Medicare Prospective Payment System (PPS)
Research Products & Journal Articles
Browse the full list of research publications on this topic completed by the Rural Health Research Centers.
Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.
Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.
2023
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Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
Journal Article
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 09/2023
The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.
2018
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Critical Access Hospital Swing-Bed Quality Measures: Findings From Key Informant Interviews
Policy Brief
University of Minnesota Rural Health Research Center
Date: 04/2018
This study examines how Critical Access Hospitals (CAHs) are currently assessing the quality of care provided to their swing-bed patients.
2016
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2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2016
The profitability of urban hospitals to that of rural hospitals are compared for fiscal years 2012-2014 based on size and rural Medicare payment classifications. -
Geographic Variation in the Profitability of Urban and Rural Hospitals
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2016
Historic and recent evidence suggest that unprofitability can reduce hospital services and quality, or worse, lead to closure. This study describes the current geographic variability of hospital profitability by comparing the 2014 profitability of CAHs, other rural hospitals, and urban hospitals by census region, census division, and state.
2015
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Medicare Value-Based Payment Reform: Priorities for Transforming Rural Health Systems
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 11/2015
As Medicare moves to value-based payment, healthcare groups are made more accountable for patient health. But the changes have been concentrated in urban areas. Policies meant to strengthen rural health systems are complicating payment and delivery system reform in rural areas. This study examines ways to include rural areas in the changes. -
Do Current Medicare Rural Hospital Payment Systems Align With Cost Determinants?
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2015
To inform policy discussions on how complex current payment models may affect rural hospitals, the North Carolina Rural Health Research Program studied differences in financial condition among rural hospitals and important determinants of differences in rural hospital costs.
2010
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A Comparison of Rural Hospitals With Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment (Final Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2010
This final report compares the financial performance and condition of rural hospitals with special Medicare payment provisions to urban and rural hospitals paid under prospective payment (UPPS and R-PPS hospitals, respectively). Nine ratios from the three most common categories of ratios used in financial statement analysis (profitability, liquidity, and capital structure) as well as four other ratios that are commonly used to evaluate rural hospital financial performance are assessed. -
Rural Medicare Advantage: Modest Enrollment Growth in 2010
RUPRI Center for Rural Health Policy Analysis
Date: 08/2010
Despite a slight drop in enrollment and a dramatic shift in the landscape of the rural Medicare Advantage (MA) market in early 2010, MA plans have experienced modest growth in enrollment in rural areas during the last two quarters of 2010. The majority of the growth is concentrated in preferred provider organization plans. -
A Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2010
This brief compares the profitability of hospitals in the four classifications of rural hospitals that can qualify for special payment provisions under Medicare (critical access, Medicare-dependent, and sole community hospitals and rural referral centers) to urban and rural hospitals paid under prospective payment during a recent three-year period.
2009
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July 2009: Rural Enrollment in Medicare Advantage Continues to Grow
RUPRI Center for Rural Health Policy Analysis
Date: 08/2009
Rural enrollment in Medicare Advantage continues to increase, with growth in the last 18 months led by the growth of preferred provider organization (PPO) plans. Despite the growth in PPO plans, private fee-for-service plans continue to dominate enrollment in rural areas and have accounted for much of the program's growth since 2005. -
May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
RUPRI Center for Rural Health Policy Analysis
Date: 06/2009
Rural Medicare Advantage (MA) enrollment had rapid growth in preferred provider organization (PPO) plans and a decline in the growth rate of private fee-for-service (PFFS) plans. MA enrollment has continued to climb, but it has been impacted by the slowed rate of growth in PFFS plans, which cover more than half of MA enrollees in rural areas.
2007
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How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 07/2007
This policy brief examines the financial effect that changes in current Medicare bad debt payment policy, as proposed in the FY2007 budget, might have on rural hospitals.
2006
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A Primer on the Occupational Mix Adjustment to the Medicare Hospital Wage Index
North Carolina Rural Health Research and Policy Analysis Center
Date: 09/2006
This paper focuses on the occupational mix adjustment (OMA) to the labor-related share in the hospital inpatient prospective payment system. The primer explains what the OMA is, why it is needed, and how it has been calculated. In addition, reasons why the effect of the OMA has been less than some rural advocates anticipated are discussed.
2005
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Utilization of Home Health Services Among Rural Medicare Beneficiaries Before and After the PPS
NORC Walsh Center for Rural Health Analysis
Date: 08/2005
This report describes a study conducted on the rural effects of the PPS, including whether the PPS contributed to changes in the demographic and clinical characteristics of home care users, the likelihood of using each of six home care disciplines, and the intensity of services.
2004
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Financially Distressed Rural Hospitals in Four States
NORC Walsh Center for Rural Health Analysis
Date: 01/2004
The effect of the outpatient prospective payment system on the financial performance of rural hospitals was simulated in four states: Iowa, Texas, Washington, and West Virginia. -
Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Brief Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2004
Hourly wage data from Medicare-participating nursing homes were used to examine urban/rural patterns in average hourly nursing home wages and wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.
2003
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Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Full Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2003
Hourly wage data collected were used to examine urban/rural patterns in average hourly nursing home wages and pattern variation within the statewide rural labor markets. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.
2001
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Quality of Medicare Outpatient Claims Data and Its Implications for Rural Outpatient Payment Policy
NORC Walsh Center for Rural Health Analysis
Date: 12/2001
This study analyzes Medicare outpatient claims to see if the relatively poor quality of small rural hospitals' claims data have amplified the negative effects of the new payment system on small hospitals. -
PPS Inpatient Payment and the Area Wage Index
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2001
This fact sheet discusses how inpatient rates are calculated, the role of the wage index, and issues surrounding the wage index and reimbursement to rural hospitals by Medicare under the Prospective Payment System. -
Will the Outpatient Prospective Payment System Increase the Number of Distressed Rural Hospitals in Iowa, Texas, Washington, and West Virginia?
NORC Walsh Center for Rural Health Analysis
Date: 01/2001
This study simulates the financial impact of the outpatient prospective payment system rates and estimates the number and type of rural hospitals in the five states likely to become financially distressed as a result of its implementation.
2000
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Rural Hospital Area Wages and the PPS Wage Index: 1900-1997
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2000
This paper examines the hospital wage index used by the Health Care Financing Administration and its effects on rural hospitals. -
The Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
RUPRI Center for Rural Health Policy Analysis
Date: 08/2000
This policy paper summarizes the positions of various rural health advocates and records the actions taken by Congress and the Health Care Financing Administration to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. -
Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2000
This policy brief explains how the area wage index is calculated and used and identifies the major unresolved issues related to its calculation and use. -
Rural Home Health Agencies: The Impact of the Balanced Budget Act
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 04/2000
This policy analysis brief examines how the characteristics of rural and urban Medicare-certified home health agencies differ, estimates the impact of interim payment system on these agencies, and discusses policy implications for a Medicare home health prospective payment system. -
At-Risk Hospitals: The Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2000
This report examines not-for-profit hospitals that potentially qualify as critical access hospitals and identifies facilities at risk as a result of Medicare's prospective payment systems to non-acute care settings. -
Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2000
This findings brief examines rural hospitals that potentially qualify as critical access hospitals and identifies facilities at substantial financial risk as a result of Medicare's expansion of prospective payment systems to non-acute settings.