Rural Health
Resources by Topic: Reimbursement and payment models
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
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
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
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
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
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
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
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
Sponsoring organization: Rural Health Information Hub
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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
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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
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The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals
Compares rural low volume hospitals (LVH) with non-LVH (Inpatient Prospective Payment System) hospitals. Discusses the financial impact of removing the LVH program and returning to the 2005 LVH classification and payment adjustment, and the effect this will have on Medicare beneficiaries.
Author(s): Rebecca G. Whitaker, G. Mark Holmes, George H. Pink
Date: 10/2016
Sponsoring organization: North Carolina Rural Health Research Program
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Compares rural low volume hospitals (LVH) with non-LVH (Inpatient Prospective Payment System) hospitals. Discusses the financial impact of removing the LVH program and returning to the 2005 LVH classification and payment adjustment, and the effect this will have on Medicare beneficiaries.
Author(s): Rebecca G. Whitaker, G. Mark Holmes, George H. Pink
Date: 10/2016
Sponsoring organization: North Carolina Rural Health Research Program
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Rural Hospital Participation and Performance in Value-Based Purchasing and Other Delivery System Reform Initiatives
Reports on the participation of delivery system reform initiatives by rural hospitals, and discusses the supporting factors and challenges for successful participation. Includes data comparing rural and urban Hospital Value-Based Payment (HVBP) performance.
Author(s): Karen E. Joynt, Nguyen Nguyen, Lok Wong Samson, et al.
Date: 10/2016
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Reports on the participation of delivery system reform initiatives by rural hospitals, and discusses the supporting factors and challenges for successful participation. Includes data comparing rural and urban Hospital Value-Based Payment (HVBP) performance.
Author(s): Karen E. Joynt, Nguyen Nguyen, Lok Wong Samson, et al.
Date: 10/2016
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Aging in Rural and Frontier Oregon: Challenges Facing Rural and Frontier Home Health Agencies
Provides an overview of the services and challenges affecting home health agencies offering assistance to the aging population in rural Oregon by county. Includes discussion on healthcare access, home health agency regulation and reimbursement, recruitment and retention of healthcare providers, and physician compliance.
Author(s): Callie Walsh-Bailey, Jamie Horst
Date: 09/2016
Sponsoring organization: Oregon Office of Rural Health
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Provides an overview of the services and challenges affecting home health agencies offering assistance to the aging population in rural Oregon by county. Includes discussion on healthcare access, home health agency regulation and reimbursement, recruitment and retention of healthcare providers, and physician compliance.
Author(s): Callie Walsh-Bailey, Jamie Horst
Date: 09/2016
Sponsoring organization: Oregon Office of Rural Health
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State Innovation Models (SIM) Initiative Evaluation: Model Test Year Two Annual Report
Second annual report detailing the findings of CMS's State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Vermont, and Oregon - to accelerate health system transformation in the areas of delivery systems, payment models, information technology, workforce development, and more. Presents results from the second of three planned site visits to the states, including interviews, focus groups, and surveys. Connections made throughout to issues specifically affecting rural healthcare.
Date: 08/2016
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Second annual report detailing the findings of CMS's State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Vermont, and Oregon - to accelerate health system transformation in the areas of delivery systems, payment models, information technology, workforce development, and more. Presents results from the second of three planned site visits to the states, including interviews, focus groups, and surveys. Connections made throughout to issues specifically affecting rural healthcare.
Date: 08/2016
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Report to Congress: E-health and Telemedicine
Reports the state of e-health and telemedicine after the implementation of the Affordable Care Act (ACA). Includes current policy challenges, discussion of federal level telehealth activity, and a legislative proposal for FY17.
Date: 08/2016
Sponsoring organization: U.S. Department of Health and Human Services
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Reports the state of e-health and telemedicine after the implementation of the Affordable Care Act (ACA). Includes current policy challenges, discussion of federal level telehealth activity, and a legislative proposal for FY17.
Date: 08/2016
Sponsoring organization: U.S. Department of Health and Human Services
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