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.

2024

Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 09/2024
This brief presents financial performance trends of hospitals who participated in Medicare's Shared Savings Program (SSP) from 2011 to 2018. Trends in six financial outcomes are compared between SSP and non-SSP hospitals over time and between rural and urban hospitals.

2023

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.

2015

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.

2010

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.

2009

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

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.

2005

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

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.

2001

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.
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

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.