Rural Health
Resources by Topic: Reimbursement and payment models
MedPAC Report to the Congress: Medicare Payment Policy: Hospice Services: Chapter 9
Discusses payment adequacy for hospice and palliative support services. Includes data on average costs by day and aggregate margins by urban and rural status, as well as demographics on Medicare decedents who used hospice during 2010 and between 2019-2023. Compares the actual hospice utilization rates in micropolitan, rural adjacent, rural nonadjacent, and frontier areas to urban hospice utilization rates.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
Discusses payment adequacy for hospice and palliative support services. Includes data on average costs by day and aggregate margins by urban and rural status, as well as demographics on Medicare decedents who used hospice during 2010 and between 2019-2023. Compares the actual hospice utilization rates in micropolitan, rural adjacent, rural nonadjacent, and frontier areas to urban hospice utilization rates.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
MedPAC Report to the Congress: Medicare Payment Policy, 2025
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for Medicare fee-for-service payment systems, Medicare Advantage (MA), and Medicare Part D.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for Medicare fee-for-service payment systems, Medicare Advantage (MA), and Medicare Part D.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
March 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2025 meeting. Covers research and proposals related to reforming physician fee schedule updates and improving the accuracy of relative payment rates, reducing beneficiary cost-sharing for outpatient services at Critical Access Hospitals, Medicare insurance agents, Medigap, payment for ground ambulance services, home healthcare use among Medicare Advantage enrollees, and institutional special needs plans. Includes rural references and considerations throughout.
Additional links: Mandated Report: Payment for Ground Ambulance Services, Reducing Beneficiary Cost-Sharing for Outpatient Services at Critical Access Hospitals
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2025 meeting. Covers research and proposals related to reforming physician fee schedule updates and improving the accuracy of relative payment rates, reducing beneficiary cost-sharing for outpatient services at Critical Access Hospitals, Medicare insurance agents, Medigap, payment for ground ambulance services, home healthcare use among Medicare Advantage enrollees, and institutional special needs plans. Includes rural references and considerations throughout.
Additional links: Mandated Report: Payment for Ground Ambulance Services, Reducing Beneficiary Cost-Sharing for Outpatient Services at Critical Access Hospitals
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
Merit-Based Incentive Payment System (MIPS): 2024 Opt-in and Voluntary Reporting Election Process Guide
Discusses the eligibility of clinicians, groups, and Alternative Payment Model (APM) participants that exceed some low-volume threshold criteria to opt-in to the Merit-Based Incentive Payment System (MIPS) and the APM Performance Pathway (APP) for the 2024 performance period. Compares opting in and voluntarily reporting MIPS data and provides an overview of the election process.
Date: 03/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Discusses the eligibility of clinicians, groups, and Alternative Payment Model (APM) participants that exceed some low-volume threshold criteria to opt-in to the Merit-Based Incentive Payment System (MIPS) and the APM Performance Pathway (APP) for the 2024 performance period. Compares opting in and voluntarily reporting MIPS data and provides an overview of the election process.
Date: 03/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Rural Hospital Experiences in the Colorado Hospital Transformation Program
Provides an overview of the Colorado Hospital Transformation Program (CO HTP), a 5-year program that ties Medicaid supplemental payments to hospitals' ability to meet performance targets through September 2026. Describes the experiences of three Critical Access Hospitals (CAHs) and explores how CO HTP impacts rural hospitals. Covers planning and community engagement, quality of care, and healthcare costs.
Date: 03/2025
Sponsoring organization: Rural Health Value
view details
Provides an overview of the Colorado Hospital Transformation Program (CO HTP), a 5-year program that ties Medicaid supplemental payments to hospitals' ability to meet performance targets through September 2026. Describes the experiences of three Critical Access Hospitals (CAHs) and explores how CO HTP impacts rural hospitals. Covers planning and community engagement, quality of care, and healthcare costs.
Date: 03/2025
Sponsoring organization: Rural Health Value
view details
Cost Burden of Cancer Screening in Kansas by Region and Rural/Urban Designation
Analyzes the cost burden of self-pay cancer screenings in Kansas by rural and urban location and geographic region of the state, with data on colonoscopies, chest computed tomography (CT) scans, and mammograms. Discusses rural-urban disparities in price of services and pricing transparency.
Author(s): Kale Mills, Nicole Freund
Citation: Kansas Journal of Medicine, 18(1):10–13
Date: 02/2025
view details
Analyzes the cost burden of self-pay cancer screenings in Kansas by rural and urban location and geographic region of the state, with data on colonoscopies, chest computed tomography (CT) scans, and mammograms. Discusses rural-urban disparities in price of services and pricing transparency.
Author(s): Kale Mills, Nicole Freund
Citation: Kansas Journal of Medicine, 18(1):10–13
Date: 02/2025
view details
Introduction to Rural Clinically Integrated Networks
Provides an overview of clinically integrated networks (CINs), including common CIN characteristics and the relationship between CINs and healthcare value. Offers examples of CINs comprised of independent rural healthcare organizations.
Date: 02/2025
Sponsoring organization: Rural Health Value
view details
Provides an overview of clinically integrated networks (CINs), including common CIN characteristics and the relationship between CINs and healthcare value. Offers examples of CINs comprised of independent rural healthcare organizations.
Date: 02/2025
Sponsoring organization: Rural Health Value
view details
February 2025 MACPAC Meeting Transcript
Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) February 2025 meeting. Covers transitions of care for children and youth with special healthcare needs (CYSHCN), hospital non-disproportionate share hospital supplemental payments and directed payment targeting, improving access to medications for opioid use disorder, healthcare access for children in foster care, and more. Includes rural references throughout.
Additional links: Hospital Non-DSH Supplemental Payment and Directed Payment Targeting Analyses
Date: 02/2025
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details
Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) February 2025 meeting. Covers transitions of care for children and youth with special healthcare needs (CYSHCN), hospital non-disproportionate share hospital supplemental payments and directed payment targeting, improving access to medications for opioid use disorder, healthcare access for children in foster care, and more. Includes rural references throughout.
Additional links: Hospital Non-DSH Supplemental Payment and Directed Payment Targeting Analyses
Date: 02/2025
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details
The Growing Impact of Medicare Advantage on Rural Hospitals Across America
Examines the impact of Medicare Advantage (MA) on rural hospitals. Discusses payment and reimbursement, healthcare access, hospital finance and patient data, hospital case examples, and more.
Date: 02/2025
Sponsoring organization: American Hospital Association
view details
Examines the impact of Medicare Advantage (MA) on rural hospitals. Discusses payment and reimbursement, healthcare access, hospital finance and patient data, hospital case examples, and more.
Date: 02/2025
Sponsoring organization: American Hospital Association
view details
Medicare Advantage Penetration and the Financial Distress of Rural Hospitals
Examines county-level Medicare Advantage (MA) penetration rates and the financial impact on rural hospitals. Utilizes 2014-2020 American Hospital Association data to analyze Medicare and non-Medicare inpatient days paid by the plans, with data breakdowns according to patient demographics, rural versus urban location, timing of inpatient stay, and more.
Author(s): Guido Cataife, Siying Liu
Citation: Health Economics Review, 15, 9
Date: 02/2025
view details
Examines county-level Medicare Advantage (MA) penetration rates and the financial impact on rural hospitals. Utilizes 2014-2020 American Hospital Association data to analyze Medicare and non-Medicare inpatient days paid by the plans, with data breakdowns according to patient demographics, rural versus urban location, timing of inpatient stay, and more.
Author(s): Guido Cataife, Siying Liu
Citation: Health Economics Review, 15, 9
Date: 02/2025
view details