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

Publications

Alphabetical list. You can also view by publication date.

• Analysis of Availability of Medicare+Choice, Commercial HMO, and FEHBP Plans in Rural Areas: Implications for Medicare Reform
  Author(s): Timothy McBride, Courtney Andrews, Keith Mueller, Michael Shambaugh-Miller
  Date: 03 / 2003
  Topic: Medicare
  Examines viability of introducing private competition into the Medicare program. Discusses availability of Medicare+Choice1 (M+C), commercial HMO, and Federal Employees Health Benefits Program (FEHBP) plans in rural (nonmetropolitan) counties.
• Analysis of the Agreement of Financial Data between the Medicare Cost Report and the Audited Hospital Financial Statement
  Author(s): Li-Wu Chen, Julie Stoner, Catherine Makhanu, Kathy Minikus, Keith J. Mueller
  Report Number: Rural Policy Brief Vol. 9, No. 4 (PB2004-4 )
  Date: 05 / 2004
  Topics: Health care financing, Hospitals and clinics, Medicare
  Very few studies have thoroughly examined the discrepancies between the Medicare Cost Report (MCR) and the audited hospital financial statement (FS), and none have been conducted for rural hospitals. Findings from this study which focused on the MCR and FS for rural hospitals suggest that relying on a single source of financial data such as the MCR to assess the financial performance of rural hospitals may be inappropriate.
• Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
  Author(s): Anthony Wellever, Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
  Date: 08 / 2000
  Topics: Health care financing, Legislation and regulation, Medicare Prospective Payment System (PPS), Medicare Wage Index
  This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) 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. Report produced by the RUPRI Rural Health Panel.
• Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results?
  Author(s): Li-Wu Chen, Susan Puumala, Keith J. Mueller, Liyan Xu, Kathy Minikus, Catherine Makhanu
  Report Number: Rural Policy Brief Vol. 10, No. 3 (PB2005-3 )
  Date: 11 / 2005
  Topics: Health care financing, Hospitals and clinics, Medicare
  Explores how predictions of changes in hospital financial performance as a result of change in Medicare payment differ when comparing results using data from the Medicare Cost Report (MCR) to results using data from the audited hospital financial statement (FS). Results indicate that when policy analysts and policymakers examine the effect of payment policies on hospitals' financial performance (e.g., total margin) using the best available national data (the MCR) rather than FS data, the results are likely to be valid, despite previously reported discrepancies in the financial information between the two data sources Using statistical analysis of MCR data as a basis for decisions is, therefore, valid for hospitals as a whole. However, using MCR data to directly track the financial performance of individual hospitals may not be valid. This analysis does not, therefore, support using only MCR data for particular hospitals when FS data are available. In those situations, the findings would support using both data sources because of the potential disagreements between the financial data in the MCR and the FS.
• Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
  Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Date: 01 / 2003
  Topics: Legislation and regulation, Medicare, Pharmacy and prescription drugs
  This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
• Availability and Use of Health Plan Choices in Rural America: Medicare+Choice, Commercial HMO, and Federal Employees Health Benefit Program Plans
  Author(s): Timothy McBride, Courtney Andrews, Keith Mueller, Michael Shambaugh-Miller
  Date: 10 / 2003
  Topics: Health insurance and the uninsured, Medicare
  Discusses availability of Medicare + Choice (M+C), commercial HMO, and Federal Employee Health Benefit Program (FEHBP) insurance plans, and the potential impact of M+C service delivery area changes on health care access in rural areas.
• Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System
  Author(s): Anthony Wellever
  Date: 06 / 2000
  Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index
  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. Report produced by the RUPRI Rural Health Panel.
• Can Payment Policies Attract M+C Plans to Rural Areas?
