Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
Medicare Accountable Care Organizations: Presence in Rural America
Presentation slides from a June 6, 2023, webinar for the Rural Northern Border Healthcare Support Technical Assistance Center. Provides an overview of the Medicare Shared Savings Program, including the composition of program participants in 2023, the spread of Accountable Care Organizations (ACOs) in rural counties, and the federal and state policy landscape. Details changes to the Shared Savings Program for 2024.
Author(s): Keith J. Mueller
Date: 06/2023
Type: Presentation Slides
Sponsoring organization: Rural Policy Research Institute
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Presentation slides from a June 6, 2023, webinar for the Rural Northern Border Healthcare Support Technical Assistance Center. Provides an overview of the Medicare Shared Savings Program, including the composition of program participants in 2023, the spread of Accountable Care Organizations (ACOs) in rural counties, and the federal and state policy landscape. Details changes to the Shared Savings Program for 2024.
Author(s): Keith J. Mueller
Date: 06/2023
Type: Presentation Slides
Sponsoring organization: Rural Policy Research Institute
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Closed, Converted, Merged, and New Hospitals with Medicare Rural Designations: January 2018-November 2022
Provides an overview of four Medicare rural hospital designations - Critical Access Hospital, Low-Volume Hospital, Medicare Dependent Hospital, and Sole Community Hospital - and factors related to financial distress that these designations are intended to address. Explores the number of rural-designated hospitals that have closed, merged, converted, or opened between January 2018-November 2022 and compares the number of rural-designated hospitals with the number of non-designated hospitals. Outlines considerations for Congress regarding policy options for rural hospitals and access to healthcare services in rural areas.
Date: 04/2023
Type: Document
Sponsoring organization: Congressional Research Service
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Provides an overview of four Medicare rural hospital designations - Critical Access Hospital, Low-Volume Hospital, Medicare Dependent Hospital, and Sole Community Hospital - and factors related to financial distress that these designations are intended to address. Explores the number of rural-designated hospitals that have closed, merged, converted, or opened between January 2018-November 2022 and compares the number of rural-designated hospitals with the number of non-designated hospitals. Outlines considerations for Congress regarding policy options for rural hospitals and access to healthcare services in rural areas.
Date: 04/2023
Type: Document
Sponsoring organization: Congressional Research Service
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April 2023 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2023 meeting. Covers high prices of drugs covered under Medicare Part B, draft recommendations for reforming Medicare's wage index systems, aligning fee-for-service payment rates across ambulatory settings, leveraging Medicare policies to address social determinants of health, assessing post-sale rebates for prescription drugs in Medicare Part D, and assessing the need for Medicare safety net payments for skilled nursing facilities and home health agencies. Features discussions on draft reports regarding a prototype design for a post-acute care prospective payment system, telehealth in Medicare, and behavioral health in Medicare. Includes rural references throughout.
Date: 04/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2023 meeting. Covers high prices of drugs covered under Medicare Part B, draft recommendations for reforming Medicare's wage index systems, aligning fee-for-service payment rates across ambulatory settings, leveraging Medicare policies to address social determinants of health, assessing post-sale rebates for prescription drugs in Medicare Part D, and assessing the need for Medicare safety net payments for skilled nursing facilities and home health agencies. Features discussions on draft reports regarding a prototype design for a post-acute care prospective payment system, telehealth in Medicare, and behavioral health in Medicare. Includes rural references throughout.
Date: 04/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Optimizing Population-Based Total Cost of Care (PB-TCOC) Models in the Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)
Report from the Physician-Focused Payment Model Technical Advisory Committee (PTAC) summarizing findings on population-based total cost of care (PB-TCOC) payment models and the role these models can play in optimizing health care delivery and value-based transformation in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs). Provides an overview of key issues relating to PB-TCOC models and value-based care transformation. Identifies areas where additional research is needed and some potential next steps. Includes rural references throughout.
Date: 03/2023
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Report from the Physician-Focused Payment Model Technical Advisory Committee (PTAC) summarizing findings on population-based total cost of care (PB-TCOC) payment models and the role these models can play in optimizing health care delivery and value-based transformation in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs). Provides an overview of key issues relating to PB-TCOC models and value-based care transformation. Identifies areas where additional research is needed and some potential next steps. Includes rural references throughout.
