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Rural Healthcare Payment and Reimbursement – Resources

Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.

Merit-Based Incentive Payment System (MIPS): 2025 MIPS Payment Year (2023 Performance Year) - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Health Care Affordability and Medical Debt: Differences by Rurality, Region, and Socio-Demographic Characteristics
Policy brief examining rural/urban differences in health care affordability and medical debt concerns. Features statistics including rates of affordability issues with breakdowns by rural and urban location, and among rural residents with breakdowns by socio-demographic characteristics.
Author(s): Ingrid Jacobson, Katie Rydberg, Mariana Tuttle, et al.
Date: 09/2024
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Environmental Scan on Identifying a Pathway Toward Maximizing Participation in Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan on the identification of a pathway toward maximizing participation in population-based total cost of care (PB-TCOC) models. Describes the Center for Medicare & Medicaid Services's (CMS's) goal of having all Medicare beneficiaries with Parts A and B in accountable care relationships by 2030. Discusses challenges and technical issues related to maximizing participation in PB-TCOC models, including organizational structure, payment, and risk adjustment. Summarizes relevant features of CMS Innovation Center (CMMI) models identified in previous Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references and considerations throughout.
Date: 09/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule – CMS-1808-F
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Low-Volume Hospital Adjustment Before and During COVID-19
Describes characteristics of rural low-volume hospitals (LVHs) between April 2018 and March 2022. Compares the characteristics and profitability of rural LVHs with other rural prospective payment system (PPS) hospitals before and during the COVID-19 pandemic. Presents data on LVH profitability margins with and without the LVH payment adjustment.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George Pink
Date: 07/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Why Primary Care Practitioners Aren't Joining Value-Based Payment Models: Reasons and Potential Solutions
Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Type: Document
Sponsoring organization: Commonwealth Fund
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Proposed CY 2025 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering proposed Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the calendar year (CY) 2025 Physician Fee Schedule proposed rule. Covers proposals related to audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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MedPAC Data Book: Health Care Spending and the Medicare Program, 2024
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures.
Date: 07/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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How Payment Caps Can Reduce Hospital Prices and Spending: Lessons from the Oregon State Employee Plan
Report discusses how policy changes to state employee insurance plans affected healthcare costs in Oregon. Details Oregon's plan to place payment caps tied to Medicare reimbursement rates and exceptions for rural and Critical Access Hospitals.
Author(s): Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan
Date: 07/2024
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Last Updated: 9/30/2024