Development of An All‐Payer Quality Program for the Pennsylvania Rural Health Model

Herzog, M.; Fried, Jonathan E; Liebers, David T.; MacKinney, A. Clinton

doi:10.1111/jrh.12547

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…Georgia’s unique tax credit approach to stabilizing rural hospitals is one of several state approaches to improve rural health care systems. For example, Pennsylvania recently implemented a multipayer global budget model for rural hospitals, 21 while Texas increased Medicaid inpatient rates for rural hospitals. 22 However, despite these ongoing efforts, evaluations of the impact as well as comparative effectiveness of these approaches are generally lacking.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Financial Health of Rural Hospitals After Implementation of the Georgia Rural Hospital Tax Credit Program

et al. 2021

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IMPORTANCE In 2016, Georgia implemented the Rural Hospital Tax Credit Program, which allows taxpayers to receive a tax credit for contributions to qualifying rural hospitals in the state. Empirical evidence of the program's association with the viability of the state's rural hospitals is needed. OBJECTIVE To examine the association of the tax credit program with the financial health of participating rural hospitals. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cross-sectional study used hospital financial data from the Centers for Medicare & Medicaid Services for 2015 to 2019. A difference-indifferences analytic approach was used to examine the association of the tax credit program with rural hospital financial health. Study participants included Georgia rural hospitals eligible to participate in the program. Comparison hospitals were selected from the southern states of Alabama,

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Section: Discussionmentioning

confidence: 99%

Assessment of the Financial Health of Rural Hospitals After Implementation of the Georgia Rural Hospital Tax Credit Program

et al. 2021

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“…As designers (JEF, DTL) of, and an advisor (ALS) for, a proposed pay‐for‐performance (P4P) program for the PARHM, 2 we identified three central challenges in constructing and implementing P4P programs for rural hospitals, along with potential solutions. We hope that the lessons we learned can inform similar policy efforts.…”

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confidence: 99%

Designing Quality Programs for Rural Hospitals

Fried

Liebers

Schwartz

2021

Journal of Hospital Medicine

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P opulation-based hospital payments provide incentives to reduce unnecessary healthcare use and a mechanism to finance population health investments. For hospitals, these payments provide stable revenue and flexibility in exchange for increased financial risk. The COVID-19 pandemic significantly reduced fee-for-service revenues, which has spurred provider interest in population-based payments, particularly from cash-strapped rural hospitals.The Centers for Medicare & Medicaid Services (CMS) recently announced the launch of the Community Health Access and Rural Transformation (CHART) Model to test whether up-front, population-based payments improve access to high-quality care in rural communities and protect the financial stability of rural providers. This model follows the ongoing Pennsylvania Rural Health Model (PARHM), which offers similar payments to Pennsylvania's rural hospitals. Prospective population-based hospital reimbursement appears to have helped Maryland's hospitals survive the financial stress of the COVID-19 pandemic, 1 and it is likely that the PARHM did the same for rural hospitals in Pennsylvania. Both the PARHM and the CHART Model place quality measurement and improvement at the core of payment reform, and for good reason. Capitation generates incentives for care stinting; linking prospective payments to quality measurement helps to ensure accountability. However, measuring the quality of rural healthcare is challenging. Rural health is different: Hospital size, payment mechanisms, and community health priorities are all distinct from those of metropolitan areas, which is why CMS exempts Critical Access Hospitals from Medicare's core quality programs. Rural quality reporting programs could be established that address the unique aspects of rural healthcare.As designers (JEF, DTL) of, and an advisor (ALS) for, a proposed pay-for-performance (P4P) program for the PARHM, 2 we identified three central challenges in constructing and implementing P4P programs for rural hospitals, along with potential solutions. We hope that the lessons we learned can inform similar policy efforts.First, many rural hospitals serve as stewards of community health resources. While metropolitan hospital systems can make

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Early impacts of the Pennsylvania Rural Health Model on potentially avoidable utilization

Bourne,

Roberts,

Sabik

2024

Health Affairs Scholar

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The Pennsylvania Rural Health Model (PARHM) is a novel alternative payment model for rural hospitals that aims to test whether hospital-based global budgets, coupled with delivery transformation plans, improves the quality of health care and health outcomes in rural communities. Eighteen hospitals joined PARHM in three cohorts between 2019 and 2021. This study assessed PARHM’s impact on changes in potentially avoidable utilization (PAUs)—a measure of admission rates policymakers explicitly targeted for improvement in PARHM. Using a difference-in-differences analysis and all-payer hospital discharge data for Pennsylvania hospitals from 2016-2022, we found no significant overall reduction in community-level PAU rates up to four years post-PARHM implementation, relative to changes in rural Pennsylvania communities whose hospitals did not join PARHM. However, heterogeneous treatment effects were observed across cohorts that joined PARHM in different years, and between critical access vs. prospective payment system hospitals. These findings offer insight into how alternative payment models in rural health care settings may have heterogeneous impacts based on contextual factors and highlight the importance of accounting for these factors in proposed expansions of alternative payment models for rural health systems.

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Development of An All‐Payer Quality Program for the Pennsylvania Rural Health Model

Cited by 4 publications

References 14 publications

Assessment of the Financial Health of Rural Hospitals After Implementation of the Georgia Rural Hospital Tax Credit Program

Assessment of the Financial Health of Rural Hospitals After Implementation of the Georgia Rural Hospital Tax Credit Program

Designing Quality Programs for Rural Hospitals

Early impacts of the Pennsylvania Rural Health Model on potentially avoidable utilization

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