals. Discusses uncompensated care trends over time and analyzes operating expenses.
Author(s): Emmaline Keesee
Date: 03/2024
Type: Document
Sponsoring organization: The Cecil G. Sheps Center for Health Services Research
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The 340B Drug Pricing Program: A Small Part of the Prescription Drug Market, Delivering Large Benefits to Patients and Communities
Analyzes impacts of the 340B Drug Pricing Program on access, hospital finance, drug companies, and public expenditures. Discusses how the 340B program is shaped by legislation, policy, finance, prescribing patterns, and market influences. Highlights rural and underserved communities throughout.
Date: 03/2024
Type: Document
Sponsoring organization: American Hospital Association
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