  Author(s): Timothy McBride, Joan Penrod, Keith Mueller, Courtney Andrews, Micah Hughes
  Report Number: Rural Policy Brief Vol. 6, Number 8 (PB2001-8)
  Date: 05 / 2001
  Topic: Medicare
  Presents information on some of the factors that discourage insurance plans from offering Medicare managed care plans in non-metropolitan counties. Lists three policy levers other than payment rates that might give rural beneficiaries access to the same benefits as urban beneficiaries. 1) Combine counties into service areas for purposes of M+C payment to make the areas more attractive to managed care plans. 2) Use risk-adjusted fee-for-service payment and abandon geographically based M+C payment rates. 3) Accept that traditional fee-for-service Medicare will be the only option for many rural beneficiaries and focus on equity in payment policies and expansion of Medicare benefits.
• Care Across the Continuum: Access to Health Care Services in Rural America
  Author(s): Keith J. Mueller, A. Clinton MacKinney
  Report Number: Working Policy Paper P2003-10
  Date: 12 / 2003
  Topic: Health services
  Proposes that a continuum of care serve as the framework with which to consider rural health care policies, focusing on people and on places where people live rather than on the wants of providers and constituencies. The continuum of care describes the breadth of health care services in seven stages, from personal behavior to palliative care. The framework helps establish which health care services should be provided locally and which provided at a distance, emphasizing seamless linkages between all stages of the continuum.
• Care Across the Continuum: Access to Health Care Services in Rural America
  Author(s): Keith J. Mueller, A. Clinton MacKinney
  Citation: Journal of Rural Health, 22(1), 43-49
  Date: 2006
  Topic: Health services
  Proposes a continuum of care that serves as a framework with which to assess public and private policies designed to ensure that rural residents receive appropriate health care services, in a timely manner, and in a place that optimizes care effectiveness. Community leaders and policymakers can use this health care continuum as a design framework to help reduce system complexity and implement a patient- and community-focused, rather than provider-focused, health care system. The article is divided into 3 sections: 1) basic principles that determine services to be included in the continuum and how success in providing those services is judged; 2) definition of the continuum and its basic stages based on the health systems research literature; 3) applications of the continuum and policy implications of the framework.
• Changing Rural Populations and Impact on Public Policy
  Author(s): Keith Mueller, Michael D. Shambaugh-Miller
  Date: 10 / 2002
  Topics: Health policy, Rural statistics and demographics
  Population movement in rural areas and health policy issues
• Chronic Disease Management Systems (Registries) in Rural Health Care
  Author(s): Anne Skinner, Roslyn Fraser-Maginn, Keith J. Mueller
  Report Number: Rural Policy Brief Vol. 11, Number 1 (PB2006-1 )
  Date: 05 / 2006
  Topics: Chronic diseases and conditions, Quality, Technology
  A Chronic Disease Management System (CDMS), or registry, is a tool that helps providers efficiently collect and analyze patient information to promote quality care for the rural population. The focus of this study was on the use of CDMSs in the management of diabetes, a disease prevalent in rural populations. Findings show that CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology.
• Comments on Regulatory and Contractor Reform Legislation
  Author(s): Keith Mueller, Brandi Shay
  Report Number: Rural Policy Brief Vol. 7, No. 1 (PB2002-1)
  Date: 01 / 2002
  Topics: Legislation and regulation, Medicare
  Informs policy and reports back to the "field" regarding the rural issue of, and suggested modifications to, contractor reform following the passage of the Medicare Regulatory and Contracting Reform Act of 2001. Findings consist of responses from interviews with a range of health care professionals and experts.
• Comments on the June 2001 Report of the Medicare Payment Advisory Commission: Medicare in Rural America
  Author(s): Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
  Date: 09 / 2001
  Topics: Health policy, Medicare
  Comments on and critiques the findings in MedPAC's Medicare in Rural America. The authors believe that while the MedPAC report helps set a framework for analysis, it is not a definitive treatise on the role of Medicare in rural health. Among its findings: most of MedPAC's recommendations would have positive impacts on health care for rural beneficiaries, others would do no harm, others could be strengthened, and a few, particularly those relating to access to services, "suffer from disparities and weaknesses." Report produced by the RUPRI Rural Health Panel.
• Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
  Author(s): Michelle Mason, Roslyn Fraser-Maginn, Keith Mueller, Jennifer King, Andrea Radford, Rebecca Slifkin, Jennifer Lenardson, Lauren Silver, Curt Mueller
  Date: 12 / 2005
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare Advantage (MA)
  Summarizes the experience of Critical Access Hospital (CAH) administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms administrators have been offered, their experiences negotiating with MA plans, and their advice for others dealing with this issue.
• Critical Access Hospitals' Experience with Medicare Advantage Plans
  Date: 03 / 2008
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Hospitals and clinics, Medicare Advantage (MA)
  This report details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage (MA) plans. Findings from this research identify concerns of CAH administrators that, as the MA program evolves, may be addressed through technical assistance and changes in regulation or legislation.
• Definition of Rural in the Context of the MMA Access Standards for Prescription Drug Plans
  Author(s): Keith J. Mueller, Rebecca T. Slifkin, Michael D. Shambaugh-Miller, Randy K. Randolph
  Report Number: RUPRI Policy Paper P2004-7, North Carolina Working Paper No. 79
  Date: 09 / 2004
  Topics: Defining rural, Legislation and regulation, Pharmacy and prescription drugs
  Access to local pharmacy services is dependent upon the extent to which prescription drug plans offering the Medicare benefit incorporate local rural pharmacies into their provider networks. This will be based on market considerations and on the requirements for local access contained in the MMA and regulation, which in turn will be shaped by how "rural" is defined. This paper assesses how the definition of rural affects the potential impact of the specific access standards in the Proposed Rule to implement Title I of the MMA, and finds that the congressional objective to achieve convenient access to pharmacies (other than mail order) would be more fully realized if the Proposed Rule definition of rural is changed.
• Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
  Author(s): Andrew F. Coburn, Erika C. Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Date: 08 / 2000
  Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
• Directory of Rural Health Networks: Profiling Network Information Technology Use
  Author(s): Keith J. Mueller, Brandi Shay, Sue Nardie, J. Patrick Hart, Dianne Harrop, Donadea Rasmussen
  Date: 03 / 2005
  Topics: Networking and collaboration, Technology
  Profiles of selected rural health networks funded by the Office of Rural Health Policy. Includes information on each network's current use of information technology (IT) and future plans for IT.
• Electronic Health Records Adoption: Rural Providers' Decision-Making Process (Policy Brief)
  Author(s): Li-Wu Chen, Anne Skinner
  Report Number: 2008-4
  Date: 10 / 2008
  Topics: Health information technology, Hospitals and clinics
  This brief reports findings of a study that examined the decision-making process that small rural physician clinics and hospitals use as they investigate and select an electronic health record (EHR) system. Policy makers can use the study findings to understand the challenges that rural health care providers may face in the process of adopting EHRs and to develop incentives that promote the use of health information technology in rural America.
• Elements of Successful Rural Diabetes Management Programs
  Author(s): Roslyn Fraser, Anne M. Skinner, Keith J. Mueller
  Report Number: P2006-2
  Date: 07 / 2006
  Topic: Chronic diseases and conditions
  Reports findings from a study about local innovations implemented by rural chronic disease management programs. Using diabetes as a proxy for all chronic diseases, the authors explored how local innovations overcame challenges of the rural setting, such as low income, cultural differences, and long travel distances, to provide effective and efficient disease management.
• Enrollment in FEHBP Plans In Rural America: What Are The Implications For Medicare Reform?
  Author(s): Timothy McBride, Keith Mueller, Courtney Andrews, Liyan Xu, Roslyn Fraser
  Report Number: Rural Policy Brief Vol. 8, Number 8 (PB2003-8)
  Date: 06 / 2003
  Topic: Medicare
  Recent proposals to reform the Medicare program and add an outpatient prescription drug benefit have used the Federal Employees Health Benefits Program (FEHBP) as the model for how private plans could be incorporated into the Medicare program. This policy brief presents information showing how FEHBP is functioning in rural areas of the country. Enrollment patterns into the various options available in the FEHBP, descriptions of the choices typically available in rural areas, and location of primary care providers used by plans in a sample of rural communities is presented.
