RHCs and CAHs Participating in the Medicare Shared Savings Program (MSSP): Characteristics of the Providers and Communities

View Policy Brief

11/2025

Since the Medicare Shared Savings Program's (MSSP) implementation, Centers for Medicare & Medicaid Services has implemented changes to the program to broaden its appeal and impact. Some of these changes are credited with increasing numbers of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the MSSP.

Key Findings:

• In 2023, approximately one-third of RHCs (35.9 percent) and CAHs (33.4 percent) participated in MSSP.
• Provider-based RHCs had a much higher participation rate in MSSP (42.7 percent) compared to free-standing RHCs (23.3 percent).
• CAHs and RHCs participating in MSSP are larger (have larger staff sizes and more patient encounters) and have better finances (larger revenue and lower expenses) than those not participating in MSSP.
• CAHs participating in MSSP are more likely to be in counties with higher household incomes and larger Medicare enrollments.

RUPRI Center for Rural Health Policy Analysis

Edmer Lazaro, Dan Shane, Fred Ullrich, Keith Mueller

Critical Access Hospitals (CAHs), Hospitals and clinics, Medicare, Rural Health Clinics (RHCs)