Rural Health
Resources by Topic: Reimbursement and payment models
Global Budgets for Rural Hospitals
Discusses the financial and budgetary challenges faced by rural hospitals, explains how some rural hospitals have responded, and presents the case for using global budgets as an alternative payment model. Includes information on some of the proposed policy solutions such as Maryland's all-payer system and the Save Rural Hospitals Act.
Author(s): Joshua M. Sharfstein
Citation: The Milbank Quarterly, 94(2), 255-259
Date: 06/2016
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Discusses the financial and budgetary challenges faced by rural hospitals, explains how some rural hospitals have responded, and presents the case for using global budgets as an alternative payment model. Includes information on some of the proposed policy solutions such as Maryland's all-payer system and the Save Rural Hospitals Act.
Author(s): Joshua M. Sharfstein
Citation: The Milbank Quarterly, 94(2), 255-259
Date: 06/2016
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Stroudwater Population Health
An 8-part video series designed to help rural healthcare organizations transition from payment for volume to payment for value and advance population health strategies. Each part discusses an important strategy for achieving population health, including: quality and efficiency, network relationships and service rationalization, employer-sponsored health plans and fee-for-service payments, shared savings plans, and full risk payments and capitation.
Date: 06/2016
Sponsoring organization: Stroudwater Associates
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An 8-part video series designed to help rural healthcare organizations transition from payment for volume to payment for value and advance population health strategies. Each part discusses an important strategy for achieving population health, including: quality and efficiency, network relationships and service rationalization, employer-sponsored health plans and fee-for-service payments, shared savings plans, and full risk payments and capitation.
Date: 06/2016
Sponsoring organization: Stroudwater Associates
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2016
Includes chapters on pricing and payment systems, Medicare drug spending, Part B drug and oncology payment policy issues, improving Part D, improving efficiency and preserving access to emergency care in rural areas, telehealth services and Medicare, and issues affecting dual-eligible beneficiaries. Rural providers and rural patient populations are discussed throughout the report.
Date: 06/2016
Sponsoring organization: Medicare Payment Advisory Commission
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Includes chapters on pricing and payment systems, Medicare drug spending, Part B drug and oncology payment policy issues, improving Part D, improving efficiency and preserving access to emergency care in rural areas, telehealth services and Medicare, and issues affecting dual-eligible beneficiaries. Rural providers and rural patient populations are discussed throughout the report.
Date: 06/2016
Sponsoring organization: Medicare Payment Advisory Commission
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Association Between the Value-Based Purchasing Pay for Performance Program and Patient Mortality in US Hospitals: Observational Study
Examines the impact of Medicare's Hospital Value-Based Purchasing (HVBP) program on mortality for pneumonia, heart failure, and acute myocardial infarction by comparing data from acute care hospitals participating in the program to data from over 1,300 Critical Access Hospitals (CAHs) and 44 hospitals in Maryland not in the program.
Author(s): Jose F. Figueroa, Yusuke Tsugawa, Jie Zheng, E. John Orav, Ashish K. Jha
Citation: BMJ, 9(353), i2214
Date: 05/2016
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Examines the impact of Medicare's Hospital Value-Based Purchasing (HVBP) program on mortality for pneumonia, heart failure, and acute myocardial infarction by comparing data from acute care hospitals participating in the program to data from over 1,300 Critical Access Hospitals (CAHs) and 44 hospitals in Maryland not in the program.
Author(s): Jose F. Figueroa, Yusuke Tsugawa, Jie Zheng, E. John Orav, Ashish K. Jha
Citation: BMJ, 9(353), i2214
Date: 05/2016
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FQHC and RHC Supplemental Payment Requirements and FQHC, RHC, and FBC Network Sufficiency under Medicaid and CHIP Managed Care
Provides state health officials with guidance on Federally-qualified Health Center (FQHC) and Rural Health Clinic (RHC) payment methodologies under both Medicaid and Children's Health Insurance Program (CHIP) managed care delivery systems. Also provides guidance on FQHC, RHC, and freestanding birth center (FBC) network sufficiency standards applicable to a Medicaid managed care delivery system.
