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Rural Health
Resources by Topic: Reimbursement and payment models

Global Budget Process as an Alternative Payment Model
Analyzes the all-payer hospital rate-setting system of McCready Health in rural Maryland. Discusses the Total Patient Revenue (TPR) system and corresponding essential functions such as rate setting, strategic planning, and care coordination.
Date: 03/2017
Type: Document
Sponsoring organization: Rural Health Value
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MedPAC Report to the Congress: Medicare Payment Policy, 2017
Provides an annual review of Medicare payment policies, with recommendations to Congress. Includes discussions on Medicare payment policies that directly affect rural providers and beneficiaries. Analyses payment adequacy for home health, skilled nursing, long-term care hospitals, hospice, ambulatory surgical centers, and rehabilitation facilities.
Date: 03/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Getting Started with the Quality Payment Program: An Overview of MIPS for Small, Rural, and Underserved Practices
Provides a webinar recording discussing the effects of the Merit-Based Incentive Payment System (MIPS) on small, rural, and underserved practices. Includes sections on eligibility, participation, reporting, performance categories, and submission and scoring methods. Outlines specific eligibility requirements for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs), and provides a checklist for preparing and participating in MIPS.
Additional links: Presentation Slides, Transcript, Webinar Playlist by Section
Date: 02/2017
Type: Video/Multimedia
Sponsoring organization: Centers for Medicare and Medicaid Services
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Telemedicine and Primary Care Obesity Management in Rural Areas – Innovative Approach for Older Adults?
Explores telemedicine as a potential delivery tool for the Medicare Obesity Benefit in primary care settings. Describes challenges in implementing the benefit in rural areas, including increasing older adult populations, shortages in primary care and specialized healthcare providers, reimbursement issues, and transportation barriers. Presents the potential utility of telemedicine in rural obesity care and non-physician staff delivery options, which require regulatory changes.
Author(s): John Batsis, Sarah Pletcher, James Stahl
Citation: BMC Geriatrics, 17, 6
Date: 01/2017
Type: Document
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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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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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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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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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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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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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