Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
Evaluation of the Vermont All-Payer Accountable Care Organization Model: 2018-2022 - Fourth Evaluation Report
Evaluates the first five performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Includes analyses of Medicare ACO subgroups and Medicaid spending, utilization, and quality of care trends. Outlines challenges and lessons learned.
Additional links: Findings at a Glance, Technical Appendices
Date: 06/2024
Sponsoring organizations: Centers for Medicare & Medicaid Services, NORC at the University of Chicago
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Evaluates the first five performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Includes analyses of Medicare ACO subgroups and Medicaid spending, utilization, and quality of care trends. Outlines challenges and lessons learned.
Additional links: Findings at a Glance, Technical Appendices
Date: 06/2024
Sponsoring organizations: Centers for Medicare & Medicaid Services, NORC at the University of Chicago
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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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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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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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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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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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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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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 & Medicaid Services, Mathematica
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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 & Medicaid Services, Mathematica
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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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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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Report on Prevention of Out-Of-Network Ground Ambulance Emergency Service Balance Billing
Recommendations from the Ground Ambulance and Patient Billing Advisory Committee, convened between May and November, 2023, to protect consumers from balance billing and protect their access to emergency services. Features sections on rural ambulance services and community paramedicine.
Date: 03/2024
Sponsoring organization: Ground Ambulance and Patient Billing Advisory Committee
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Recommendations from the Ground Ambulance and Patient Billing Advisory Committee, convened between May and November, 2023, to protect consumers from balance billing and protect their access to emergency services. Features sections on rural ambulance services and community paramedicine.
Date: 03/2024
Sponsoring organization: Ground Ambulance and Patient Billing Advisory Committee
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Primary Care Spending in Medicare Fee-for-Service: An Illustrative Analysis Using Alternative Definitions of Primary Care
Discusses the importance of primary care to promote positive health outcomes and how reimbursement rates illustrate what healthcare areas are given priority. Utilizes Medicare fee-for-service data to estimate primary care spending and provides data breakdowns according to beneficiary characteristics, including rural versus urban location.
Date: 03/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Discusses the importance of primary care to promote positive health outcomes and how reimbursement rates illustrate what healthcare areas are given priority. Utilizes Medicare fee-for-service data to estimate primary care spending and provides data breakdowns according to beneficiary characteristics, including rural versus urban location.
Date: 03/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Environmental Scan on Developing and Implementing Performance Measures for Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan regarding the development and implementation of population-based total cost of care (PB-TCOC) payment models. Describes types of performance measures used in value-based payment models and pay-for-reporting programs, data sources used for constructing performance measures, features of PB-TCOC models, challenges in developing and implementing performance measures and opportunities for Alternative Payment Models (APMs) and PB-TCOC models to address these challenges, trends in existing performance measures across several Center for Medicare and Medicaid Innovation (CMMI) models and Medicare value-based care programs, and more. Includes rural references and considerations throughout.
Date: 03/2024
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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Presents results of an environmental scan regarding the development and implementation of population-based total cost of care (PB-TCOC) payment models. Describes types of performance measures used in value-based payment models and pay-for-reporting programs, data sources used for constructing performance measures, features of PB-TCOC models, challenges in developing and implementing performance measures and opportunities for Alternative Payment Models (APMs) and PB-TCOC models to address these challenges, trends in existing performance measures across several Center for Medicare and Medicaid Innovation (CMMI) models and Medicare value-based care programs, and more. Includes rural references and considerations throughout.
Date: 03/2024
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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