Rural Health
Resources by Topic: Reimbursement and payment models
Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform
Identifies and discusses health services research on the utilization and integration of Community Health Workers (CHWs) into healthcare service delivery. Includes an analysis regarding the various CHW models, employment data, training and credentialing, and challenges associated with the development of this occupation.
Author(s): John E. Snyder
Date: 01/2016
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Identifies and discusses health services research on the utilization and integration of Community Health Workers (CHWs) into healthcare service delivery. Includes an analysis regarding the various CHW models, employment data, training and credentialing, and challenges associated with the development of this occupation.
Author(s): John E. Snyder
Date: 01/2016
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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ACO Investment Model, Rural Hospital Collaboration
Highlights how 3 rural Minnesota hospitals implemented the Accountable Care Organization Investment Model (AIM), which encourages coordinated care in rural areas through upfront and ongoing Centers for Medicare & Medicaid Services (CMS) payments.
Date: 2016
Sponsoring organization: American Hospital Association Rural Health Services
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Highlights how 3 rural Minnesota hospitals implemented the Accountable Care Organization Investment Model (AIM), which encourages coordinated care in rural areas through upfront and ongoing Centers for Medicare & Medicaid Services (CMS) payments.
Date: 2016
Sponsoring organization: American Hospital Association Rural Health Services
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Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
Evaluates the rural-urban differences in the proportion of hospitals that receive penalties under the Centers for Medicare & Medicaid Services (CMS) Readmission Reduction Program, and compares the specific health condition risk-adjusted readmission rates by rural and urban location. Analyzes characteristics of hospitals receiving readmission penalties.
Author(s): Peiyin Hung, Michelle Casey, Ira Moscovice
Date: 10/2015
Sponsoring organization: University of Minnesota Rural Health Research Center
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Evaluates the rural-urban differences in the proportion of hospitals that receive penalties under the Centers for Medicare & Medicaid Services (CMS) Readmission Reduction Program, and compares the specific health condition risk-adjusted readmission rates by rural and urban location. Analyzes characteristics of hospitals receiving readmission penalties.
Author(s): Peiyin Hung, Michelle Casey, Ira Moscovice
Date: 10/2015
Sponsoring organization: University of Minnesota Rural Health Research Center
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Hospital Value-based Purchasing: Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of-Care Trends
Evaluates the initial effects of the Hospital Value-based Purchasing (HVBP) program on Medicare bonus payments and penalties, the quality of care provided, and selected quality improvement efforts during FY 2013-15. Analyzes data from safety net, small urban, and small rural hospitals.
Additional links: Full Report
Date: 10/2015
Sponsoring organization: Government Accountability Office
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Evaluates the initial effects of the Hospital Value-based Purchasing (HVBP) program on Medicare bonus payments and penalties, the quality of care provided, and selected quality improvement efforts during FY 2013-15. Analyzes data from safety net, small urban, and small rural hospitals.
Additional links: Full Report
Date: 10/2015
Sponsoring organization: Government Accountability Office
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Performance Measurement for Rural Low-Volume Providers: Final Report
Identifies challenges to measuring healthcare performance among low-volume rural providers, and presents recommendations to meet these challenges. Primary focus is on finding appropriate quality measures for use within Centers for Medicare and Medicaid Services' (CMS) pay-for-performance programs and encouraging rural participation in CMS quality improvement initiatives.
Date: 09/2015
Sponsoring organization: National Quality Forum
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Identifies challenges to measuring healthcare performance among low-volume rural providers, and presents recommendations to meet these challenges. Primary focus is on finding appropriate quality measures for use within Centers for Medicare and Medicaid Services' (CMS) pay-for-performance programs and encouraging rural participation in CMS quality improvement initiatives.
Date: 09/2015
Sponsoring organization: National Quality Forum
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Simulation and Analysis of an Alternative Medicare Home Health Payment System Not Based on Number of Therapy Visits
Outlines a possible approach to redesigning the Medicare home health payment system and describes the likely impacts of such a change. Includes statistics with breakdowns by number of therapy and non-therapy visits, payment-to-cost ratios, medical procedure or chronic illness, and type of health facility.
Author(s): Doug Wissoker, Bowen Garrett
Date: 08/2015
Sponsoring organization: Urban Institute
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Outlines a possible approach to redesigning the Medicare home health payment system and describes the likely impacts of such a change. Includes statistics with breakdowns by number of therapy and non-therapy visits, payment-to-cost ratios, medical procedure or chronic illness, and type of health facility.
