State Announces Hospitals, Payers Selected for Pennsylvania’s Rural Health Payment Model

Last Updated: Mar 7, 2019

hospital-signOn 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:

  1. Barnes Kasson in Susquehanna, Susquehanna County
  2. Endless Mountains in Montrose, Susquehanna County
  3. Jersey Shore in Jersey Shore, Lycoming County
  4. UPMC Kane in Kane, McKean County
  5. 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.


2 comments

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  1. Steve Karp | Jun 01, 2018

    Dr. Thomas is going easy on the NP's. It's about more than the money. What this is about is practicing medicine without a license which used to carry stiff penalties. Where was the PA medical society and state board of medicine years ago on this issue? No one today believes that NP's practice 'advanced practice nursing as evidenced by the general public seeing no difference between a nurse anesthetist and anesthesiologist. What NP's are allowed to do is akin to patent infringement. If you create something that is too similar to a patent or trademark there's a price to pay. In medicine it's we who are paying the price.

  2. Dr. X | May 31, 2018

    Physicians should be paid more not less to take care of patients in rural areas.

    Change pay to incentivize physicians to move to rural areas.Medicare should increase rates to physicians who practice in rural areas.

    Change pay for Nurse practitioners to go to rural areas. They should earn less than 25% of that of a physician in the cities and perhaps earn 40% of a physician if they work in rural areas.That would incentivize the NP's to actually go to rural areas. Without such they will take all the jobs from physicians in the cities.

    Keep Nurse Practitioners  pay commensurate with their education relative to education and training of physicians. If you pay NP's 85% of what a physician makes then CVS and hospitals will hire Nurse Practitioners all day long and fire all the physicians much to the detriment of the patients of Pennsylvania.

     

     

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