Rural Health
Resources by Topic: Reimbursement and payment models
Why Primary Care Practitioners Aren't Joining Value-Based Payment Models: Reasons and Potential Solutions
Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Type: Document
Sponsoring organization: Commonwealth Fund
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Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Type: Document
Sponsoring organization: Commonwealth Fund
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Proposed CY 2025 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering proposed Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the calendar year (CY) 2025 Physician Fee Schedule proposed rule. Covers proposals related to audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Fact sheet covering proposed Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the calendar year (CY) 2025 Physician Fee Schedule proposed rule. Covers proposals related to audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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MedPAC Data Book: Health Care Spending and the Medicare Program, 2024
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures.
Date: 07/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures.
Date: 07/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Positioning Telehealth Policy to Ensure High-Quality, Cost-Effective Care
Presents policy recommendations and suggestions to guide policymakers when considering the future of telehealth. Analyzes peer-reviewed research; government reports; and findings from interviews with payers, providers, provider associations, federal agencies, consumer advocates, technology leaders, policy experts, and other stakeholders. Includes rural references and considerations throughout.
Author(s): Maya Sandalow, Julia Harris, Mikayla Curtis, Marilyn Werber Serafini
Date: 07/2024
Type: Document
Sponsoring organization: Bipartisan Policy Center
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Presents policy recommendations and suggestions to guide policymakers when considering the future of telehealth. Analyzes peer-reviewed research; government reports; and findings from interviews with payers, providers, provider associations, federal agencies, consumer advocates, technology leaders, policy experts, and other stakeholders. Includes rural references and considerations throughout.
Author(s): Maya Sandalow, Julia Harris, Mikayla Curtis, Marilyn Werber Serafini
Date: 07/2024
Type: Document
Sponsoring organization: Bipartisan Policy Center
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How Payment Caps Can Reduce Hospital Prices and Spending: Lessons from the Oregon State Employee Plan
Report discusses how policy changes to state employee insurance plans affected healthcare costs in Oregon. Details Oregon's plan to place payment caps tied to Medicare reimbursement rates and exceptions for rural and Critical Access Hospitals.
Author(s): Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan
Date: 07/2024
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Report discusses how policy changes to state employee insurance plans affected healthcare costs in Oregon. Details Oregon's plan to place payment caps tied to Medicare reimbursement rates and exceptions for rural and Critical Access Hospitals.
Author(s): Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan
Date: 07/2024
Type: Document
Sponsoring organization: Milbank Memorial Fund
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CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS 1809-P)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding updates and changes to the Medicare payments for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2025. Summarizes provisions regarding changes to Intensive Outpatient Program (IOP) and partial hospital program rate setting; a proposal to include an add-on payment to the Medicare outpatient hospital all-inclusive rate (AIR) for certain high-cost drugs for people with Medicare who receive care at Indian Health Service (IHS) or tribal hospitals; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; a proposal for new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services; Medicaid and CHIP continuous eligibility; Medicaid clinic services "four walls" exceptions; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding updates and changes to the Medicare payments for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2025. Summarizes provisions regarding changes to Intensive Outpatient Program (IOP) and partial hospital program rate setting; a proposal to include an add-on payment to the Medicare outpatient hospital all-inclusive rate (AIR) for certain high-cost drugs for people with Medicare who receive care at Indian Health Service (IHS) or tribal hospitals; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; a proposal for new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services; Medicaid and CHIP continuous eligibility; Medicaid clinic services "four walls" exceptions; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Calendar Year (CY) 2025 Medicare Physician Fee Schedule Proposed Rule
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2025. Summarizes provisions related to telehealth services; advanced primary care management services; behavioral health services; opioid treatment programs; dental and oral health services; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Conditions for Coverage, care coordination services, telecommunication services, payment for vaccine costs, intensive outpatient program (IOP) services; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2025. Summarizes provisions related to telehealth services; advanced primary care management services; behavioral health services; opioid treatment programs; dental and oral health services; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Conditions for Coverage, care coordination services, telecommunication services, payment for vaccine costs, intensive outpatient program (IOP) services; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Describes the estimated impact of three major Medicare home health payment policy changes - implementation of the Patient-Driven Groupings Model (PDGM), revisions to rural add-on payments, and the demonstration and nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) model - on home health agency (HHA) reimbursement for Medicare beneficiaries. Compares the estimated impact of these payment policy changes by HHA rural-serving status, U. S. Census Division, profit status, quality rating, and episode volume.
Author(s): Tracy M. Mroz, Lisa A. Garberson, C. Holly A. Andrilla, Davis G. Patterson
Date: 07/2024
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Describes the estimated impact of three major Medicare home health payment policy changes - implementation of the Patient-Driven Groupings Model (PDGM), revisions to rural add-on payments, and the demonstration and nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) model - on home health agency (HHA) reimbursement for Medicare beneficiaries. Compares the estimated impact of these payment policy changes by HHA rural-serving status, U. S. Census Division, profit status, quality rating, and episode volume.
Author(s): Tracy M. Mroz, Lisa A. Garberson, C. Holly A. Andrilla, Davis G. Patterson
Date: 07/2024
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Disruptors, Essential Services, and Reflections on a Career in Rural Health, with John Supplitt
An episode of the Exploring Rural Health podcast featuring John Supplitt, Senior Director of Rural Health Services for the American Hospital Association. Focuses on the importance of maintaining rural essential services, along with insights from Supplitt's long career in rural health.
Date: 07/2024
Type: Audio
Sponsoring organization: Rural Health Information Hub
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An episode of the Exploring Rural Health podcast featuring John Supplitt, Senior Director of Rural Health Services for the American Hospital Association. Focuses on the importance of maintaining rural essential services, along with insights from Supplitt's long career in rural health.
Date: 07/2024
Type: Audio
Sponsoring organization: Rural Health Information Hub
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Report to the Secretary of Health and Human Services: Encouraging Rural Participation in Population-Based Total Cost of Care (PB-TCOC) Models
Summarizes findings from the Physician-Focused Payment Model Technical Advisory Committee's (PTAC) review of information on best practices for addressing rural health challenges and encouraging rural participation in value-based care and PB-TCOC models. Describes the importance of addressing challenges affecting patients and providers in rural communities, developing financial incentives and glide paths to encourage rural participation in value-based care, and measuring and incentivizing value-based care and social determinants of health for patients in rural areas. Identifies areas where areas where additional research is needed, considerations for policymakers, and potential next steps.
Date: 06/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Summarizes findings from the Physician-Focused Payment Model Technical Advisory Committee's (PTAC) review of information on best practices for addressing rural health challenges and encouraging rural participation in value-based care and PB-TCOC models. Describes the importance of addressing challenges affecting patients and providers in rural communities, developing financial incentives and glide paths to encourage rural participation in value-based care, and measuring and incentivizing value-based care and social determinants of health for patients in rural areas. Identifies areas where areas where additional research is needed, considerations for policymakers, and potential next steps.
Date: 06/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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