• Enrollment in FEHBP Plans in Rural Areas
  Author(s): Timothy D. McBride, Courtney Andrews, Keith Mueller
  Date: 05 / 2003
  Topics: Health insurance and the uninsured, Medicare
  Study of health plan enrollment decisions made by rural retirees and federal workers. Discusses how a Federal Employees Health Benefit Program (FEHBP) plan may work when applied to Medicare.
• Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
  Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
  Report Number: Rural Policy Brief Vol. 12, No. 1 (PB2007-1)
  Date: 01 / 2007
  Topic: Medicare Part D
  Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United States. Updates findings presented in RUPRI Center policy brief PB2006-8. Maps showing the percent of rural persons enrolled in Part D plans are available: black and white map, color map.
• Enrollment in the Federal Employees Health Benefit Program (FEHBP): State and County-Level Enrollment Analysis
  Author(s): Timothy D. McBride, Courtney Andrews, Keith Mueller
  Date: 05 / 2003
  Topics: Health insurance and the uninsured, Medicare
  Information on Federal Employees Health Benefit Program (FEHBP) enrollment in rural counties, including the number of health insurance plans available and number of enrollees. FEHBP is being considered as a model for involving private insurers in Medicare. Rural FEHBP enrollment choices may provide insights into how a similar program might work for Medicare.
• Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
  Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
  Citation: Journal of Rural Health, 23(4), 286–293
  Date: 2007
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Describes first-hand reports from rural pharmacist-owners about their experiences with Medicare Part D plans in the first 7 months of 2006 in order to gain a more thorough understanding of the challenges faced by rural independent pharmacies as a result of program implementation.
• Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
  Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
  Report Number: Working Paper No. 87 (NC), Policy Paper P2006-3 (RUPRI)
  Date: 11 / 2006
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Case study describing first-hand reports from 12 rural independent pharmacists in seven states about their experiences with Medicare Part D plans (PDPs) in the first seven months of 2006. The rural independent pharmacists interviewed are experiencing major changes in payment, administrative burden, and interaction with patients as a result of the shift of patients into Medicare Part D plans. Previously, these patients were mostly non-covered cash or Medicaid-covered clients. Two consequences are apparent in the data collected: 1) Payment per prescription is lower from Medicare PDPs than from either non-covered cash or Medicaid, and in some instances payment from PDPs is less than the combined cost of stocking the medications and dispensing them, representing a reduction in revenue; and 2)The number of plans that provide Part D benefits greatly exceeds the two payment sources pharmacists previously dealt with, representing an increase in administrative burden for independent pharmacies.
• Federal Employees' Health Benefits Program: A Model for Competition in Rural America?
  Author(s): Keith J. Mueller, Timothy D. McBride, Courtney Andrews, Roslyn Fraser, Liyan Xu
  Citation: Journal of Rural Health, 21(2), 105-113
  Date: 2005
  Topics: Health insurance and the uninsured, Medicare Advantage (MA)
  Tests the hypothesis that the Federal Employees' Health Benefits Program (FEHBP) has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas. There is a strong relationship between the number of FEHBP plans and areas with high population counts and high population density. In many counties with low population counts (under 3,000), most PPOs are not contracting with the nearest primary care provider. The authors conclude that the FEHBP is not a perfect predictor of Medicare Advantage (MA) plan activity because the MA program does not use the FEHBP approach of certifying regional plans that must offer local access. However, the FEHBP experience indicates that plans are attracted to areas with high population counts and high population density.
• Health Insurance in Rural America
  Author(s): Louis Pol
  Date: 08 / 2000
  Topic: Health insurance and the uninsured
  This brief focuses on the differences between the rural and urban uninsured.
• Health Services at Risk in "Vulnerable" Rural Places
  Author(s): Michael D. Shambaugh-Miller, Julie Stoner, Louis Pol, Keith Mueller
  Report Number: Rural Policy Brief Vol. 7, Number 5 (PB2002-5)
  Date: 10 / 2002
  Topic: Health services
  Describes, applies, and discusses implications of a method to identify places in rural America that are at risk of (vulnerable to) being without adequate health care services because 1) they lack a sufficient number of people to support a practice/provider, 2) they lack a sufficient number of people who are able to pay the full cost of care, 3) the population size and composition do not warrant the level of services currently available.
