Rural Health
Resources by Topic: Reimbursement and payment models
Medicare Payment Basics: Critical Access Hospitals Payment System
Presents an overview of Medicare payments for Critical Access Hospitals (CAHs). Compares differences in Medicare payments for CAHs, Sole Community Hospitals, and Medicare-Dependent Hospitals.
Date: 10/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Presents an overview of Medicare payments for Critical Access Hospitals (CAHs). Compares differences in Medicare payments for CAHs, Sole Community Hospitals, and Medicare-Dependent Hospitals.
Date: 10/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Exploring Patient Care Navigation in the Medicare Program
Presents an overview of patient navigation programs through an environmental scan of literature published between 2013 and 2023 and discussions with key informants at four healthcare organizations. Describes the variety of patient navigation services, types of patients targeted, settings that offer navigation services, staffing, funding, clinical outcomes, and more. Includes a brief discussion of programs targeting patients in rural areas. Identifies implementation and policy considerations and potential barriers to supporting patient navigation services.
Additional links: Annex, Executive Summary
Author(s): Zachary Predmore, Joachim Hero, Stephanie Dellva, et al.
Date: 09/2023
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Health Care
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Presents an overview of patient navigation programs through an environmental scan of literature published between 2013 and 2023 and discussions with key informants at four healthcare organizations. Describes the variety of patient navigation services, types of patients targeted, settings that offer navigation services, staffing, funding, clinical outcomes, and more. Includes a brief discussion of programs targeting patients in rural areas. Identifies implementation and policy considerations and potential barriers to supporting patient navigation services.
Additional links: Annex, Executive Summary
Author(s): Zachary Predmore, Joachim Hero, Stephanie Dellva, et al.
Date: 09/2023
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Health Care
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Environmental Scan on Encouraging Rural Participation in Population-Based TCOC Models
Presents results of an environmental scan regarding population-based total cost of care (PB-TCOC) payment models and encouraging rural participation in these models. Describes challenges affecting rural patients and providers; opportunities for alternative payment models (APMs) and PB-TCOC models to address challenges in rural areas; trends in rural providers' participation in APMs; driving care delivery transformation in rural providers, including models that include or target rural participants in their model designs; leveraging financial incentives to improve rural health care; adoption and use of health information technology, including telehealth and data analytics among rural providers; and the measurement of rural providers' performance in APMs.
Date: 09/2023
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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Presents results of an environmental scan regarding population-based total cost of care (PB-TCOC) payment models and encouraging rural participation in these models. Describes challenges affecting rural patients and providers; opportunities for alternative payment models (APMs) and PB-TCOC models to address challenges in rural areas; trends in rural providers' participation in APMs; driving care delivery transformation in rural providers, including models that include or target rural participants in their model designs; leveraging financial incentives to improve rural health care; adoption and use of health information technology, including telehealth and data analytics among rural providers; and the measurement of rural providers' performance in APMs.
Date: 09/2023
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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Sustaining Essential Rural Health Services Through Changes in Payment and Related Public Policies
Presentation slides that discuss payment policies and models, Medicare and Medicaid, Accountable Care Organizations (ACOs), commercial plans, value-based care, and more, with data and maps illustrating impacts in specific areas.
Author(s): Keith J. Mueller
Date: 09/2023
Type: Presentation Slides
Sponsoring organizations: Iowa Department of Health Management and Policy, Rural Policy Research Institute
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Presentation slides that discuss payment policies and models, Medicare and Medicaid, Accountable Care Organizations (ACOs), commercial plans, value-based care, and more, with data and maps illustrating impacts in specific areas.
Author(s): Keith J. Mueller
Date: 09/2023
Type: Presentation Slides
Sponsoring organizations: Iowa Department of Health Management and Policy, Rural Policy Research Institute
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MedPAC Response to a Congressional Request for Information on Improving Access to Health Care in Rural and Underserved Areas
Letter to the House Committee on Ways and Means request for information on improving access to healthcare in rural and underserved areas. Covers MedPAC recommendations for policies to target payments to better support rural and vulnerable beneficiaries' access to care, including the Rural Emergency Hospital program and a proposed Medicare Safety-Net Index; changes to the hospital wage index to address geographic inequities; and the alignment of payment rates across ambulatory settings for certain services.
