Rural Health
Resources by Topic: Reimbursement and payment models
Medicaid Managed Care and the Rural Exception: A Review of Issues and Perspectives from the Field
Analyzes Medicaid waivers through September 2017 to examine how state Medicaid procedures affect rural populations. Covers information gathered from State Offices of Rural Health (SORHs), state Medicaid offices, and other stakeholders to describe the process of waiver development.
Author(s): Janice C. Probst, Amy B. Martin, Victor Kirksey
Date: 05/2018
Type: Document
Sponsoring organization: Rural and Minority Health Research Center (formerly the South Carolina Rural Health Research Center)
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Analyzes Medicaid waivers through September 2017 to examine how state Medicaid procedures affect rural populations. Covers information gathered from State Offices of Rural Health (SORHs), state Medicaid offices, and other stakeholders to describe the process of waiver development.
Author(s): Janice C. Probst, Amy B. Martin, Victor Kirksey
Date: 05/2018
Type: Document
Sponsoring organization: Rural and Minority Health Research Center (formerly the South Carolina Rural Health Research Center)
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Changes in Hospital Utilization Three Years into Maryland's Global Budget Program for Rural Hospitals
Examines the impact of Maryland's global budget program for acute care hospitals, with a focus on Medicare beneficiaries served by rural hospitals. Compares changes in hospital use and hospital spending between the rural hospitals participating in the global budget program and a control group during a 3-year period. Discusses the policy implications for other states considering alternate payment models.
Author(s): Eric T. Roberts, Laura A. Hatfield, J. Michael McWilliams, et al.
Citation: Health Affairs, 37(4), 644-653
Date: 04/2018
Type: Document
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Examines the impact of Maryland's global budget program for acute care hospitals, with a focus on Medicare beneficiaries served by rural hospitals. Compares changes in hospital use and hospital spending between the rural hospitals participating in the global budget program and a control group during a 3-year period. Discusses the policy implications for other states considering alternate payment models.
Author(s): Eric T. Roberts, Laura A. Hatfield, J. Michael McWilliams, et al.
Citation: Health Affairs, 37(4), 644-653
Date: 04/2018
Type: Document
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Market Characteristics Associated with Rural Hospitals' Provision of Post-Acute Care
Findings brief summarizing hospital- and market-level factors related to post-acute care (PAC) provided in rural hospitals from 2012-2015. Features statistics from 2012-2015 rural Medicare cost reports, PAC provision by census region in 2015, and percent of hospitals in frontier and remote areas in 2015 with breakdowns by type and PAC provision.
Author(s): Abby F. Hoffman, Randy K. Randolph, Alex R. Schulte, George H. Pink
Date: 04/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Findings brief summarizing hospital- and market-level factors related to post-acute care (PAC) provided in rural hospitals from 2012-2015. Features statistics from 2012-2015 rural Medicare cost reports, PAC provision by census region in 2015, and percent of hospitals in frontier and remote areas in 2015 with breakdowns by type and PAC provision.
Author(s): Abby F. Hoffman, Randy K. Randolph, Alex R. Schulte, George H. Pink
Date: 04/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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CMS Innovation Center: Model Implementation and Center Performance
Examines the activities of the Centers for Medicare and Medicaid Services' Innovation Center. Discusses the Center's goals of identifying, testing, and improving payment and delivery models, while cutting healthcare costs and sharing best practices. Includes models tested in rural areas.
Additional links: Full Report
Date: 03/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Examines the activities of the Centers for Medicare and Medicaid Services' Innovation Center. Discusses the Center's goals of identifying, testing, and improving payment and delivery models, while cutting healthcare costs and sharing best practices. Includes models tested in rural areas.
Additional links: Full Report
Date: 03/2018
Type: Document
Sponsoring organization: Government Accountability Office
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State Innovation Models (SIM) Initiative Evaluation: Model Test Year Four Annual Report
Fourth 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). Describes the experiences of providers, health systems, consumers, payers, and state officials during the final full implementation year for most Round 1 states. Presents interim impacts on healthcare utilization, cost, and quality for individuals reached by SIM-supported VPMs during the SIM Initiative period. Includes information specific to rural areas.
Date: 03/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Fourth 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). Describes the experiences of providers, health systems, consumers, payers, and state officials during the final full implementation year for most Round 1 states. Presents interim impacts on healthcare utilization, cost, and quality for individuals reached by SIM-supported VPMs during the SIM Initiative period. Includes information specific to rural areas.
