Last Updated: Mar 7, 2019
On March 5, 2019, the state announced the first five hospitals selected to participate in the Pennsylvania Rural Health Model, a reimbursement model that seeks to increase access to care in rural areas, improve health outcomes, and ensure financial sustainability for rural hospitals.
The first five participants in the model are:
- Barnes Kasson in Susquehanna, Susquehanna County
- Endless Mountains in Montrose, Susquehanna County
- Jersey Shore in Jersey Shore, Lycoming County
- UPMC Kane in Kane, McKean County
- Wayne Memorial in Honesdale, Wayne County
The initial insurance payers for the model are Gateway, Geisinger, Highmark, UPMC, and Medicaid.
The Pa. Department of Health says that nearly half of all rural hospitals in Pennsylvania are operating with negative margins and are at risk of closure. The new payment model offers an opportunity to ensure that these hospitals remain open and viable.
Background on the Pennsylvania Rural Health Model
The payment model was created in partnership with the Centers for Medicare and Medicaid Services (CMS). Its major components are:
- Hospital Global Budgets—Pennsylvania sets the all-payer global budget for hospitals to cover inpatient and outpatient services. A global budget is a fixed amount set in advance and funded by participating payers.
- Hospital Care Delivery Transformation—Participating hospitals are required to plan for changes to the care they provide, including things like investment in preventative care and chronic disease management and tailoring services to the needs of the local community (i.e. population health).
The model is open to critical access hospitals and acute care hospitals in rural Pennsylvania as well as other payers in the state.
For more details on the Pennsylvania Rural Health Initiative, visit CMS’ Pennsylvania Rural Health Model webpage.