Rural Health
Resources by Topic: Reimbursement and payment models
Social Determinants of Health
Policy brief informed by a September 2016 National Advisory Committee on Rural Health and Human Services meeting held in Albuquerque, New Mexico, with site visits to update the committee about factors that affect health outcomes. Identifies emerging payment models and financing strategies, and provides policy recommendations for addressing the social determinants of health in rural communities.
Date: 01/2017
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Policy brief informed by a September 2016 National Advisory Committee on Rural Health and Human Services meeting held in Albuquerque, New Mexico, with site visits to update the committee about factors that affect health outcomes. Identifies emerging payment models and financing strategies, and provides policy recommendations for addressing the social determinants of health in rural communities.
Date: 01/2017
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Accounting for Social Risk Factors in Medicare Payment
Fifth and final report in a series designed to identify social risk factors that affect the health outcomes of Medicare beneficiaries and methods to account for these factors in Medicare payment programs. Offers thoughts about selecting the best methods to account for social risk factors and achieve policy goals. Chapter 2 includes a discussion about urbanicity and rurality, and suggests that a beneficiary's place of residence is a stronger indicator of social risk than their provider's location. Report was assembled by an ad hoc committee under the direction of the U.S. Department of Health and Human Services, Office of the Assistant Secretary of Planning and Evaluation.
Additional links: Read Online
Author(s): Committee on Accounting for Socioeconomic Status in Medicare Payment Programs
Date: 01/2017
Type: Document
Sponsoring organization: Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
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Fifth and final report in a series designed to identify social risk factors that affect the health outcomes of Medicare beneficiaries and methods to account for these factors in Medicare payment programs. Offers thoughts about selecting the best methods to account for social risk factors and achieve policy goals. Chapter 2 includes a discussion about urbanicity and rurality, and suggests that a beneficiary's place of residence is a stronger indicator of social risk than their provider's location. Report was assembled by an ad hoc committee under the direction of the U.S. Department of Health and Human Services, Office of the Assistant Secretary of Planning and Evaluation.
Additional links: Read Online
Author(s): Committee on Accounting for Socioeconomic Status in Medicare Payment Programs
Date: 01/2017
Type: Document
Sponsoring organization: Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
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State Law Fact Sheet: A Summary of State Community Health Worker Laws
Details the state laws pertaining to Community Health Workers as of June 30, 2016. Includes laws defining scope of practice, team-based care models, reimbursement, and the core certification process.
Date: 2017
Type: Document
Sponsoring organization: Centers for Disease Control and Prevention
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Details the state laws pertaining to Community Health Workers as of June 30, 2016. Includes laws defining scope of practice, team-based care models, reimbursement, and the core certification process.
Date: 2017
Type: Document
Sponsoring organization: Centers for Disease Control and Prevention
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Center for Medicare and Medicaid Innovation: Report to Congress
Details the activities and progress of the CMS Innovation Center, focusing on the time period between October 1, 2014, and September 30, 2016. Includes updates on multiple rural-relevant models and initiatives such as the Accountable Care Organization Investment Model, Health Care Innovation Awards, and the Strong Start for Mothers and Newborns initiative.
Date: 12/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Details the activities and progress of the CMS Innovation Center, focusing on the time period between October 1, 2014, and September 30, 2016. Includes updates on multiple rural-relevant models and initiatives such as the Accountable Care Organization Investment Model, Health Care Innovation Awards, and the Strong Start for Mothers and Newborns initiative.
Date: 12/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Report to Congress: Social Risk Factors and Performance Under Medicare's Value-Based Purchasing Program
Uses Medicare data to examine the relationship between social risk factors and the performance of value-based purchasing programs. Discusses policy considerations that could help ensure value-based purchasing programs achieve their intended results, especially among high social risk populations. Categorizes rurality as a community risk factor and discusses whether beneficiaries with social risk factors such as rurality have worse outcomes due to their social risk profile, or because of the providers they see. Also provides rural-specific statistics and recommendations for using value-based purchasing to improve health outcomes among high social risk populations. Appendices summarize and provide additional details for each of the 9 programs evaluated. See the second report.
Additional links: Appendices
Date: 12/2016
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Uses Medicare data to examine the relationship between social risk factors and the performance of value-based purchasing programs. Discusses policy considerations that could help ensure value-based purchasing programs achieve their intended results, especially among high social risk populations. Categorizes rurality as a community risk factor and discusses whether beneficiaries with social risk factors such as rurality have worse outcomes due to their social risk profile, or because of the providers they see. Also provides rural-specific statistics and recommendations for using value-based purchasing to improve health outcomes among high social risk populations. Appendices summarize and provide additional details for each of the 9 programs evaluated. See the second report.