Date: 03/2023
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Financial Risk Acceptance among Rural Health Care Providers Participating in the Quality Payment Program
Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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CMS Bundled Payments for Care Improvement Advanced Model: Fourth Evaluation Report
Third annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Explores the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 3. Analyzes BPCI Advanced outcomes for beneficiaries from populations that have been historically underserved, including beneficiaries in rural areas and areas with a high Area Deprivation Index (ADI).
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Third annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Explores the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 3. Analyzes BPCI Advanced outcomes for beneficiaries from populations that have been historically underserved, including beneficiaries in rural areas and areas with a high Area Deprivation Index (ADI).
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Modernizing Payment to Critical Access Hospitals: A Proposal for the Next Iteration of the Flex Program
Commentary briefly describing the history the Medicare Rural Hospital Flexibility Program (Flex) and Cost-Based Reimbursement (CBR) for Medicare. Outlines the challenges of CBR for Critical Access Hospitals (CAH) and proposes a new payment system.
Author(s): Clint MacKinney, Keith Mueller, Alva Ferdinand, et al.
Citation: Journal of Rural Health, 39(4), 716-718
Date: 02/2023
Type: Document
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Commentary briefly describing the history the Medicare Rural Hospital Flexibility Program (Flex) and Cost-Based Reimbursement (CBR) for Medicare. Outlines the challenges of CBR for Critical Access Hospitals (CAH) and proposes a new payment system.
Author(s): Clint MacKinney, Keith Mueller, Alva Ferdinand, et al.
Citation: Journal of Rural Health, 39(4), 716-718
Date: 02/2023
Type: Document
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Rural Hospitals Must Keep up with Innovation to Remain Viable
Describes changes to the healthcare market environment, including technology, telehealth, services offered by retailers and large corporations, and declining patient volume. Outlines priorities for Critical Access Hospitals to remain viable, including the transition to population-based payment. Details a transition framework to guide hospitals as they move to a population-based payment system and navigate a changing environment.
Date: 01/2023
Type: Document
Sponsoring organization: Stroudwater Associates
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Describes changes to the healthcare market environment, including technology, telehealth, services offered by retailers and large corporations, and declining patient volume. Outlines priorities for Critical Access Hospitals to remain viable, including the transition to population-based payment. Details a transition framework to guide hospitals as they move to a population-based payment system and navigate a changing environment.
Date: 01/2023
Type: Document
Sponsoring organization: Stroudwater Associates
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Evaluation of the Rural Community Hospital Demonstration: Interim Report Two (Covering 2016-2018)
Provides an overview of the Rural Community Hospital Demonstration (RCHD). Describes the characteristics of RCHD participants as of fiscal year 2018, the Medicare payments received under the program, and the impact of the RCHD on hospital financial measures. Examines whether hospitals that continued to participate in the RCHD under the 21st Century Cures Act (CCA) extension experienced additional changes to their financial condition, as well as the impact of the program on hospitals that joined the demonstration for the first time under the CCA extension.
Additional links: Findings at a Glance
Date: 12/2022
Type: Document
Sponsoring organizations: American Institutes for Research, Centers for Medicare and Medicaid Services
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Provides an overview of the Rural Community Hospital Demonstration (RCHD). Describes the characteristics of RCHD participants as of fiscal year 2018, the Medicare payments received under the program, and the impact of the RCHD on hospital financial measures. Examines whether hospitals that continued to participate in the RCHD under the 21st Century Cures Act (CCA) extension experienced additional changes to their financial condition, as well as the impact of the program on hospitals that joined the demonstration for the first time under the CCA extension.
Additional links: Findings at a Glance
Date: 12/2022
Type: Document
Sponsoring organizations: American Institutes for Research, Centers for Medicare and Medicaid Services
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The Evolution of Hospital Designations and Payment in the U.S.: Implications for Rural Hospitals
Provides a history and overview of Medicare hospital payment polices as well as alternative payment models and their impact on rural facilities. Discusses the context in which rural hospitals serve patients, rural hospital payment provisions and designations, and current federal payment models that impact rural hospitals.
Author(s): Onyinye Oyeka, Clinton MacKinney, Keith J. Mueller
Date: 12/2022
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Provides a history and overview of Medicare hospital payment polices as well as alternative payment models and their impact on rural facilities. Discusses the context in which rural hospitals serve patients, rural hospital payment provisions and designations, and current federal payment models that impact rural hospitals.
Author(s): Onyinye Oyeka, Clinton MacKinney, Keith J. Mueller
Date: 12/2022
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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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: 4/1/2024