• Immediate and Future Role of the J-1 Visa Waiver Program for Physicians: The Consequences of Change for Rural Health Care Service Delivery
  Author(s): Keith J. Mueller
  Report Number: Policy Brief 2002-3
  Date: 04 / 2002
  Topics: J-1 Visa Waiver, Physicians, Workforce
  Examines the consequences for the delivery of health care services in rural underserved areas if current policies governing the granting of J-1 visa waivers are changed and increases or decreases the numbers of physicians affected. Among its findings: J-1 visa waiver doctors provide care to more than 4 million people living in underserved areas of rural America. If all primary care doctors in the program were to leave, the number of rural counties with no primary care physicians would go from 161 to 212. Makes several recommendations: 1) The Department of Health and Human Services--which currently only requests waivers for physicians involved in research-should consider requesting waivers for doctors to practice in underserved areas. 2) Physicians recommended for waivers should be allowed to begin practicing in underserved areas as soon as the request is made. If, in subsequent screening, a problem turns up the waiver would be revoked. 3) The Conrad State 20 Program, which allows the 44 states that participate in it to sponsor waivers, should be expanded from 20 waivers per year to 40.
• Impact of National Policy on Access to Health Care: The Rural Perspective
  Author(s): Keith Mueller
  Date: 10 / 2002
  Topics: Health policy, Health services
  Current state of financial and geographic access to health care in the U.S. and federal policy
• Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
  Author(s): Timothy D. McBride, Courtney Andrews
  Report Number: Rural Policy Brief Vol. 10, No. 6 (PB2005-6 )
  Date: 12 / 2005
  Topics: Health insurance and the uninsured, Poverty
  Explores the impact of welfare reform on the health insurance coverage of welfare recipients and other low-income persons over the period when the reform was phased in. Key findings of this study showed that a substantial percentage of persons who left the Aid to Families with Dependent Children (AFDC) program after reform became uninsured, and former AFDC recipients in rural areas were more likely than urban counterparts to lose insurance coverage. Insurance loss was more likely for those who gained employment than for those who remained unemployed.
• Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
  Author(s): Andrew F. Coburn, Erika Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Date: 06 / 2000
  Topics: Legislation and regulation, Pharmacy and prescription drugs
  This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
• Inequitable Access: Medicare+ Choice Program Fails to Serve Rural America
  Author(s): Timothy McBride, Keith Mueller
  Date: 02 / 2002
  Topic: Medicare
  This brief discusses the Medicare+ Choice plan and how it has failed to meet the health issues of Americans.
• Information Technology and Rural Health Networks: An Overview of Network Practices
  Author(s): Keith J. Mueller, Brandi Shay, J. Patrick Hart, Diane Harrop, Donadea Rasmussen
  Report Number: PB 2004-3
  Date: 05 / 2004
  Topics: Networking and collaboration, Technology
  Focuses on the use of information technology (IT) in rural health networks, based on detailed interviews with representatives for 15 rural health networks that received funding from the federal Rural Health Network Development Grant program. In general, IT was found to be most beneficial to the network when it was integrated into the initial plans for network development, scaled to the needs of the specific project, and expanded to new applications only as the network itself matured to take on new tasks.
• Medicare Issues
  Author(s): Keith J. Mueller
  Date: 08 / 2003
  Topic: Medicare
  Overview of rural policy issues related to Medicare. Presentation made 8/26/03 in Casper, WY.
• Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
  Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
  Report Number: Rural Policy Brief Vol. 10, No. 8 (PB2006-8 )
  Date: 04 / 2006
  Topic: Medicare Part D
  Provides a first snapshot of enrollment in Medicare Part D in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under this program. These early findings show mixed results for the Medicare prescription drug plan (PDP) in rural areas, with enrollment in the Medicare stand-alone PDP higher in rural areas (21%) than in urban areas (13%). However, this is balanced by low enrollment in MA-PD plans in rural areas, which offer relatively less generous plan choices to rural persons. Additionally, enrollment in employer and federal plans is lower in rural areas (20%) than in urban areas (24%). Finally, the relatively high enrollment in Part D in rural areas reflects the high enrollment of Medicaid dual eligibles also covered by Medicare, who were not enrolled in Part D voluntarily.
