Rural Health
Resources by Topic: Reimbursement and payment models
2019 Telehealth Reimbursement
Provides an overview of Medicare reimbursement for telehealth services and discusses factors, policies, and legislation affecting reimbursement including: geographic and originating site restrictions; provider restrictions; service restrictions; payment for remote communication technology; chronic care management and remote monitoring; Medicare Advantage; Accountable Care Organizations, bundled care, and telehealth. Covers Medicaid and private payer telehealth reimbursement policies.
Date: 02/2019
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Provides an overview of Medicare reimbursement for telehealth services and discusses factors, policies, and legislation affecting reimbursement including: geographic and originating site restrictions; provider restrictions; service restrictions; payment for remote communication technology; chronic care management and remote monitoring; Medicare Advantage; Accountable Care Organizations, bundled care, and telehealth. Covers Medicaid and private payer telehealth reimbursement policies.
Date: 02/2019
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Illinois Critical Access Hospitals: Exploring the Financial Impacts of the Swing Bed Program
Examines the swing bed program in 30 Illinois Critical Access Hospitals (CAHs) by analyzing financial indicators, patient outcomes, and community benefits. Includes background information on the swing bed program and population data for rural Illinois. Covers demographic statistics for metro and nonmetro counties in 2010 and 2016.
Author(s): Melissa Henriksen, Brian Richard, Jeanna Ballard
Date: 02/2019
Type: Document
Sponsoring organizations: Illinois Critical Access Hospital Network, Northern Illinois University Center for Governmental Studies
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Examines the swing bed program in 30 Illinois Critical Access Hospitals (CAHs) by analyzing financial indicators, patient outcomes, and community benefits. Includes background information on the swing bed program and population data for rural Illinois. Covers demographic statistics for metro and nonmetro counties in 2010 and 2016.
Author(s): Melissa Henriksen, Brian Richard, Jeanna Ballard
Date: 02/2019
Type: Document
Sponsoring organizations: Illinois Critical Access Hospital Network, Northern Illinois University Center for Governmental Studies
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Rural Report: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-Quality, Affordable Care
Reports on continuing, current, and emerging challenges for rural hospitals working to provide access to healthcare services in rural communities. Includes discussion on policy recommendations to improve access and covers new models of care, reimbursement policies, regulatory requirements, telehealth, workforce issues, and prescription drug costs.
Additional links: Executive Summary, Infographic
Date: 02/2019
Type: Document
Sponsoring organization: American Hospital Association
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Reports on continuing, current, and emerging challenges for rural hospitals working to provide access to healthcare services in rural communities. Includes discussion on policy recommendations to improve access and covers new models of care, reimbursement policies, regulatory requirements, telehealth, workforce issues, and prescription drug costs.
Additional links: Executive Summary, Infographic
Date: 02/2019
Type: Document
Sponsoring organization: American Hospital Association
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Technical Assistance for Hospitals Applying to the Pennsylvania Rural Health Model — A CMMI-Sponsored Rural Hospital Global Budget Model
Describes the experiences of the Rural Health Value program in coaching hospitals in Pennsylvania that were interested in participating in a global budget model. Explains a process to quickly develop a plan focused on community health rather than exclusively on clinical services, to facilitate the transition from volume to value.
Date: 2019
Type: Document
Sponsoring organization: Rural Health Value
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Describes the experiences of the Rural Health Value program in coaching hospitals in Pennsylvania that were interested in participating in a global budget model. Explains a process to quickly develop a plan focused on community health rather than exclusively on clinical services, to facilitate the transition from volume to value.
Date: 2019
Type: Document
Sponsoring organization: Rural Health Value
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State Innovation Models (SIM) Round 2: Model Test Annual Report Three
Third annual report on the Round 2 State Innovation Models (SIM) program across eleven participating states - Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee, and Washington. Addresses the adoption of delivery models and payment reforms related to value-based payment (VBP) and alternative payment models (APMs). Offers an update and lessons learned on strategies to support healthcare delivery transformation related to behavioral health integration, data for improving health care quality and performance, health information technology, care coordination, and workforce development. Describes states' population health activities. Includes discussion of rural issues throughout the report.
