Rural Health
Resources by Topic: Reimbursement and payment models
Evaluation of the Rural Community Hospital Demonstration: Report Covering 2005-2017 (Interim Report 1)
Provides an overview of the Rural Community Hospital Demonstration (RCHD). Describes the characteristics of RCHD participants that entered the demonstration between 2005-2012, the Medicare payments received under program, and the impact of the RCHD on hospital finances between 2005-2017.
Additional links: Findings at a Glance
Date: 09/2021
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Rural Community Hospital Demonstration (RCHD). Describes the characteristics of RCHD participants that entered the demonstration between 2005-2012, the Medicare payments received under program, and the impact of the RCHD on hospital finances between 2005-2017.
Additional links: Findings at a Glance
Date: 09/2021
Sponsoring organization: Centers for Medicare and Medicaid Services
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MedPAC Comment on CMS's Proposed Rule on Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs for CY 2022
Comments on an August 4, 2021, Federal Register proposed rule revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2022. Includes considerations for Rural Emergency Hospital payments and emergency department staffing requirements.
Date: 09/2021
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on an August 4, 2021, Federal Register proposed rule revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2022. Includes considerations for Rural Emergency Hospital payments and emergency department staffing requirements.
Date: 09/2021
Sponsoring organization: Medicare Payment Advisory Commission
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Air Ambulance Use and Surprise Billing
Provides an overview of air ambulance services, including the types and number of air ambulance providers and suppliers, utilization rates by patients, average costs, and the potential for balance billing for air ambulance transport. Summarizes key policies and legislation related to air ambulances, including the No Surprises Act. Presents data on air ambulance utilization by rurality between 2014-2018.
Author(s): Gina Turrini, Joel Ruhter, Andre R. Chappel, Nancy De Lew
Date: 09/2021
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Provides an overview of air ambulance services, including the types and number of air ambulance providers and suppliers, utilization rates by patients, average costs, and the potential for balance billing for air ambulance transport. Summarizes key policies and legislation related to air ambulances, including the No Surprises Act. Presents data on air ambulance utilization by rurality between 2014-2018.
Author(s): Gina Turrini, Joel Ruhter, Andre R. Chappel, Nancy De Lew
Date: 09/2021
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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MedPAC Comment on CMS's Proposed Rule on the Physician Fee Schedule and Other Revisions to Part B for CY 2022
Comment on a July 23, 2021, Federal Register proposed rule revising the physician fee schedule to improve payment systems for physicians and other Medicare Part B revisions. Includes a discussion of the expansion of telehealth service coverage after the COVID-19 public health emergency, as well as reimbursement rates to Rural Health Clinics and Federally Qualified Health Centers for telehealth mental health services.
Date: 09/2021
Sponsoring organization: Medicare Payment Advisory Commission
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Comment on a July 23, 2021, Federal Register proposed rule revising the physician fee schedule to improve payment systems for physicians and other Medicare Part B revisions. Includes a discussion of the expansion of telehealth service coverage after the COVID-19 public health emergency, as well as reimbursement rates to Rural Health Clinics and Federally Qualified Health Centers for telehealth mental health services.
Date: 09/2021
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
Policy brief describing differences in Medicare Outpatient Prospective Payment System (OPPS) payments between urban and rural hospitals. Features statistics on OPPS payments as a percent of total net patient revenue, as a percent of Medicare outpatient cost by hospital payment classification, and as a percent of Medicare outpatient cost by number of acute beds, with breakdowns by urban and rural location.
Author(s): Pranathi Sana, George H. Pink
Date: 09/2021
Sponsoring organization: North Carolina Rural Health Research Program
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Policy brief describing differences in Medicare Outpatient Prospective Payment System (OPPS) payments between urban and rural hospitals. Features statistics on OPPS payments as a percent of total net patient revenue, as a percent of Medicare outpatient cost by hospital payment classification, and as a percent of Medicare outpatient cost by number of acute beds, with breakdowns by urban and rural location.