Date: 09/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Letter to the House Committee on Ways and Means request for information on improving access to healthcare in rural and underserved areas. Covers MedPAC recommendations for policies to target payments to better support rural and vulnerable beneficiaries' access to care, including the Rural Emergency Hospital program and a proposed Medicare Safety-Net Index; changes to the hospital wage index to address geographic inequities; and the alignment of payment rates across ambulatory settings for certain services.
Date: 09/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Merit-Based Incentive Payment System (MIPS): Small Practice Countdown to Performance Year 2023 Data Submission Checklist
Checklist outlining the steps small practices must follow to submit Merit-based Incentive Payment System (MIPS) 2023 performance year data. Highlights key dates and links to key resources for small practices.
Date: 09/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Checklist outlining the steps small practices must follow to submit Merit-based Incentive Payment System (MIPS) 2023 performance year data. Highlights key dates and links to key resources for small practices.
Date: 09/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Health: Pathway to Progress
Presents insights and perspectives from four rural healthcare leaders. Describes strategies for overcoming workforce challenges, increasing access to specialty care, and addressing cost pressures. Requires registration to download.
Date: 09/2023
Type: Document
Sponsoring organization: Reuters Events
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Presents insights and perspectives from four rural healthcare leaders. Describes strategies for overcoming workforce challenges, increasing access to specialty care, and addressing cost pressures. Requires registration to download.
Date: 09/2023
Type: Document
Sponsoring organization: Reuters Events
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Assessing the Impact of Medicaid Telehealth Policy Change on Equitable Access to Telehealth Services in North Carolina
Describes the evolution of North Carolina's Medicaid telehealth coverage and reimbursement policies in response to the COVID-19 pandemic. Discusses the impact of these policies on access to care. Compares data on telehealth claims by volume and as a percentage of total claims by race and rural-urban residence between March 2020 and December 2022.
Author(s): Shannon Dowler, Sam Thompson, Michelle Savuto, Jacqueline Marks-Smith, Jared Augenstein
Date: 09/2023
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Describes the evolution of North Carolina's Medicaid telehealth coverage and reimbursement policies in response to the COVID-19 pandemic. Discusses the impact of these policies on access to care. Compares data on telehealth claims by volume and as a percentage of total claims by race and rural-urban residence between March 2020 and December 2022.
Author(s): Shannon Dowler, Sam Thompson, Michelle Savuto, Jacqueline Marks-Smith, Jared Augenstein
Date: 09/2023
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Aging in Place: The Vital Role of Home Health in Access to Care
Recording of a September 19, 2023, U.S. Senate Committee on Finance Subcommittee on Health Care hearing on access to home health services and the role of home health in supporting aging in place. Features testimony from Carrie Edwards, Director of Home Care Services at Mary Lanning Healthcare in rural Nebraska, and Tracy Mroz, Associate Professor at the University of Washington and Investigator at the WWAMI Rural Health Research Center.
Additional links: Carrie Edwards, Mary Lanning Healthcare - Testimony, Tracy M. Mroz, University of Washington - Testimony
Date: 09/2023
Type: Video/Multimedia
Sponsoring organization: Senate Committee on Finance, Subcommittee on Health Care
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Recording of a September 19, 2023, U.S. Senate Committee on Finance Subcommittee on Health Care hearing on access to home health services and the role of home health in supporting aging in place. Features testimony from Carrie Edwards, Director of Home Care Services at Mary Lanning Healthcare in rural Nebraska, and Tracy Mroz, Associate Professor at the University of Washington and Investigator at the WWAMI Rural Health Research Center.
Additional links: Carrie Edwards, Mary Lanning Healthcare - Testimony, Tracy M. Mroz, University of Washington - Testimony
Date: 09/2023
Type: Video/Multimedia
Sponsoring organization: Senate Committee on Finance, Subcommittee on Health Care
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The Pennsylvania Rural Health Model (PARHM): Third Annual Evaluation Report
Evaluates the third performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2021. Includes three case studies discussing three themes: the recruitment and retention of system-affiliated hospitals, engagement and coordination with community organizations and providers, and exploring service line changes.
Additional links: Appendix, Findings at a Glance
Date: 09/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the third performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2021. Includes three case studies discussing three themes: the recruitment and retention of system-affiliated hospitals, engagement and coordination with community organizations and providers, and exploring service line changes.
Additional links: Appendix, Findings at a Glance
Date: 09/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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