Date: 04/2016
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides state health officials with guidance on Federally-qualified Health Center (FQHC) and Rural Health Clinic (RHC) payment methodologies under both Medicaid and Children's Health Insurance Program (CHIP) managed care delivery systems. Also provides guidance on FQHC, RHC, and freestanding birth center (FBC) network sufficiency standards applicable to a Medicaid managed care delivery system.
Date: 04/2016
Sponsoring organization: Centers for Medicare and Medicaid Services
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Improving Efficiency and Preserving Access to Emergency Care in Rural Areas
Slides that provide background on rural hospital payment policy and strategies to preserve access to emergency care in rural areas. Discusses existing payment models and benefits and drawbacks of different models.
Author(s): Jeff Stensland, Zach Gaumer
Date: 04/2016
Sponsoring organization: Medicare Payment Advisory Commission
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Slides that provide background on rural hospital payment policy and strategies to preserve access to emergency care in rural areas. Discusses existing payment models and benefits and drawbacks of different models.
Author(s): Jeff Stensland, Zach Gaumer
Date: 04/2016
Sponsoring organization: Medicare Payment Advisory Commission
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Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review
Reports on a review of 67 studies evaluating the effectiveness of community-based health workers (CBHWs) as an intervention model for chronic disease management and care among low-income, underserved, and racial and ethnic minority populations at risk for health disparities. Discusses the roles and tasks of CBHWs, the effectiveness of their intervention, their qualifications and training, and the reimbursement and sustainability of CBHWs.
Author(s): Kyounghae Kim, Janet S. Choi, Eunsuk Choi, et al.
Citation: American Journal of Public Health, 106(4), e3–e28
Date: 04/2016
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Reports on a review of 67 studies evaluating the effectiveness of community-based health workers (CBHWs) as an intervention model for chronic disease management and care among low-income, underserved, and racial and ethnic minority populations at risk for health disparities. Discusses the roles and tasks of CBHWs, the effectiveness of their intervention, their qualifications and training, and the reimbursement and sustainability of CBHWs.
Author(s): Kyounghae Kim, Janet S. Choi, Eunsuk Choi, et al.
Citation: American Journal of Public Health, 106(4), e3–e28
Date: 04/2016
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Dental Therapy Toolkit: Summary of Dental Therapy Regulatory and Payment Processes
Reviews the payment and regulatory processes for dental therapists in Minnesota. Covers the following aspects related to practicing dental therapy: education and examination requirements, supervision, clinical experiences, practice settings, scope of practice, and more. Offers guidance on payment and billing procedures for Minnesota's Medical Assistance program for care delivered by dental therapists.
Date: 03/2016
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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Reviews the payment and regulatory processes for dental therapists in Minnesota. Covers the following aspects related to practicing dental therapy: education and examination requirements, supervision, clinical experiences, practice settings, scope of practice, and more. Offers guidance on payment and billing procedures for Minnesota's Medical Assistance program for care delivered by dental therapists.
Date: 03/2016
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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MedPAC Report to the Congress: Medicare Payment Policy, 2016
Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report. Focuses on payment adequacy, Medicare Advantage, and Medicare Part D.
Date: 03/2016
Sponsoring organization: Medicare Payment Advisory Commission
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Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report. Focuses on payment adequacy, Medicare Advantage, and Medicare Part D.
Date: 03/2016
Sponsoring organization: Medicare Payment Advisory Commission
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2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
Compares the total margin and operating margin of rural and urban hospitals using 2012-2014 profitability data. Analysis divides rural hospitals by the size of the prospective payment system and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare dependent hospitals, sole community hospitals, and rural referral centers.
Author(s): Sharita R. Thomas, G. Mark Holmes, George H. Pink
Date: 03/2016
Sponsoring organization: North Carolina Rural Health Research Program
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Compares the total margin and operating margin of rural and urban hospitals using 2012-2014 profitability data. Analysis divides rural hospitals by the size of the prospective payment system and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare dependent hospitals, sole community hospitals, and rural referral centers.
Author(s): Sharita R. Thomas, G. Mark Holmes, George H. Pink
Date: 03/2016
Sponsoring organization: North Carolina Rural Health Research Program
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