Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis

Completed Projects

Access to Services Across a Continuum of Care for Rural Beneficiaries
Funder: Office of Rural Health Policy (ORHP)
Topic: Health services

Analysis of Information Networking Technology in Sustaining Rural Delivery Systems
Funder: Office of Rural Health Policy (ORHP)
Topics: Networking and collaboration, Technology

Analysis Related to Health Care Reform Issues
The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Health services

Assessment of Small Rural Hospital Activities to Report Medication Errors
This research will determine how small rural hospitals have responded to the environmental pressure to improve patient safety and quality by implementing safe medication practices and by reporting and monitoring medication errors.
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality

Changing the Medicare Program According to the Principles of Managed Competition
Funder: Office of Rural Health Policy (ORHP)
Topic: Medicare

Characteristics of Low-volume Communities
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Legislation and regulation, Medicare

Comments on Regulatory and Contractor Reform Legislation
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Legislation and regulation, Medicare

Developing and Using a Classification Schema to Identify Sentinel Communities in the U.S.
This project will enable rural researchers to track the effect of current policies on rural communities, anticipate the effect of proposed policies, and demonstrate policy effects that link one sector to another.
Funder: Office of Rural Health Policy (ORHP)
Topic: Health policy

Discrepancies of Financial Data between Medicare Cost Report and Hospital Audited Financial Statement and Its Implication for Measuring Financial Impact of Payment Policy on Rural Hospitals
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Hospitals and clinics

Establishing a Fair Payment for Rural Physicians
This project will analyze differences in physician payment as a function of practice location and simulate policy choices that change the current payment formula.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Physicians, Workforce

Estimating the Medicare+Choice Threshold Payment Rate
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Medicare

Examining Recent Trends and Variation in Ambulatory Care Sensitive Conditions-related Hospital Expenditures of Rural Americans with Different Health Insurance Coverage and Status
This study documents the national time-trend and regional variation of rural Ambulatory Care Sensitive Conditions (ACSC)-related hospital expenditures by patient insurance coverage/status. The study will also compare the pattern of difference in the ACSC-related expenditures of rural patients with different insurance coverage/status by patient demographic and economic characteristics as well as hospital characteristics.
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health care financing, Health insurance and the uninsured, Health services

Examining the Applicability of the AHRQ's Inpatient Quality Indicators to Rural Hospitals and the Implications of the Relationship Between the Indicators and Financial Measures for Medicare Payment Policies
This study will investigate how the Agency for Healthcare Research and Quality's inpatient quality indicators can be applied to rural hospitals and will explore the application of those indicators in answering relevant policy questions.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Hospitals and clinics, Quality

Examining the Magnitudes, Geographic Variations, and Determinants Of Expenditures Due to Ambulatory Care Sensitive Conditions in Rural Hospitals
This project will document the magnitude of and variation in ambulatory care sensitive condition (ACSC) expenditures of rural hospitals and explore the relationships between rural hospital ACSC expenditure and its key determinants in the areas of population demand, health care system supply, and provider practice style.
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health care financing, Hospitals and clinics

Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Health policy

How Will Rural Hospitals Meet Requirements for Patient Privacy?
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Legislation and regulation

How Would Health Insurance Exchanges Work in Rural America?
The passage of the Patient Protection and Affordable Care Act (PPACA) of 2010 has created the potential for states to create health insurance exchanges (HIEs). This project will assess the potential of these plans to meet the needs of rural residents. Empirical work will establish baseline measures of choices available to rural residents and literature reviews will yield prospective analysis of how exchanges could operate to benefit rural residents.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Health policy

Impact of Changing Medicare Advantage Landscape on Rural Enrollees
This project will explore three important questions related to Medicare Advantage (MA) plans. What is the impact of recent changes in the MA market on rural Medicare beneficiaries, providers and communities? In particular, how have recent changes in markets and payment policy led to changes in the choices of plans facing beneficiaries, and the quality of those plans (as defined by the coverage offered by the plans)? Finally, what is the likely impact of changes made in Medicare Advantage payment rates passed in the Patient Protection Affordable Care Act of 2010 (PPACA) on rural enrollment in MA plans in 2011 and beyond?
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicare, Medicare Advantage (MA)

