Rural Healthcare Payment and Reimbursement – Resources

Health Subcommittee Hearing on Improving Value-Based Care for Patients and Providers
Recording of a June 26, 2024, House Committee on Ways and Means Subcommittee on Health hearing on the challenges and opportunities associated with delivering better health outcomes and Medicare savings through value-based care. Features testimony from Sarah Chouinard, Chief Medical Officer of Main Street Health, regarding value-based care delivery in rural areas.
Additional links: Sarah Chouinard, Main Street Health - Testimony
Date: 06/2024
Sponsoring organization: House Ways and Means Committee, Subcommittee on Health
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2018‐23 Profitability of Rural and Urban Hospitals by Medicare Payment Designation
Examines the profitability of rural and urban hospitals according to special Medicare payment designations, including: Critical Access Hospitals (CAHs), Prospective Payment System (PPS) hospitals, Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), Rural Referral Centers (RRCs), and Essential Access Community Hospitals (EAC). Utilizes 2018-2023 data to analyze hospital profitability by rural versus urban status and facility/payment type.
Author(s): Sruthi Malavika Srinivasan, Kristie Thompson, George Pink
Date: 06/2024
Sponsoring organization: North Carolina Rural Health Research Program
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Five Things to Know About Medicare Site-Neutral Payment Reforms
Discusses site-neutral payment reforms that seek to align Medicare payments with outpatient services in different settings. Examines benefits and drawbacks of the policy and discusses how the policy would impact rural hospitals.
Author(s): Zachary Levinson, Tricia Neuman, Scott Hulver
Date: 06/2024
Sponsoring organization: KFF
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2024
Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers approaches for updating fee-for-service (FFS) Medicare's physician fee schedule (PFS) payments and incentivizing participation in alternative payment models; provider networks and prior authorization in Medicare Advantage (MA) plans; an assessment of the relative completeness of MA encounter data and other data sources; Medicare coverage and payments for medical software; alternate approaches to lower Medicare payment rates for select conditions in inpatient rehabilitation facilities; and Medicare's Acute Hospital Care at Home program. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Sources of Federal Funding for Health Care Facilities: Frequently Asked Questions
Provides an overview of how the federal government supports healthcare facilities, with a focus on hospitals. Discusses how Medicare and Medicaid pay acute care hospitals and for services rendered to beneficiaries and enrollees, as well as other payments these programs make. Identifies federal grants, loans, and technical assistance programs that can support health facilities. Describes how federal agencies, including the Health Resources and Services Administration (HRSA) and the U.S. Department of Agriculture (USDA), have supported healthcare facilities during emergencies.
Date: 06/2024
Sponsoring organization: Congressional Research Service
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Assisting American Indian and Alaska Native Consumers
Presentation slides discuss the ACA health insurance marketplace, the Indian Health Services, and provides information for American Indian and Alaska Native people pertaining to healthcare coverage. Presents guidance for AI/AN people to ensure they have consistent healthcare coverage.
Date: 05/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Best Practices for VBC Payment Arrangements
Describes themes that emerged from workgroup meetings regarding the implementation of value-based care (VBC) models, with a focus on total cost of care arrangements. Outlines voluntary best practices and domains within VBC payment arrangements for health plans, facilities, clinicians, and VBC entities to consider during the design, implementation, and evaluation of VBC participation. Includes rural information and considerations throughout.
Date: 04/2024
Sponsoring organizations: AHIP, American Medical Association, National Association of ACOs
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Evaluation of the Maryland Total Cost of Care Model: Progress Report
Provides an overview of the Maryland Total Cost of Care Model and evaluates the first four years of the program, 2019-2022. Explores the effects of the model on Medicare spending; service use, including preventable hospital use; and healthcare quality measures. Estimates the potential impact of switching Maryland to the Medicare prospective payment system (PPS) on Medicare spending and service use, including implications for rural and safety net hospitals.
Additional links: Appendices, Findings at a Glance, Transformation Spotlight
Date: 04/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Medicare Payment for Rural or Geographically Isolated Hospitals
Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2024
Sponsoring organization: Congressional Research Service
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Community Health Centers and Value-Based Payment
Discusses the role of Federally Qualified Health Centers and Rural Health Clinics, alternative payment models, and the challenges with implementing value-based payment.
Author(s): Janet Weiner
Date: 04/2024
Sponsoring organization: University of Pennsylvania Leonard Davis Institute of Health Economics
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