Rural Health
Resources by Topic: Reimbursement and payment models
Final Report of the Rural Texas Obstetrics Study
Uses data analysis, interviews, and surveys to report on rural obstetrics access issues in Texas. Discusses facility closures, distance to care, provider shortages, reimbursements, and healthcare quality. Offers an analysis of 15 facilities that closed OB departments to understand potential drivers of closures. Email address required to access report.
Date: 09/2024
Sponsoring organization: Stroudwater Associates
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Uses data analysis, interviews, and surveys to report on rural obstetrics access issues in Texas. Discusses facility closures, distance to care, provider shortages, reimbursements, and healthcare quality. Offers an analysis of 15 facilities that closed OB departments to understand potential drivers of closures. Email address required to access report.
Date: 09/2024
Sponsoring organization: Stroudwater Associates
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September 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2024 meeting. Covers Medicare's overall financial situation, cost-sharing for outpatient services at Critical Access Hospitals, and experiences and challenges of measuring the quality of care provided by rural providers.
Additional links: Cost Sharing for Outpatient Services at Critical Access Hospitals - Presentation Slides, Medicare's Measurement of Rural Provider Quality - Presentation Slides
Date: 09/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2024 meeting. Covers Medicare's overall financial situation, cost-sharing for outpatient services at Critical Access Hospitals, and experiences and challenges of measuring the quality of care provided by rural providers.
Additional links: Cost Sharing for Outpatient Services at Critical Access Hospitals - Presentation Slides, Medicare's Measurement of Rural Provider Quality - Presentation Slides
Date: 09/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Exploring the State of Value-Based Care
Slides presented to the South Dakota Rural Health Equity Summit on September 5, 2024. Provides an overview of value-based care and payment models and progress toward value-based care models. Describes potential strategies state agencies and organizations may use to assist rural healthcare organizations to deliver value-based care and receive value-based payments. Highlights state-level engagements to advance rural value-based care and payment in North Dakota and Pennsylvania.
Author(s): Karla Weng
Date: 09/2024
Sponsoring organization: Rural Health Value
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Slides presented to the South Dakota Rural Health Equity Summit on September 5, 2024. Provides an overview of value-based care and payment models and progress toward value-based care models. Describes potential strategies state agencies and organizations may use to assist rural healthcare organizations to deliver value-based care and receive value-based payments. Highlights state-level engagements to advance rural value-based care and payment in North Dakota and Pennsylvania.
Author(s): Karla Weng
Date: 09/2024
Sponsoring organization: Rural Health Value
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Environmental Scan on Identifying a Pathway Toward Maximizing Participation in Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan on the identification of a pathway toward maximizing participation in population-based total cost of care (PB-TCOC) models. Describes the Center for Medicare & Medicaid Services's (CMS's) goal of having all Medicare beneficiaries with Parts A and B in accountable care relationships by 2030. Discusses challenges and technical issues related to maximizing participation in PB-TCOC models, including organizational structure, payment, and risk adjustment. Summarizes relevant features of CMS Innovation Center (CMMI) models identified in previous Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references and considerations throughout.
Date: 09/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan on the identification of a pathway toward maximizing participation in population-based total cost of care (PB-TCOC) models. Describes the Center for Medicare & Medicaid Services's (CMS's) goal of having all Medicare beneficiaries with Parts A and B in accountable care relationships by 2030. Discusses challenges and technical issues related to maximizing participation in PB-TCOC models, including organizational structure, payment, and risk adjustment. Summarizes relevant features of CMS Innovation Center (CMMI) models identified in previous Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references and considerations throughout.
Date: 09/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Rural Emergency Hospitals Fact Sheet
Provides a brief overview of the Rural Emergency Hospital (REH) provider designation. Outlines REH payment, services, eligibility requirements, and how to apply for REH designation.
Date: 09/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides a brief overview of the Rural Emergency Hospital (REH) provider designation. Outlines REH payment, services, eligibility requirements, and how to apply for REH designation.
Date: 09/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Evaluating the Effectiveness of a Patient-Centered, Nonphysician Led Self-Monitoring Blood Pressure Program in a Rural Federally Qualified Health Center
Evaluated the effectiveness of a self-monitoring blood pressure program (SMBP) involving a nonphysician team for 205 patients with recent hypertension diagnoses in a rural Washington Federally Qualified Health Center (FQHC). Discusses facilitators and barriers to implementation including COVID-19, telehealth, community health workers, working with limited English proficiency populations, reimbursement, and collaborations.
Author(s): Magali Sanchez, KeliAnne Hara-Hubbard, Bárbara Baquero
Citation: Journal of Public Health Management and Practice, 30, S3167-S174
Date: 09/2024
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Evaluated the effectiveness of a self-monitoring blood pressure program (SMBP) involving a nonphysician team for 205 patients with recent hypertension diagnoses in a rural Washington Federally Qualified Health Center (FQHC). Discusses facilitators and barriers to implementation including COVID-19, telehealth, community health workers, working with limited English proficiency populations, reimbursement, and collaborations.
Author(s): Magali Sanchez, KeliAnne Hara-Hubbard, Bárbara Baquero
Citation: Journal of Public Health Management and Practice, 30, S3167-S174
Date: 09/2024
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Merit-based Incentive Payment System (MIPS): 2024 What's New for Small Practices
Summarizes new elements of the Merit-based Incentive Payment System (MIPS) for small practices - a group of 15 or fewer clinicians billing under a practice's Taxpayer Identification Number (TIN) - during the 2024 performance year. Discusses changes to performance category requirements and flexibilities, new MIPS Value Pathways (MVPs), and performance threshold and payment adjustments. Includes information on performance category redistribution policies for small practices.
Date: 09/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes new elements of the Merit-based Incentive Payment System (MIPS) for small practices - a group of 15 or fewer clinicians billing under a practice's Taxpayer Identification Number (TIN) - during the 2024 performance year. Discusses changes to performance category requirements and flexibilities, new MIPS Value Pathways (MVPs), and performance threshold and payment adjustments. Includes information on performance category redistribution policies for small practices.
Date: 09/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Billing for Telehealth Encounters: An Introductory Guide on Fee-for-Service
Presents an overview of how to bill fee-for-service Medicare and Medicaid for telehealth encounters. Includes information on originating and distant sites, virtual healthcare, and coding telehealth services. Lists types of practice sites, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and implications for billing telehealth services. Provides contact information for Regional Telehealth Research Centers (RTRC).
Date: 09/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Presents an overview of how to bill fee-for-service Medicare and Medicaid for telehealth encounters. Includes information on originating and distant sites, virtual healthcare, and coding telehealth services. Lists types of practice sites, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and implications for billing telehealth services. Provides contact information for Regional Telehealth Research Centers (RTRC).
Date: 09/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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MedPAC Comment on CMS's Proposed Rule on the Payment System for End-Stage Renal Disease for CY 2025
Comments on a July 5, 2024, Federal Register proposed rule related to Medicare payment policies for end-stage renal disease (ESRD). Includes comments addressing modifications to the outlier policy, updates to the low-volume payment adjustment (LVPA), and updates to the wage index methodology.
Date: 08/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on a July 5, 2024, Federal Register proposed rule related to Medicare payment policies for end-stage renal disease (ESRD). Includes comments addressing modifications to the outlier policy, updates to the low-volume payment adjustment (LVPA), and updates to the wage index methodology.
Date: 08/2024
Sponsoring organization: Medicare Payment Advisory Commission
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