Author(s): Doug Wissoker, Bowen Garrett
Date: 08/2015
Sponsoring organization: Urban Institute
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Hospital Policy Issues: Statement by Mark Miller, Medicare Payment Advisory Commission before Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives
Testimony from the Medicare Payment Advisory Commission's executive director presented at a July 22nd, 2015, Ways and Means subcommittee hearing concerning Medicare hospital payment issues, rural health issues, and beneficiary access to care. Discusses Medicare's rural hospital payment adjustments, how they impact access to care, and principles to consider in evaluating rural add-on payments. Also discusses MedPAC recommendations related to graduate medical education (GME), including some related to rural training.
Author(s): Mark E. Miller
Date: 07/2015
Sponsoring organizations: House Ways and Means Committee, Subcommittee on Health, Medicare Payment Advisory Commission
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Testimony from the Medicare Payment Advisory Commission's executive director presented at a July 22nd, 2015, Ways and Means subcommittee hearing concerning Medicare hospital payment issues, rural health issues, and beneficiary access to care. Discusses Medicare's rural hospital payment adjustments, how they impact access to care, and principles to consider in evaluating rural add-on payments. Also discusses MedPAC recommendations related to graduate medical education (GME), including some related to rural training.
Author(s): Mark E. Miller
Date: 07/2015
Sponsoring organizations: House Ways and Means Committee, Subcommittee on Health, Medicare Payment Advisory Commission
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Characteristics of Children in Medicaid Managed Care and Medicaid Fee-for-service, 2003-2005
Examines how children enrolled in Medicaid fee-for-service programs compare to those in comprehensive managed care programs. Includes information on sociodemographic, health, and geographic characteristics. Table 5 provides figures by type of Medicaid program for urban and rural enrollees.
Author(s): Patricia C. Lloyd, Alan E. Simon, Jennifer D. Parker
Date: 06/2015
Sponsoring organization: National Center for Health Statistics
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Examines how children enrolled in Medicaid fee-for-service programs compare to those in comprehensive managed care programs. Includes information on sociodemographic, health, and geographic characteristics. Table 5 provides figures by type of Medicaid program for urban and rural enrollees.
Author(s): Patricia C. Lloyd, Alan E. Simon, Jennifer D. Parker
Date: 06/2015
Sponsoring organization: National Center for Health Statistics
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Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10)
Full text of the Medicare Access and CHIP Reauthorization Act of 2015, commonly referred to as MACRA. MACRA seeks to transition healthcare from fee-for-service to value-based care by repealing the Sustainable Growth Rate (SGR) formula and replacing it with the Quality Payment Program (QPP). The QPP streamlines data collection efforts and rewards providers based on value instead of volume through the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).
Date: 04/2015
Sponsoring organization: U.S. Congress
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Full text of the Medicare Access and CHIP Reauthorization Act of 2015, commonly referred to as MACRA. MACRA seeks to transition healthcare from fee-for-service to value-based care by repealing the Sustainable Growth Rate (SGR) formula and replacing it with the Quality Payment Program (QPP). The QPP streamlines data collection efforts and rewards providers based on value instead of volume through the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).
Date: 04/2015
Sponsoring organization: U.S. Congress
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Sole Community Hospitals: Early Indications Show That TRICARE's Revised Reimbursement Rules Have Not Affected Access to Care
Reports on the impact of a January 2014 revision to TRICARE's reimbursement for Sole Community Hospitals (SCHs), which serve primarily rural areas. The new TRICARE reimbursement rules approximate Medicare's for these hospitals. Looks at the impact of revised SCH reimbursement on healthcare access for servicemembers and their dependents. Findings based on claims data, as well as interviews with 10 SCHs and with national stakeholders. Appendices include information on SCHs with a high number of TRICARE admissions.
Additional links: Full Report
Date: 04/2015
Sponsoring organization: Government Accountability Office
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Reports on the impact of a January 2014 revision to TRICARE's reimbursement for Sole Community Hospitals (SCHs), which serve primarily rural areas. The new TRICARE reimbursement rules approximate Medicare's for these hospitals. Looks at the impact of revised SCH reimbursement on healthcare access for servicemembers and their dependents. Findings based on claims data, as well as interviews with 10 SCHs and with national stakeholders. Appendices include information on SCHs with a high number of TRICARE admissions.
Additional links: Full Report
Date: 04/2015
Sponsoring organization: Government Accountability Office
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