Date: 03/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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MedPAC Report to the Congress: Medicare Payment Policy, 2018
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses Medicare Part D, Medicare Advantage, telehealth, payment incentive programs, and payment adequacy for healthcare facilities and services.
Additional links: Chapter 14 Online-Only Appendixes: The Medicare Prescription Drug Program (Part D): Status Report (March 2018 Report, Revised June 25, 2018), Chapter 16 Online-Only Appendixes: Mandated Report: Telehealth Services and the Medicare Program (March 2018 report), Errata Sheet: Table 9-7, Page 255 (March 2018 Report, Revised May 30, 2018)
Date: 03/2018
Type: Document
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 Medicare Part D, Medicare Advantage, telehealth, payment incentive programs, and payment adequacy for healthcare facilities and services.
Additional links: Chapter 14 Online-Only Appendixes: The Medicare Prescription Drug Program (Part D): Status Report (March 2018 Report, Revised June 25, 2018), Chapter 16 Online-Only Appendixes: Mandated Report: Telehealth Services and the Medicare Program (March 2018 report), Errata Sheet: Table 9-7, Page 255 (March 2018 Report, Revised May 30, 2018)
Date: 03/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress on Medicaid and CHIP, March 2018
Reports on three aspects of Medicaid: managed care, telehealth, and Disproportionate Share Hospital (DSH) payments. Chapter 2 discusses how the use of telehealth services can help patients access healthcare services in rural and frontier areas. Chapter 3 includes the third annual report on DSH payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Table 3-2 identifies DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Reports on three aspects of Medicaid: managed care, telehealth, and Disproportionate Share Hospital (DSH) payments. Chapter 2 discusses how the use of telehealth services can help patients access healthcare services in rural and frontier areas. Chapter 3 includes the third annual report on DSH payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Table 3-2 identifies DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Behavioral Health Integration into Primary Care
Profile of a rural health system, Western Wisconsin Health (WWH), and its work to deliver behavioral health services. Provides an overview of how behavioral health providers and services were integrated with primary care, with a cultural change to focus on whole-person care. Includes information on Medicare and Medicaid reimbursement for the behavioral health services provided at WWH's Rural Health Clinic. Discusses how WWH behavioral health providers offer telehealth services to other rural areas of Wisconsin.
Date: 03/2018
Type: Document
Sponsoring organization: Rural Health Value
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Profile of a rural health system, Western Wisconsin Health (WWH), and its work to deliver behavioral health services. Provides an overview of how behavioral health providers and services were integrated with primary care, with a cultural change to focus on whole-person care. Includes information on Medicare and Medicaid reimbursement for the behavioral health services provided at WWH's Rural Health Clinic. Discusses how WWH behavioral health providers offer telehealth services to other rural areas of Wisconsin.
Date: 03/2018
Type: Document
Sponsoring organization: Rural Health Value
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Rural Health Care Costs: Are They Higher and Why Might They Differ from Urban Health Care Costs?
Explores issues surrounding healthcare costs and investigates differences between rural and urban expenditures. Includes statistics on Medicare fee-for-service expenditures in 2014 with breakdowns by metropolitan and non-metropolitan status.
Author(s): Dunc Williams, Mark Holmes
Citation: North Carolina Medical Journal, 79(1), 51-55
Date: 01/2018
Type: Document
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Explores issues surrounding healthcare costs and investigates differences between rural and urban expenditures. Includes statistics on Medicare fee-for-service expenditures in 2014 with breakdowns by metropolitan and non-metropolitan status.
Author(s): Dunc Williams, Mark Holmes
Citation: North Carolina Medical Journal, 79(1), 51-55
Date: 01/2018
Type: Document
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2018 OPPS Medicare Part B Payment Impact Analysis
Examines how changes to the CY 2018 Medicare Outpatient Prospective Payment System (OPPS) will impact hospitals' net Part B payments. Discusses the payment reduction for drugs purchased through the 340B Program and how the reduction will affect rural and urban hospitals. Includes a state-by-state analysis of aggregate impacts.
Additional links: Full Report
Date: 01/2018
Type: Document
Sponsoring organization: Avalere
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Examines how changes to the CY 2018 Medicare Outpatient Prospective Payment System (OPPS) will impact hospitals' net Part B payments. Discusses the payment reduction for drugs purchased through the 340B Program and how the reduction will affect rural and urban hospitals. Includes a state-by-state analysis of aggregate impacts.
Additional links: Full Report
Date: 01/2018
Type: Document
Sponsoring organization: Avalere
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