Impact of Medicare Advantage Plan Concentration on Choices and Competition in Rural Areas
This project focuses on the analysis of Medicare Advantage (MA) plan choices for rural beneficiaries and what the concentration of plan choices in rural areas may mean in the context of how rural beneficiaries are making their choices. Using measures of concentration from the economics literature, this project will explore the relationship between market concentration in MA plans and the generosity of MA plans, and how it varies by the location of residence of Medicare beneficiaries.
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicare, Medicare Advantage (MA)

Implementation of Health Reform Legislation in Rural America
The RUPRI Center has developed particular expertise, including the use of simulations, in how changes in public policy that are now part of the Patient Protection and Affordable Care Act (PPACA) affect the rural health care providers and communities. We have published policy briefs and papers related to Medicare Advantage and Part D plans, effects of insurance reform on the percentage of uninsured in rural areas, and effects of changes in physician payment on projected total income of rural primary care physicians. The purpose of this project is to take advantage of RUPRI's capacity for further simulation analysis and empirically based analyses of changes occurring as a result of the PPACA.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Health policy, Medicare

Implementation of the Medicare Prescription Drug Benefit: What is Available to Rural Beneficiaries?
This study will focus on the impact of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on rural beneficiaries, based on actual prescription drug plan contracts, comparing the impact of the legislation on rural beneficiaries to their urban counterparts.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Legislation and regulation, Medicare Part D

Is Medicare Beneficiary Access to Primary Care Physicians At Risk?
This project examined the impact of changes in Medicare payment to physicians on access to care for rural beneficiaries.
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicare, Physicians

J-1 Visa Project
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, International Medical Graduates (IMGs), J-1 Visa Waiver, Workforce

Locating Community Pharmacies (Independent and Chain) in Rural America
A comprehensive database of all rural U.S. pharmacies including pharmacy name, pharmacy type (chain or independent), town, ZIP code, county, state, RUCA code, and Federal Information Processing Standards will be developed. The databases will be usable in most widely used statistics and geographic information systems software packages.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Pharmacy and prescription drugs

Medicare Modernization Act: Reality for Rural Beneficiaries and Providers
This project will focus on two areas of new activity in Medicare�beneficiary participation in Medicare Advantage (MA) plans and prescription drug plans and implementation of the new Part D benefit through private health plans. We will describe enrollment into specific types of MA prescription drug plans and other prescription drug plans, and analyze differences across regions, states, and types of counties. We will also examine the impact of the transfer to Part D coverage on rural dual eligibles and their local pharmacies.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicare Advantage (MA), Medicare Part D

Medicare Reform: Rural Considerations
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicare Prospective Payment System (PPS), Medicare Wage Index

National Rural Hospital Flexibility Program Tracking Project Dissemination
Funder: Office of Rural Health Policy (ORHP)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Nationwide Analysis of New Entrants into Medicare+Choice Demonstrations
This project will examine the effects of recent changes in the Medicare+Choice program on enrollment in rural areas and on activities of rural-based health plans.
Funder: Office of Rural Health Policy (ORHP)
Topic: Medicare

Patient-Centered Medical Home: A Model for Rural Physician Practices and Communities?
Rural practices will need to meet the expectations inherent in the patient-centered medical home (PCMH) model or lose any payment advantage that comes with participating as a PCMH. The goal of this project is to assess rural readiness to adopt services seen as part of a PCMH.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Physicians

Rural Provider Participation in a Statewide Health Information Project
Nebraska has recently constructed a communication infrastructure that links all the hospitals in the state with broadband, high-speed systems (using T1 lines to the Critical Access Hospitals). That infrastructure is considered to be the backbone for a statewide health information network being designed by a coalition of organizations. The aim of this project is to delineate reasons for rural providers to participate in the coalition by assessing the associated costs and benefits.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health information technology, Hospitals and clinics, Networking and collaboration

