Rural Health
Resources by Topic: Reimbursement and payment models
California Federally Qualified Health Center Alternative Payment Model Implementation Guide
Provides an overview on how the California Federally Qualified Health Center Alternative Payment Model (FQHC APM) may impact FQHCs and how facilities can prepare for the transition. Discusses the financial impact of the FQHC APM and assists facilities and staff in setting priorities, determining staffing needs, understanding necessary data collection, building staff competencies, and more.
Author(s): Greg Howe, Karla Silverman, Rob Houston
Date: 03/2023
Sponsoring organizations: California Health Care Foundation, Center for Health Care Strategies
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Provides an overview on how the California Federally Qualified Health Center Alternative Payment Model (FQHC APM) may impact FQHCs and how facilities can prepare for the transition. Discusses the financial impact of the FQHC APM and assists facilities and staff in setting priorities, determining staffing needs, understanding necessary data collection, building staff competencies, and more.
Author(s): Greg Howe, Karla Silverman, Rob Houston
Date: 03/2023
Sponsoring organizations: California Health Care Foundation, Center for Health Care Strategies
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Financial Risk Acceptance among Rural Health Care Providers Participating in the Quality Payment Program
Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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MedPAC Report to the Congress: Medicare Payment Policy, 2023
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 healthcare facilities and services; Medicare Advantage (MA), including a mandated report comparing per enrollee spending in the MA program with that of traditional fee-for-service (FFS) Medicare; and Medicare Part D.
Date: 03/2023
Sponsoring organization: Medicare Payment Advisory Commission
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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 healthcare facilities and services; Medicare Advantage (MA), including a mandated report comparing per enrollee spending in the MA program with that of traditional fee-for-service (FFS) Medicare; and Medicare Part D.
Date: 03/2023
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress on Medicaid and CHIP, March 2023
Reports on four aspects of Medicaid: 1) collecting and reporting Medicaid race and ethnicity data, 2) increasing the transparency and improving the collection of nursing facility payment data, 3) strengthening evidence under Medicaid drug coverage, and 4) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 4 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 number of hospitals with high levels of uncompensated care that also provide essential community services. Table 4-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2023
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Reports on four aspects of Medicaid: 1) collecting and reporting Medicaid race and ethnicity data, 2) increasing the transparency and improving the collection of nursing facility payment data, 3) strengthening evidence under Medicaid drug coverage, and 4) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 4 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 number of hospitals with high levels of uncompensated care that also provide essential community services. Table 4-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2023
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Use of Telemedicine among Office-Based Physicians, 2021
Details the usage of telemedicine by physicians who are office-based, self-employed or employed by a health system, including their specialty, participation in payment models, satisfaction with telemedicine, and continued use post-pandemic. Provides data on rural and urban physician use of telemedicine tools and platforms integrated with electronic health records (EHR).
Author(s): Yuriy Pylypchuk, Wesley Barker
Citation: ONC Data Brief, 65
Date: 03/2023
Sponsoring organization: Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology
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Details the usage of telemedicine by physicians who are office-based, self-employed or employed by a health system, including their specialty, participation in payment models, satisfaction with telemedicine, and continued use post-pandemic. Provides data on rural and urban physician use of telemedicine tools and platforms integrated with electronic health records (EHR).
Author(s): Yuriy Pylypchuk, Wesley Barker
Citation: ONC Data Brief, 65
Date: 03/2023
Sponsoring organization: Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology
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RHCs & the Medicare Shared Savings Program - What You Need to Know
Recording of a March 7, 2023, webinar providing an overview of the transition to value-based care, Accountable Care Organizations, and the Medicare Shared Savings Program. Discusses considerations for Rural Health Clinic participation in the Shared Savings Program. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides, Transcript
Date: 03/2023
Sponsoring organization: National Association of Rural Health Clinics
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Recording of a March 7, 2023, webinar providing an overview of the transition to value-based care, Accountable Care Organizations, and the Medicare Shared Savings Program. Discusses considerations for Rural Health Clinic participation in the Shared Savings Program. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides, Transcript
Date: 03/2023
Sponsoring organization: National Association of Rural Health Clinics
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Rural Track Program Funding: An Erosion in Definitions of Rural Places Requires New Action
Policy position paper discussing graduate medical education (GME) in rural areas. Discusses policy changes to rural hospital classification and the impact of these changes on rural GME and rural training track programs.
Date: 03/2023
Sponsoring organization: National Rural Health Association
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Policy position paper discussing graduate medical education (GME) in rural areas. Discusses policy changes to rural hospital classification and the impact of these changes on rural GME and rural training track programs.
Date: 03/2023
Sponsoring organization: National Rural Health Association
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CMS Bundled Payments for Care Improvement Advanced Model: Fourth Evaluation Report
Fourth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Explores the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 3. Analyzes BPCI Advanced outcomes for beneficiaries from underserved communities, including beneficiaries in rural areas and areas with a high Area Deprivation Index (ADI).
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2023
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fourth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Explores the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 3. Analyzes BPCI Advanced outcomes for beneficiaries from underserved communities, including beneficiaries in rural areas and areas with a high Area Deprivation Index (ADI).
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2023
Sponsoring organization: Centers for Medicare and Medicaid Services
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Obstetric Readiness in Rural Communities Lacking Hospital Labor and Delivery Units
Policy brief discussing the current rural maternal healthcare workforce and their capacity to manage obstetric emergencies during pregnancy, labor, and delivery. Offers recommendations to promote obstetric readiness for emergency care in rural hospitals without obstetric units and support for community-based, emergency department-adjacent health workers.
Author(s): Eneka Lamb, Madeline Merwin, Quinyatta Mumford, et al.
Date: 02/2023
Sponsoring organization: National Rural Health Association
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Policy brief discussing the current rural maternal healthcare workforce and their capacity to manage obstetric emergencies during pregnancy, labor, and delivery. Offers recommendations to promote obstetric readiness for emergency care in rural hospitals without obstetric units and support for community-based, emergency department-adjacent health workers.
Author(s): Eneka Lamb, Madeline Merwin, Quinyatta Mumford, et al.
Date: 02/2023
Sponsoring organization: National Rural Health Association
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Modernizing Payment to Critical Access Hospitals: A Proposal for the Next Iteration of the Flex Program
Commentary briefly describing the history the Medicare Rural Hospital Flexibility Program (Flex) and Cost-Based Reimbursement (CBR) for Medicare. Outlines the challenges of CBR for Critical Access Hospitals (CAH) and proposes a new payment system.
Author(s): Clint MacKinney, Keith Mueller, Alva Ferdinand, et al.
Citation: Journal of Rural Health, 39(4), 716-718
Date: 02/2023
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Commentary briefly describing the history the Medicare Rural Hospital Flexibility Program (Flex) and Cost-Based Reimbursement (CBR) for Medicare. Outlines the challenges of CBR for Critical Access Hospitals (CAH) and proposes a new payment system.
Author(s): Clint MacKinney, Keith Mueller, Alva Ferdinand, et al.
Citation: Journal of Rural Health, 39(4), 716-718
Date: 02/2023
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