Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
Supporting and Sustaining Rural Hospitals
Describes state and federal actions to support and safeguard rural hospitals. Discusses appropriated funding opportunities for struggling hospitals, Medicaid coverage and eligibility, alternative payment models, and technical assistance programs.
Author(s): Noah Cruz
Date: 04/2021
Type: Document
Sponsoring organization: National Conference of State Legislatures
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Describes state and federal actions to support and safeguard rural hospitals. Discusses appropriated funding opportunities for struggling hospitals, Medicaid coverage and eligibility, alternative payment models, and technical assistance programs.
Author(s): Noah Cruz
Date: 04/2021
Type: Document
Sponsoring organization: National Conference of State Legislatures
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State-Driven Initiatives to Support Moving to Value-Based Care in the Era of COVID-19
Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Type: Document
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Type: Document
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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Medicare Hospital Payments: Adjusting for Variation in Geographic Area Wages
Provides an overview of the use of the hospital wage index applied to the Medicare inpatient prospective payment system (IPPS) to account for geographic differences in hospitals' labor costs. Discusses the effect of the wage index on Medicare payments for inpatient hospital services, exceptions to wage index adjustments, and proposals for wage index reforms.
Date: 03/2021
Type: Document
Sponsoring organization: Congressional Research Service
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Provides an overview of the use of the hospital wage index applied to the Medicare inpatient prospective payment system (IPPS) to account for geographic differences in hospitals' labor costs. Discusses the effect of the wage index on Medicare payments for inpatient hospital services, exceptions to wage index adjustments, and proposals for wage index reforms.
Date: 03/2021
Type: Document
Sponsoring organization: Congressional Research Service
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The Effect of Medicare Payment Standardization Methods on the Perceived Cost of Post-Acute Swing Bed Care in Critical Access Hospitals
Discusses the different payment systems the Centers for Medicare and Medicaid Services (CMS) uses to reimburse for post-acute care in Critical Access Hospitals (CAHs), prospective payment system (IPPS) hospitals, and skilled nursing facilities (SNFs). Describes how the payment standardization methods may influence post-acute care discharge patterns and access to care for rural residents. Examines the effects of these payment methods on the perceived cost of CAH swing bed care as it relates to the Medicare Spending per Beneficiary performance measure.
Author(s): Tyler Malone, Denise Kirk, Kristin Reiter
Date: 03/2021
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Discusses the different payment systems the Centers for Medicare and Medicaid Services (CMS) uses to reimburse for post-acute care in Critical Access Hospitals (CAHs), prospective payment system (IPPS) hospitals, and skilled nursing facilities (SNFs). Describes how the payment standardization methods may influence post-acute care discharge patterns and access to care for rural residents. Examines the effects of these payment methods on the perceived cost of CAH swing bed care as it relates to the Medicare Spending per Beneficiary performance measure.
Author(s): Tyler Malone, Denise Kirk, Kristin Reiter
Date: 03/2021
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report
Summarizes a July 2020 virtual summit of rural participants in value‐based care (VBC) models and programs. Details six themes on VBC model design, implementation, and operation that can influence rural organization participation in VBC models. Provides recommendations for VBC model designers to improve rural healthcare provider participation and success in VBC models.
Author(s): Keith Mueller, Clint MacKinney, Jennifer Lundblad, Karla Weng
Date: 12/2020
Type: Document
Sponsoring organization: Rural Health Value
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Summarizes a July 2020 virtual summit of rural participants in value‐based care (VBC) models and programs. Details six themes on VBC model design, implementation, and operation that can influence rural organization participation in VBC models. Provides recommendations for VBC model designers to improve rural healthcare provider participation and success in VBC models.
Author(s): Keith Mueller, Clint MacKinney, Jennifer Lundblad, Karla Weng
Date: 12/2020
Type: Document
Sponsoring organization: Rural Health Value
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Evaluation of the Accountable Care Organization Investment Model: Final Report
Examines the ACO Investment Model (AIM) over three performance years. AIM tested the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. Reports on AIM results related to ACO formation, risk-taking, and sustainability, including the impact of rurality. Also discusses impacts on healthcare costs, utilization, and quality of care.
Additional links: Appendices, CMS Perspective Report, Findings at a Glance
Date: 09/2020
Type: Document
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Examines the ACO Investment Model (AIM) over three performance years. AIM tested the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. Reports on AIM results related to ACO formation, risk-taking, and sustainability, including the impact of rurality. Also discusses impacts on healthcare costs, utilization, and quality of care.
Additional links: Appendices, CMS Perspective Report, Findings at a Glance
Date: 09/2020
Type: Document
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Evaluation of the Health Care Innovation Awards, Round 2: Final Report
Summarizes the final evaluation results of 38 Health Care Innovation Awards Round Two projects. Discusses program impacts on healthcare service use and costs, factors associated with positive impacts, and awardees' experiences sustaining programs and implementing payment models after the end of the awards. Offers overall findings and awardee-specific evaluation reports. Includes some information on results for projects serving rural areas.
Additional links: Findings at a Glance
Date: 09/2020
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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Summarizes the final evaluation results of 38 Health Care Innovation Awards Round Two projects. Discusses program impacts on healthcare service use and costs, factors associated with positive impacts, and awardees' experiences sustaining programs and implementing payment models after the end of the awards. Offers overall findings and awardee-specific evaluation reports. Includes some information on results for projects serving rural areas.
Additional links: Findings at a Glance
Date: 09/2020
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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The Impact of Medicare's Rural Add-on Payments on Supply of Home Health Agencies Serving Rural Counties
Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
Type: Document
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Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
Type: Document
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Medicaid: State Views on Program Administration Challenges
Describes four federal Medicaid policies that pose barriers to effective program administration. Highlights the requirement for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) under the prospective payment system as a challenge for states. Identifies three issues for federal policymakers to consider when addressing these administrative challenges.
Additional links: Full Report
Date: 04/2020
Type: Document
Sponsoring organization: Government Accountability Office
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Describes four federal Medicaid policies that pose barriers to effective program administration. Highlights the requirement for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) under the prospective payment system as a challenge for states. Identifies three issues for federal policymakers to consider when addressing these administrative challenges.
Additional links: Full Report
Date: 04/2020
Type: Document
Sponsoring organization: Government Accountability Office
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Rural Hospital Participation in Medicare Accountable Care Organizations
Report explores the rates of rural hospital participation in Medicare Shared Savings Program (SSP) Accountable Care Organizations (ACOs). Details some of the factors that correspond to participation and compares rates by region and by rural status.
Date: 04/2020
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Report explores the rates of rural hospital participation in Medicare Shared Savings Program (SSP) Accountable Care Organizations (ACOs). Details some of the factors that correspond to participation and compares rates by region and by rural status.
Date: 04/2020
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Additional resources are available related to this guide. See the full list of resources by topic for:
- Accountable Care Organizations
- Care coordination
- Health insurance
- Healthcare business and finance
- Medicaid
- Medicare
- Policy
- Reimbursement and payment models
- Service delivery models
Last Updated: 4/3/2024