Rural Quality Improvement Focus on Diabetes
This project focused specifically on diabetes care management and quality improvement programming in rural areas as a way to understand the adaptability and policy implications of using chronic care coordination and other models in a rural environment.
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Quality

Rural-Urban Physician Payment Differences Across the Nation: Methodological Changes
This project will simulate the effects of changes to the methodologies used to calculate the three geographic practice cost indices (GPCIs) currently used to adjust physician payment across the 89 Medicare payment areas in the U.S. and territories. Changes to the payment formula will be analyzed to determine potential impact on payment across areas and revenues for rural physician practices.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicare, Physicians, Workforce

Uninsurance and Welfare Reform in Rural America
This project used widely accepted databases to examine the recent history of uninsurance rates in the U.S., focusing on the low-income population that could be eligible for welfare. Additionally, the project concentrated on how welfare reform has impacted the health insurance coverage of welfare recipients and other low-income persons over the period when welfare reform was phased in.
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Poverty

Why Are Health Care Costs Increasing and Is There a Rural Differential in National Data?
This project will determine whether growth in health insurance premiums and out-of-pocket spending differs in rural areas as compared to urban areas.
Funder: Office of Rural Health Policy (ORHP)
Topic: Health insurance and the uninsured

Topics Centers Researchers Other Resources Search		Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Completed Projects Access to Services Across a Continuum of Care for Rural Beneficiaries Funder: Office of Rural Health Policy (ORHP) Topic: Health services Analysis of Information Networking Technology in Sustaining Rural Delivery Systems Funder: Office of Rural Health Policy (ORHP) Topics: Networking and collaboration, Technology Analysis Related to Health Care Reform Issues The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation. Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health policy, Health services Assessment of Small Rural Hospital Activities to Report Medication Errors This research will determine how small rural hospitals have responded to the environmental pressure to improve patient safety and quality by implementing safe medication practices and by reporting and monitoring medication errors. Funder: Office of Rural Health Policy (ORHP) Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality Changing the Medicare Program According to the Principles of Managed Competition Funder: Office of Rural Health Policy (ORHP) Topic: Medicare Characteristics of Low-volume Communities Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Legislation and regulation, Medicare Comments on Regulatory and Contractor Reform Legislation Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, Legislation and regulation, Medicare Developing and Using a Classification Schema to Identify Sentinel Communities in the U.S. This project will enable rural researchers to track the effect of current policies on rural communities, anticipate the effect of proposed policies, and demonstrate policy effects that link one sector to another. Funder: Office of Rural Health Policy (ORHP) Topic: Health policy Discrepancies of Financial Data between Medicare Cost Report and Hospital Audited Financial Statement and Its Implication for Measuring Financial Impact of Payment Policy on Rural Hospitals Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health policy, Hospitals and clinics Establishing a Fair Payment for Rural Physicians This project will analyze differences in physician payment as a function of practice location and simulate policy choices that change the current payment formula. Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, Physicians, Workforce Estimating the Medicare+Choice Threshold Payment Rate Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Medicare Examining Recent Trends and Variation in Ambulatory Care Sensitive Conditions-related Hospital Expenditures of Rural Americans with Different Health Insurance Coverage and Status This study documents the national time-trend and regional variation of rural Ambulatory Care Sensitive Conditions (ACSC)-related hospital expenditures by patient insurance coverage/status. The study will also compare the pattern of difference in the ACSC-related expenditures of rural patients with different insurance coverage/status by patient demographic and economic characteristics as well as hospital characteristics. Funder: Office of Rural Health Policy (ORHP) Topics: Chronic diseases and conditions, Health care financing, Health insurance and the uninsured, Health services Examining the Applicability of the AHRQ's Inpatient Quality Indicators to Rural Hospitals and the Implications of the Relationship Between the Indicators and Financial Measures for Medicare Payment Policies This study will investigate how the Agency for Healthcare Research and Quality's inpatient quality indicators can be applied to rural hospitals and will explore the application of those indicators in answering relevant policy questions. Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health policy, Hospitals and clinics, Quality Examining the Magnitudes, Geographic Variations, and Determinants Of Expenditures Due to Ambulatory Care Sensitive Conditions in Rural Hospitals This project will document the magnitude of and variation in ambulatory care sensitive condition (ACSC) expenditures of rural hospitals and explore the relationships between rural hospital ACSC expenditure and its key determinants in the areas of population demand, health care system supply, and provider practice style. Funder: Office of Rural Health Policy (ORHP) Topics: Chronic diseases and conditions, Health care financing, Hospitals and clinics Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up? This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents. Funder: Office of Rural Health Policy (ORHP) Topics: Health insurance and the uninsured, Health policy How Will Rural Hospitals Meet Requirements for Patient Privacy? Funder: Office of Rural Health Policy (ORHP) Topics: Hospitals and clinics, Legislation and regulation How Would Health Insurance Exchanges Work in Rural America? The passage of the Patient Protection and Affordable Care Act (PPACA) of 2010 has created the potential for states to create health insurance exchanges (HIEs). This project will assess the potential of these plans to meet the needs of rural residents. Empirical work will establish baseline measures of choices available to rural residents and literature reviews will yield prospective analysis of how exchanges could operate to benefit rural residents. Funder: Office of Rural Health Policy (ORHP) Topics: Health insurance and the uninsured, Health policy Impact of Changing Medicare Advantage Landscape on Rural Enrollees This project will explore three important questions related to Medicare Advantage (MA) plans. What is the impact of recent changes in the MA market on rural Medicare beneficiaries, providers and communities? In particular, how have recent changes in markets and payment policy led to changes in the choices of plans facing beneficiaries, and the quality of those plans (as defined by the coverage offered by the plans)? Finally, what is the likely impact of changes made in Medicare Advantage payment rates passed in the Patient Protection Affordable Care Act of 2010 (PPACA) on rural enrollment in MA plans in 2011 and beyond? Funder: Office of Rural Health Policy (ORHP) Topics: Medicare, Medicare Advantage (MA) Impact of Medicare Advantage Plan Concentration on Choices and Competition in Rural Areas This project focuses on the analysis of Medicare Advantage (MA) plan choices for rural beneficiaries and what the concentration of plan choices in rural areas may mean in the context of how rural beneficiaries are making their choices. Using measures of concentration from the economics literature, this project will explore the relationship between market concentration in MA plans and the generosity of MA plans, and how it varies by the location of residence of Medicare beneficiaries. Funder: Office of Rural Health Policy (ORHP) Topics: Medicare, Medicare Advantage (MA) Implementation of Health Reform Legislation in Rural America The RUPRI Center has developed particular expertise, including the use of simulations, in how changes in public policy that are now part of the Patient Protection and Affordable Care Act (PPACA) affect the rural health care providers and communities. We have published policy briefs and papers related to Medicare Advantage and Part D plans, effects of insurance reform on the percentage of uninsured in rural areas, and effects of changes in physician payment on projected total income of rural primary care physicians. The purpose of this project is to take advantage of RUPRI's capacity for further simulation analysis and empirically based analyses of changes occurring as a result of the PPACA. Funder: Office of Rural Health Policy (ORHP) Topics: Health insurance and the uninsured, Health policy, Medicare Implementation of the Medicare Prescription Drug Benefit: What is Available to Rural Beneficiaries? This study will focus on the impact of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on rural beneficiaries, based on actual prescription drug plan contracts, comparing the impact of the legislation on rural beneficiaries to their urban counterparts. Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, Legislation and regulation, Medicare Part D Is Medicare Beneficiary Access to Primary Care Physicians At Risk? This project examined the impact of changes in Medicare payment to physicians on access to care for rural beneficiaries. Funder: Office of Rural Health Policy (ORHP) Topics: Medicare, Physicians J-1 Visa Project Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, International Medical Graduates (IMGs), J-1 Visa Waiver, Workforce Locating Community Pharmacies (Independent and Chain) in Rural America A comprehensive database of all rural U.S. pharmacies including pharmacy name, pharmacy type (chain or independent), town, ZIP code, county, state, RUCA code, and Federal Information Processing Standards will be developed. The databases will be usable in most widely used statistics and geographic information systems software packages. Funder: Office of Rural Health Policy (ORHP) Topics: Health services, Pharmacy and prescription drugs Medicare Modernization Act: Reality for Rural Beneficiaries and Providers This project will focus on two areas of new activity in Medicare�beneficiary participation in Medicare Advantage (MA) plans and prescription drug plans and implementation of the new Part D benefit through private health plans. We will describe enrollment into specific types of MA prescription drug plans and other prescription drug plans, and analyze differences across regions, states, and types of counties. We will also examine the impact of the transfer to Part D coverage on rural dual eligibles and their local pharmacies. Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, Medicare Advantage (MA), Medicare Part D Medicare Reform: Rural Considerations Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, Medicare Prospective Payment System (PPS), Medicare Wage Index National Rural Hospital Flexibility Program Tracking Project Dissemination Funder: Office of Rural Health Policy (ORHP) Topic: Critical Access Hospitals and Rural Hospital Flexibility Program Nationwide Analysis of New Entrants into Medicare+Choice Demonstrations This project will examine the effects of recent changes in the Medicare+Choice program on enrollment in rural areas and on activities of rural-based health plans. Funder: Office of Rural Health Policy (ORHP) Topic: Medicare Patient-Centered Medical Home: A Model for Rural Physician Practices and Communities? Rural practices will need to meet the expectations inherent in the patient-centered medical home (PCMH) model or lose any payment advantage that comes with participating as a PCMH. The goal of this project is to assess rural readiness to adopt services seen as part of a PCMH. Funder: Office of Rural Health Policy (ORHP) Topics: Health services, Physicians Rural Provider Participation in a Statewide Health Information Project Nebraska has recently constructed a communication infrastructure that links all the hospitals in the state with broadband, high-speed systems (using T1 lines to the Critical Access Hospitals). That infrastructure is considered to be the backbone for a statewide health information network being designed by a coalition of organizations. The aim of this project is to delineate reasons for rural providers to participate in the coalition by assessing the associated costs and benefits. Funder: Office of Rural Health Policy (ORHP) Topics: Health information technology, Hospitals and clinics, Networking and collaboration Rural Quality Improvement Focus on Diabetes This project focused specifically on diabetes care management and quality improvement programming in rural areas as a way to understand the adaptability and policy implications of using chronic care coordination and other models in a rural environment. Funder: Office of Rural Health Policy (ORHP) Topics: Chronic diseases and conditions, Quality Rural-Urban Physician Payment Differences Across the Nation: Methodological Changes This project will simulate the effects of changes to the methodologies used to calculate the three geographic practice cost indices (GPCIs) currently used to adjust physician payment across the 89 Medicare payment areas in the U.S. and territories. Changes to the payment formula will be analyzed to determine potential impact on payment across areas and revenues for rural physician practices. Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, Medicare, Physicians, Workforce Uninsurance and Welfare Reform in Rural America This project used widely accepted databases to examine the recent history of uninsurance rates in the U.S., focusing on the low-income population that could be eligible for welfare. Additionally, the project concentrated on how welfare reform has impacted the health insurance coverage of welfare recipients and other low-income persons over the period when welfare reform was phased in. Funder: Office of Rural Health Policy (ORHP) Topics: Health insurance and the uninsured, Poverty Why Are Health Care Costs Increasing and Is There a Rural Differential in National Data? This project will determine whether growth in health insurance premiums and out-of-pocket spending differs in rural areas as compared to urban areas. Funder: Office of Rural Health Policy (ORHP) Topic: Health insurance and the uninsured