Author(s): Pranathi Sana, George H. Pink
Date: 09/2021
Sponsoring organization: North Carolina Rural Health Research Program
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A Qualitative Assessment of Barriers and Facilitators Associated with Addressing Social Determinants of Health among Members of a Health Collaborative in the Rural Midwest
Examines capacities and barriers in addressing social determinants of health for patients in rural Northeastern Minnesota and Northwestern Wisconsin based on interviews from 37 participants of a healthcare collaborative. Discusses specific needs of rural providers, including access to community-based social services, aligned payment models, and capacity for collaboration, among others.
Author(s): Kim Nichols Dauner, Lacey Loomer
Citation: BMC Health Services Research, 21
Date: 08/2021
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Examines capacities and barriers in addressing social determinants of health for patients in rural Northeastern Minnesota and Northwestern Wisconsin based on interviews from 37 participants of a healthcare collaborative. Discusses specific needs of rural providers, including access to community-based social services, aligned payment models, and capacity for collaboration, among others.
Author(s): Kim Nichols Dauner, Lacey Loomer
Citation: BMC Health Services Research, 21
Date: 08/2021
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Evaluation of the Vermont All-Payer Accountable Care Organization Model: First Evaluation Report
Evaluates the first two performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Includes information on hospital and provider participation in rural counties and unique challenges for rural Critical Access Hospitals.
Additional links: Findings at a Glance, Technical Appendices
Date: 08/2021
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the first two performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Includes information on hospital and provider participation in rural counties and unique challenges for rural Critical Access Hospitals.
Additional links: Findings at a Glance, Technical Appendices
Date: 08/2021
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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The Pennsylvania Rural Health Model (PARHM): First Annual Report
Evaluates the first 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 health care spending. Provides an overview of the model and describes the implementation experience of the first cohort of participating hospitals. Presents preliminary, descriptive data on the financial performance and utilization outcomes of Cohort 1 participants.
Additional links: Appendix, Findings at a Glance
Date: 08/2021
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the first 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 health care spending. Provides an overview of the model and describes the implementation experience of the first cohort of participating hospitals. Presents preliminary, descriptive data on the financial performance and utilization outcomes of Cohort 1 participants.
Additional links: Appendix, Findings at a Glance
Date: 08/2021
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Paying for Telemedicine in Smaller Rural Hospitals: Extending the Technology to Those Who Benefit Most
Viewpoint article discussing the positive financial impacts of telemedicine in emergency departments (EDs) and barriers to using telemedicine in small rural hospitals related to patient volume, high upfront costs, and reimbursement issues. Outlines policy interventions to support rural telemedicine.
Author(s): Kori S. Zachrison, Jessica V. Richard, Ateev Mehrotra
Citation: JAMA Health Forum, 2(8), e211570
Date: 08/2021
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Viewpoint article discussing the positive financial impacts of telemedicine in emergency departments (EDs) and barriers to using telemedicine in small rural hospitals related to patient volume, high upfront costs, and reimbursement issues. Outlines policy interventions to support rural telemedicine.
Author(s): Kori S. Zachrison, Jessica V. Richard, Ateev Mehrotra
Citation: JAMA Health Forum, 2(8), e211570
Date: 08/2021
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Primary Care Case Management in Medicaid: A Strategy for Supporting Primary Care in Rural Areas
Describes how Medicaid agencies in five states - Alabama, Colorado, Maine, Idaho, and Oklahoma - utilize primary care case management (PCCM) programs to strengthen primary care, particularly in rural areas. Identifies three strategies implemented by some or all of these states to support primary care providers, and highlights lessons learned for state Medicaid programs that want to strengthen primary care in rural areas.
Author(s): Neva Kaye
Date: 08/2021
Sponsoring organization: National Academy for State Health Policy
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Describes how Medicaid agencies in five states - Alabama, Colorado, Maine, Idaho, and Oklahoma - utilize primary care case management (PCCM) programs to strengthen primary care, particularly in rural areas. Identifies three strategies implemented by some or all of these states to support primary care providers, and highlights lessons learned for state Medicaid programs that want to strengthen primary care in rural areas.
Author(s): Neva Kaye
Date: 08/2021
Sponsoring organization: National Academy for State Health Policy
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