Additional links: Findings at a Glance
Date: 2019
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Third annual report on the Round 2 State Innovation Models (SIM) program across eleven participating states - Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee, and Washington. Addresses the adoption of delivery models and payment reforms related to value-based payment (VBP) and alternative payment models (APMs). Offers an update and lessons learned on strategies to support healthcare delivery transformation related to behavioral health integration, data for improving health care quality and performance, health information technology, care coordination, and workforce development. Describes states' population health activities. Includes discussion of rural issues throughout the report.
Additional links: Findings at a Glance
Date: 2019
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Perspectives of Physicians in Small Rural Practices on the Medicare Quality Payment Program
Provides feedback from small, rural practices on the implementation of Medicare's Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Identifies challenges rural physicians face and offers recommendations to help more small practices participate in the program.
Author(s): Peter Mendel, Christine Buttorff, Peggy G. Chen, et al.
Date: 2019
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Corporation
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Provides feedback from small, rural practices on the implementation of Medicare's Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Identifies challenges rural physicians face and offers recommendations to help more small practices participate in the program.
Author(s): Peter Mendel, Christine Buttorff, Peggy G. Chen, et al.
Date: 2019
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Corporation
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State Innovation Models (SIM) Initiative Evaluation: Model Test Year Five Annual Report
Fifth annual report on Round 1 of the CMS State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont - to move providers to value-based payment models (VPMs). Presents the final summary findings for SIM Round 1. Includes information specific to rural areas.
Additional links: Appendices, Findings at a Glance
Date: 12/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Fifth annual report on Round 1 of the CMS State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont - to move providers to value-based payment models (VPMs). Presents the final summary findings for SIM Round 1. Includes information specific to rural areas.
Additional links: Appendices, Findings at a Glance
Date: 12/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Medicare: Voluntary and Mandatory Episode-Based Payment Models and Their Participants
Reviews tests of 6 episode-based Medicare payment models. Describes the characteristics of providers that participated in these models, including rural or urban location, addresses factors affecting their decision to participate, and compares the advantages of mandatory versus voluntary participation.
Additional links: Full Report
Date: 12/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Reviews tests of 6 episode-based Medicare payment models. Describes the characteristics of providers that participated in these models, including rural or urban location, addresses factors affecting their decision to participate, and compares the advantages of mandatory versus voluntary participation.
Additional links: Full Report
Date: 12/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Assessing the Unintended Consequences of Health Policy on Rural Populations and Places
Explores health policies that have affected, or could potentially have affected, rural people, places, and providers, in ways that ran counter to policy intent. Examines 6 historical health policies and their effect on rural health systems. Includes a framework for analyzing policy impact on rural populations and places.
Author(s): Keith J. Mueller, Charlie Alfero, Andrew F. Coburn, et al.
Date: 12/2018
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Explores health policies that have affected, or could potentially have affected, rural people, places, and providers, in ways that ran counter to policy intent. Examines 6 historical health policies and their effect on rural health systems. Includes a framework for analyzing policy impact on rural populations and places.
Author(s): Keith J. Mueller, Charlie Alfero, Andrew F. Coburn, et al.
Date: 12/2018
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Medicare Fee-for-Service: Information on the Second Year of Nationwide Reduced Payment Rates for Durable Medical Equipment
Analyzes 2017 Medicare claims data to describe changes in the number of beneficiaries receiving and suppliers furnishing Medicare beneficiaries with rate-adjusted versus non-adjusted items in non-bid areas. Includes information on changes in rural and non-rural non-bid areas.
Additional links: Full Report
Date: 12/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Analyzes 2017 Medicare claims data to describe changes in the number of beneficiaries receiving and suppliers furnishing Medicare beneficiaries with rate-adjusted versus non-adjusted items in non-bid areas. Includes information on changes in rural and non-rural non-bid areas.
Additional links: Full Report
Date: 12/2018
Type: Document
Sponsoring organization: Government Accountability Office
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