Rural Health
Resources by Topic: Reimbursement and payment models
Environmental Scan on Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation
Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Merit-Based Incentive Payment System (MIPS): 2025 Reporting Options Comparison Resource
Provides an overview of the similarities and differences among the three Merit-Based Incentive Payment System (MIPS) reporting options: Traditional MIPS, MIPS Value Pathways (MVP), and Alternative Payment Model (APM) Performance Pathway (APP). Designed to help providers understand which reporting options may be best for their practice. Includes information on reporting flexibilities and scoring for small and rural practices.
Additional links: 2025 Merit-Based Incentive Payment System (MIPS) At-A-Glance Reporting Options for Small Practices
Date: 05/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the similarities and differences among the three Merit-Based Incentive Payment System (MIPS) reporting options: Traditional MIPS, MIPS Value Pathways (MVP), and Alternative Payment Model (APM) Performance Pathway (APP). Designed to help providers understand which reporting options may be best for their practice. Includes information on reporting flexibilities and scoring for small and rural practices.
Additional links: 2025 Merit-Based Incentive Payment System (MIPS) At-A-Glance Reporting Options for Small Practices
Date: 05/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS Innovation Center Strategic Direction
Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Healthcare Provider Transition Project (RHPTP) Webinar: Quality Improvement (QI) Alignment Across the Hospital and Clinics is Key to Value-Based Payment (VBP) Success
A recorded webinar that discusses strategies to align quality improvement (QI) projects with value-based payment (VBP) across organizational settings. Discusses clinical quality measures and sustainability of QI. Transcript available below description.
Additional links: Slides
Author(s): Lisa Olson, Candy Hanson
Date: 05/2025
Sponsoring organizations: National Rural Health Resource Center, Stratis Health
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A recorded webinar that discusses strategies to align quality improvement (QI) projects with value-based payment (VBP) across organizational settings. Discusses clinical quality measures and sustainability of QI. Transcript available below description.
Additional links: Slides
Author(s): Lisa Olson, Candy Hanson
Date: 05/2025
Sponsoring organizations: National Rural Health Resource Center, Stratis Health
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Evaluation of the Primary Care First Model: Third Annual Report
Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Strategies for Sustaining Emergency Care in the United States
Assesses the value of emergency care in the United States, evaluates challenges to sustaining emergency care, measures trends in emergency care payment, and identifies alternate funding strategies for emergency care. Features a case study of a hospital-based emergency department closure in a rural community, and mentions rural throughout.
Author(s): Mahshid Abir, Brian Briscombe, Carl T. Berdahl, et al.
Date: 04/2025
Sponsoring organization: RAND Corporation
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Assesses the value of emergency care in the United States, evaluates challenges to sustaining emergency care, measures trends in emergency care payment, and identifies alternate funding strategies for emergency care. Features a case study of a hospital-based emergency department closure in a rural community, and mentions rural throughout.
Author(s): Mahshid Abir, Brian Briscombe, Carl T. Berdahl, et al.
Date: 04/2025
Sponsoring organization: RAND Corporation
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10 Things to Know About Rural Hospitals
Presents information and data on rural hospitals and rural hospital finances. Compares insurance coverage of discharges and births, margins, and the impact of Medicaid expansion by hospitals' rural and urban location. Includes information on rural hospital closures and Medicare special payment designations for rural hospitals. Discusses the potential impacts of recent federal spending proposals on rural hospitals.
Author(s): Scott Hulver, Zachary Levinson, Jamie Godwin, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Presents information and data on rural hospitals and rural hospital finances. Compares insurance coverage of discharges and births, margins, and the impact of Medicaid expansion by hospitals' rural and urban location. Includes information on rural hospital closures and Medicare special payment designations for rural hospitals. Discusses the potential impacts of recent federal spending proposals on rural hospitals.
Author(s): Scott Hulver, Zachary Levinson, Jamie Godwin, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Sustaining Rural Hospital Access: Adjustments to Medicare Rural Hospital Designations
Describes the history of Medicare rural hospital designations. Discusses how traditional Medicare, Medicare Advantage, and Medicaid impact hospital finances. Outlines policy recommendations to the Secretary of Health and Human Services (HHS) and Congress regarding rural hospitals designations, payment adjustments, Medicare Advantage, and rural ambulance and emergency services.
Author(s): Emma Sheffert, Maya Sandalow
Date: 04/2025
Sponsoring organization: Bipartisan Policy Center
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Describes the history of Medicare rural hospital designations. Discusses how traditional Medicare, Medicare Advantage, and Medicaid impact hospital finances. Outlines policy recommendations to the Secretary of Health and Human Services (HHS) and Congress regarding rural hospitals designations, payment adjustments, Medicare Advantage, and rural ambulance and emergency services.
Author(s): Emma Sheffert, Maya Sandalow
Date: 04/2025
Sponsoring organization: Bipartisan Policy Center
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Evolving Remote Monitoring: An Evidence-Based Approach to Coverage and Payment
Reports on trends in utilization of remote patient monitoring (RPM) and discusses policy and payment approaches for effectively and efficiently utilizing RPM, particularly via Medicare and Medicaid. Includes data and discussion of rural barriers to RPM access.
Date: 04/2025
Sponsoring organization: Peterson Center on Healthcare
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Reports on trends in utilization of remote patient monitoring (RPM) and discusses policy and payment approaches for effectively and efficiently utilizing RPM, particularly via Medicare and Medicaid. Includes data and discussion of rural barriers to RPM access.
Date: 04/2025
Sponsoring organization: Peterson Center on Healthcare
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