Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
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
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
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
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
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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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
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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
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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
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
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
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
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
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
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Mandated Analysis of Home Health Service Utilization From January 2016 Through March 2022
Report evaluates the distribution of rural add-on payments for home health claims. Examines the results of the Centers for Medicare and Medicaid Services's new rural add-on methodology aimed at providing higher add-on percentages for "low population density" categories and explores the effect this methodology has had on "high utilization" categories. Makes comments and recommendations as to how this methodology can be adjusted.
Additional links: Report in Brief
Date: 12/2022
Sponsoring organization: Office of Inspector General (HHS)
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Report evaluates the distribution of rural add-on payments for home health claims. Examines the results of the Centers for Medicare and Medicaid Services's new rural add-on methodology aimed at providing higher add-on percentages for "low population density" categories and explores the effect this methodology has had on "high utilization" categories. Makes comments and recommendations as to how this methodology can be adjusted.
Additional links: Report in Brief
Date: 12/2022
Sponsoring organization: Office of Inspector General (HHS)
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Medicaid Population-Based Payment: The Current Landscape, Early Insights, and Considerations for Policymakers
Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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A Global Equity Model (GEM) for the Advancement of Community Health and Health Equity
Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Sponsoring organization: National Academy of Medicine
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Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Sponsoring organization: National Academy of Medicine
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CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1772-FC) Rural Emergency Hospitals — New Medicare Provider Type
Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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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: 4/1/2025