Rural Health
Resources by Topic: Reimbursement and payment models
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
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
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
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
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
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
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
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
Sponsoring organization: Government Accountability Office
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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
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
Sponsoring organization: Government Accountability Office
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Using Telehealth to Support Opioid Use Disorder Treatment
Provides an issue brief on how telehealth can increase access to medication-assisted treatment (MAT) for opioid use disorder (OUD). Addresses how telehealth is used, implemented, and reimbursed, highlighting the implications for MAT.
Date: 11/2018
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Provides an issue brief on how telehealth can increase access to medication-assisted treatment (MAT) for opioid use disorder (OUD). Addresses how telehealth is used, implemented, and reimbursed, highlighting the implications for MAT.
Date: 11/2018
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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The Rural Hospital and Health System Affiliation Landscape - A Brief Review
Describes choices available to rural hospitals and health systems when considering affiliations with urban-based hospitals, examines motivations for these affiliations, and presents a list of some affiliation structures with examples. Features statistics showing trends in hospital system affiliation by census region from 2007-2016, with breakdowns by metropolitan and nonmetropolitan hospitals and nonmetropolitan Critical Access Hospitals.
Author(s): Onyinye Oyeka, Fred Ullrich, A. Clinton MacKinney, Joseph Lupica, Keith J. Mueller
Date: 11/2018
Sponsoring organization: Rural Policy Research Institute
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Describes choices available to rural hospitals and health systems when considering affiliations with urban-based hospitals, examines motivations for these affiliations, and presents a list of some affiliation structures with examples. Features statistics showing trends in hospital system affiliation by census region from 2007-2016, with breakdowns by metropolitan and nonmetropolitan hospitals and nonmetropolitan Critical Access Hospitals.
Author(s): Onyinye Oyeka, Fred Ullrich, A. Clinton MacKinney, Joseph Lupica, Keith J. Mueller
Date: 11/2018
Sponsoring organization: Rural Policy Research Institute
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Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments
Reports on 41 examinations of wage data of individual acute care hospitals from 2004 to 2017 to describe significant vulnerabilities observed in the wage index system for Medicare payments. Includes discussion on the rural floor wage index and the effects it has on wage index accuracy. Offers recommendations to reform the hospital wage index system.
Date: 11/2018
Sponsoring organization: Office of Inspector General (HHS)
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Reports on 41 examinations of wage data of individual acute care hospitals from 2004 to 2017 to describe significant vulnerabilities observed in the wage index system for Medicare payments. Includes discussion on the rural floor wage index and the effects it has on wage index accuracy. Offers recommendations to reform the hospital wage index system.
Date: 11/2018
Sponsoring organization: Office of Inspector General (HHS)
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Report to Congress: Rural Community Hospital Demonstration
Summarizes findings from the Rural Community Hospital Demonstration (RCHD) over the twelve years authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the Patient Protection and Affordable Care Act (ACA). Reports on the characteristics of the participating hospitals and the effect of the demonstration on hospital finances and other outcomes. Also discusses steps the hospitals expected to take at the end of the demonstration, if it had not been extended for an additional five years by the 21st Century Cures Act of 2016.
Date: 10/2018
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes findings from the Rural Community Hospital Demonstration (RCHD) over the twelve years authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the Patient Protection and Affordable Care Act (ACA). Reports on the characteristics of the participating hospitals and the effect of the demonstration on hospital finances and other outcomes. Also discusses steps the hospitals expected to take at the end of the demonstration, if it had not been extended for an additional five years by the 21st Century Cures Act of 2016.
Date: 10/2018
Sponsoring organization: Centers for Medicare and Medicaid Services
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MedPAC Comment on CMS's Proposed Rule on Medicare Shared Savings Program ACOs
Comments on an August 17, 2018, Federal Register proposed rule changing the Medicare Shared Savings Program (MSSP). Focuses on the proposed changes for Accountable Care Organizations (ACOs), including a move to two-sided risk models, using regional spending benchmarks, and more. Addresses potential impacts for small ACOs, which include rural ACOs.
Date: 10/2018
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on an August 17, 2018, Federal Register proposed rule changing the Medicare Shared Savings Program (MSSP). Focuses on the proposed changes for Accountable Care Organizations (ACOs), including a move to two-sided risk models, using regional spending benchmarks, and more. Addresses potential impacts for small ACOs, which include rural ACOs.
Date: 10/2018
Sponsoring organization: Medicare Payment Advisory Commission
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