Factors Influencing Rural Hospitals' Decisions To Join An Alternative Payment Model: A Mixed-Methods Study.

Area of Science:

• Health Services Research
• Healthcare Policy
• Rural Health

Background:

• Voluntary Alternative Payment Models (APMs) impact hospital evaluation and performance.
• The Pennsylvania Rural Health Model (PARHM) is a voluntary APM combining global budgets and care transformation.

Purpose of the Study:

• To examine factors influencing hospital participation decisions in the PARHM.
• To understand the motivations behind joining or not joining a voluntary rural APM.

Main Methods:

• Mixed-methods study combining quantitative and qualitative analyses.
• Quantitative analysis of pre-PARHM hospital characteristics.
• Qualitative analysis of interviews with hospital administrators from participating and nonparticipating hospitals.

Main Results:

• Hospitals joining PARHM had lower total margins, fewer discharges, and were more likely to be independent.
• Motivations for participation included improving financial stability and maintaining independence.
• Reasons for non-participation centered on preserving operational autonomy and future growth flexibility.

Conclusions:

• Hospital participation in voluntary APMs like PARHM is influenced by a balance of financial and operational considerations.
• Findings can inform the design and targeting of future APMs, especially for rural hospitals.
• Understanding these factors is crucial for effective healthcare policy development.