Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
The Impact of High Hospital Fixed-Cost Ratios on Rural Populations
Explores how rurality relates to hospital cost structures as categorized by Urban Influence Codes (UICs). Describes the characteristics of hospitals at different fixed-to-total-cost ratio levels, the demographics associated with hospitals at different ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or Low-Volume Hospital (LVH) designations. Discusses how findings could be used to refine hospital payment policies.
Author(s): Abigail Barker, Eliot Jost, Timothy McBride, Keith Mueller
Date: 06/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Explores how rurality relates to hospital cost structures as categorized by Urban Influence Codes (UICs). Describes the characteristics of hospitals at different fixed-to-total-cost ratio levels, the demographics associated with hospitals at different ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or Low-Volume Hospital (LVH) designations. Discusses how findings could be used to refine hospital payment policies.
Author(s): Abigail Barker, Eliot Jost, Timothy McBride, Keith Mueller
Date: 06/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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RHPTP HELP Webinar: Medicare's NEW Advanced Primary Care Management Program
Webinar recording discusses the Advanced Primary Care Management (APCM) Program, an initiative to improve the delivery, coordination, and outcomes in primary care services. Explores the process of transitioning from fee-for-service to value-based care models and discusses how Medicare's program fits the APCM model.
Additional links: Webinar Slides
Author(s): Lindsay Corcoran, Amy Graham
Date: 06/2025
Sponsoring organization: National Rural Health Resource Center
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Webinar recording discusses the Advanced Primary Care Management (APCM) Program, an initiative to improve the delivery, coordination, and outcomes in primary care services. Explores the process of transitioning from fee-for-service to value-based care models and discusses how Medicare's program fits the APCM model.
Additional links: Webinar Slides
Author(s): Lindsay Corcoran, Amy Graham
Date: 06/2025
Sponsoring organization: National Rural Health Resource Center
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2025
Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers proposed reforms to the physician fee schedule updates and the accuracy of relative payment rates; supplemental benefits in Medicare Advantage; home healthcare use among Medicare Advantage enrollees; Part D prescription drug plans for beneficiaries in fee-for-service Medicare and Medicare Advantage; Medicare beneficiaries in nursing homes; the inclusion of rural providers in current Medicare fee-for-service quality reporting programs; and recommendations related to reducing beneficiary cost sharing for outpatient services at Critical Access Hospitals. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers proposed reforms to the physician fee schedule updates and the accuracy of relative payment rates; supplemental benefits in Medicare Advantage; home healthcare use among Medicare Advantage enrollees; Part D prescription drug plans for beneficiaries in fee-for-service Medicare and Medicare Advantage; Medicare beneficiaries in nursing homes; the inclusion of rural providers in current Medicare fee-for-service quality reporting programs; and recommendations related to reducing beneficiary cost sharing for outpatient services at Critical Access Hospitals. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Comment on CMS's Proposed Rule on Inpatient Prospective Payment System for FY 2026
Comments on an April 30, 2025, Federal Register proposed rule revising the hospital inpatient and long-term care hospital (LTCH) prospective payment systems (PPS). Discusses proposals to update inpatient prospective payment systems (IPPS) payment rates, update wage index values and policies, modify the Transforming Episode Accountability Model (TEAM), and remove the proposed health-equity adjustment from the Hospital Value-Based Purchasing (VBP) Program.
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on an April 30, 2025, Federal Register proposed rule revising the hospital inpatient and long-term care hospital (LTCH) prospective payment systems (PPS). Discusses proposals to update inpatient prospective payment systems (IPPS) payment rates, update wage index values and policies, modify the Transforming Episode Accountability Model (TEAM), and remove the proposed health-equity adjustment from the Hospital Value-Based Purchasing (VBP) Program.
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Payment Source Shift for Surgical Care Among Veterans Enrolled in Medicare Advantage Plans
Examines the likelihood of veterans enrolled in Medicare Advantage (MA) plans to shift payments for inpatient surgical care from MA to the Veterans Health Administration (VHA). Analyzes 54,754 inpatient surgeries of VHA enrollees to observe payment trends, with data broken down by demographics, insurance characteristics, region, and rurality.
Author(s): Winta T. Mehtsun, Yanlei Ma, Ellen Latsko, et al.
Citation: JAMA Health Forum, 6(6)
Date: 06/2025
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Examines the likelihood of veterans enrolled in Medicare Advantage (MA) plans to shift payments for inpatient surgical care from MA to the Veterans Health Administration (VHA). Analyzes 54,754 inpatient surgeries of VHA enrollees to observe payment trends, with data broken down by demographics, insurance characteristics, region, and rurality.
Author(s): Winta T. Mehtsun, Yanlei Ma, Ellen Latsko, et al.
Citation: JAMA Health Forum, 6(6)
Date: 06/2025
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Quality Payment Program (QPP) 2023: Participation and Payment Results At-a-Glance
Provides an overview of the results of the Quality Payment Program (QPP) for the 2023 performance year. Highlights the percentages of small and rural providers receiving negative, neutral, and positive payment adjustments for 2025.
Date: 06/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the results of the Quality Payment Program (QPP) for the 2023 performance year. Highlights the percentages of small and rural providers receiving negative, neutral, and positive payment adjustments for 2025.
Date: 06/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Negotiated Prices for Care at Independent and System-Affiliated Rural Hospitals
Compares negotiated prices for procedural and imaging services at independent rural hospitals versus system-affiliated rural hospitals. Analyzes commercially negotiated price data with their associated hospital and evaluates number of negotiated prices for services. Discusses policies for rural hospital financial sustainability.
Author(s): Cody Lendon Mullens, Mitchell Mead, James D Lee, et al.
Citation: JAMA Network Open, 8(5)
Date: 05/2025
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Compares negotiated prices for procedural and imaging services at independent rural hospitals versus system-affiliated rural hospitals. Analyzes commercially negotiated price data with their associated hospital and evaluates number of negotiated prices for services. Discusses policies for rural hospital financial sustainability.
Author(s): Cody Lendon Mullens, Mitchell Mead, James D Lee, et al.
Citation: JAMA Network Open, 8(5)
Date: 05/2025
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Environmental Scan on Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation
Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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CMS Innovation Center Strategic Direction
Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Catalog of Value-Based Initiatives for Rural Providers
Summarizes rural-relevant, value-based programs currently or recently implemented by the U.S. Department of Health and Human Services (HHS), including the Centers for Medicare & Medicaid Services (CMS) and the CMS Innovation Center. Designed to help rural healthcare leaders identify HHS value-based programs that are suitable for rural participation. Contains descriptions of each demonstration and provides direct links to the corresponding agency web page.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Summarizes rural-relevant, value-based programs currently or recently implemented by the U.S. Department of Health and Human Services (HHS), including the Centers for Medicare & Medicaid Services (CMS) and the CMS Innovation Center. Designed to help rural healthcare leaders identify HHS value-based programs that are suitable for rural participation. Contains descriptions of each demonstration and provides direct links to the corresponding agency web page.
Date: 05/2025
Sponsoring organization: Rural Health Value
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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: 9/3/2025