Additional links: Appendices
Date: 12/2016
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Medicare Value-Based Payment Models: Participation Challenges and Available Assistance for Small and Rural Practices
Identifies challenges faced by small and rural physician practices when participating in Medicare's new value-based payment models, and groups them into five key areas: financial resources and risk management, health IT and data, population health management care delivery, quality and efficiency performance measurement and reporting, and effects of model participation and managing compliance with requirements. Also identifies two types of organizations, partner and non-partner, along with the services they provide, that can help small and rural practices overcome these challenges.
Additional links: Full Report
Date: 12/2016
Type: Document
Sponsoring organization: Government Accountability Office
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Identifies challenges faced by small and rural physician practices when participating in Medicare's new value-based payment models, and groups them into five key areas: financial resources and risk management, health IT and data, population health management care delivery, quality and efficiency performance measurement and reporting, and effects of model participation and managing compliance with requirements. Also identifies two types of organizations, partner and non-partner, along with the services they provide, that can help small and rural practices overcome these challenges.
Additional links: Full Report
Date: 12/2016
Type: Document
Sponsoring organization: Government Accountability Office
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Freestanding Emergency Departments: An Alternative Model for Rural Communities
Describes the freestanding emergency department (FSED) model as an option for rural communities that can no longer support inpatient services. Looks at both hospital-based and independent FSEDs, examines financial viability of the model, and features rural FSEDs in Illinois and Arizona.
Author(s): Jenn Lukens
Citation: Rural Monitor
Date: 11/2016
Type: Document
Sponsoring organization: Rural Health Information Hub
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Describes the freestanding emergency department (FSED) model as an option for rural communities that can no longer support inpatient services. Looks at both hospital-based and independent FSEDs, examines financial viability of the model, and features rural FSEDs in Illinois and Arizona.
Author(s): Jenn Lukens
Citation: Rural Monitor
Date: 11/2016
Type: Document
Sponsoring organization: Rural Health Information Hub
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The Financial Importance of the Sole Community Hospital Payment Designation
Investigates the economic importance of the Sole Community Hospital (SCH) program by reviewing data between 2006 and 2015 regarding the proportion of SCHs reimbursed at the hospital-specific rate, and their profitability of providing services to Medicare patients. Also, discusses the economic consequences that would occur if the SCH program was not in operation in 2015.
Author(s): Sharita R. Thomas, Randy Randolph, G. Mark Holmes, George H. Pink
Date: 11/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Investigates the economic importance of the Sole Community Hospital (SCH) program by reviewing data between 2006 and 2015 regarding the proportion of SCHs reimbursed at the hospital-specific rate, and their profitability of providing services to Medicare patients. Also, discusses the economic consequences that would occur if the SCH program was not in operation in 2015.
Author(s): Sharita R. Thomas, Randy Randolph, G. Mark Holmes, George H. Pink
Date: 11/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Innovations in Rural Health System Development: Moving Rural Health Systems to Value-Based Payment
Offers examples of rural health system transformation models and strategies from Maine and other regions of the U.S. to assist rural communities in moving forward with value-based payment systems.
Author(s): Sara Kahn-Troster, Andrew Coburn
Date: 10/2016
Type: Document
Sponsoring organizations: Maine Health Access Foundation, Maine Rural Health Research Center
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Offers examples of rural health system transformation models and strategies from Maine and other regions of the U.S. to assist rural communities in moving forward with value-based payment systems.
Author(s): Sara Kahn-Troster, Andrew Coburn
Date: 10/2016
Type: Document
Sponsoring organizations: Maine Health Access Foundation, Maine Rural Health Research Center
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Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Readmission Rates: Implications for the Hospital Readmissions Reduction Program
Examines what would happen to hospitals' excess readmission ratios and potential penalties if socioeconomic status and race/ethnicity were added to the Centers for Medicare & Medicaid Services risk-adjustment algorithm. Includes information on potential change in penalties for metropolitan, micropolitan, and nonmetro hospitals.
Author(s): Grant R. Martsolf, Marguerite L. Barrett, Audrey J. Weiss, et al.
Citation: Inquiry, 53
Date: 10/2016
Type: Document
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Examines what would happen to hospitals' excess readmission ratios and potential penalties if socioeconomic status and race/ethnicity were added to the Centers for Medicare & Medicaid Services risk-adjustment algorithm. Includes information on potential change in penalties for metropolitan, micropolitan, and nonmetro hospitals.
Author(s): Grant R. Martsolf, Marguerite L. Barrett, Audrey J. Weiss, et al.
Citation: Inquiry, 53
Date: 10/2016
Type: Document
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