• Medicare Payment for Services in Rural Communities: Testimony before The Subcommittee on Health, Committee on Ways & Means, U.S. House of Representatives
  Author(s): Keith Mueller
  Date: 06 / 2001
  Topic: Medicare
  Reasons to change Medicare payment policies and a new framework for making appropriate changes.
• Medicare Payment Policies
  Author(s): Keith J. Mueller
  Date: 08 / 2003
  Topics: Hospitals and clinics, Medicare, Physicians
  Overview of the policy issues related to Medicare payment to physicians and hospitals. Presented at the All Programs Meeting, Federal Office of Rural Health Policy, 8/21/03.
• Medicare Physician Payment
  Author(s): A. Clinton MacKinney, Michael D. Shambaugh-Miller, Keith Mueller
  Date: 01 / 2003
  Topics: Medicare, Physicians
  Resource-Based Relative Value Scale (RBRVS) has replaced the 25 year-old Medicare CPR charge system.
• Medicare Physician Payment Policy and the Rural Perspective (Final Report)
  Author(s): A. Clinton MacKinney, Keith J. Mueller, Timothy D. McBride
  Date: 11 / 2008
  Topic: Medicare
  During the past six years, the RUPRI Center has examined the effects of Medicare payment changes on rural physician practice revenue. Despite the apparently tenuous association between Medicare physician payment policy and physician practice decision making, we infer that changes to practice revenue potentially affect physician decisions regarding rural practice. This report presents the results of the RUPRI Center's work and provides a framework for understanding this continuing policy question.
• Medicare Physician Payment: Impacts of Changes on Rural Physicians
  Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride
  Report Number: Rural Policy Brief Vol. 11, No. 2 (PB2006-2 )
  Date: 09 / 2006
  Topics: Medicare, Physicians
  Overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Discusses the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense and the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
• Medicare Physician Payment: Practice Expense
  Author(s): A. Clinton MacKinney, Timothy D. McBride, Michael D. Shambaugh-Miller, Keith J. Mueller
  Report Number: Rural Policy Brief Vol. 8, No. 9 (PB2003-9)
  Date: 10 / 2003
  Topics: Medicare, Physicians
  Examines the physician practice expense component of Medicare payment, which proportionately results in greater geographic physician payment variation than does the physician work payment. The practice expense adjustment methodology warrants careful validation to demonstrate that the index measures actual geographic practice cost differences. A complete understanding of the reasons for different payments will inform both physicians who want to know why the same procedure results in less reimbursement in one place than it does in another and policymakers who want to address that concern.
• Medicare Prescription Drug, Improvement, And Modernization Act Of 2003, (P.L. 108-173): A Summary Of Provisions Important To Rural Health Care Delivery
  Author(s): Keith J. Mueller
  Report Number: Policy Paper P2004-1
  Date: 01 / 2004
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Provides a wide audience of rural health policymakers, advocates, and researchers a consolidated summary of legislative provisions contained in Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) that have particular meaning to the delivery of services in rural areas. Includes information on how this Act will impact beneficiaries, health care access, and payments to rural health care providers.
• National Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
  Author(s): Li-Wu Chen, Wanqing Zhang, Junfeng Sun, Keith J. Mueller
  Report Number: Policy Brief No. PB2007-4
  Date: 12 / 2007
  Topics: Chronic diseases and conditions, Health care financing, Health policy, Hospitals and clinics
  Documents the national magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals.
• One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
  Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
  Report Number: Final Report No. 92 (NC), Final Report No. P2007-1 (RUPRI)
  Date: 09 / 2007
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A findings brief is also available.
• One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
  Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
  Report Number: Findings Brief No. 83
  Date: 10 / 2007
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A final report is also available.
• Preparing for Medicare Part D: An Opportunity for State Offices of Rural Health and State Rural Health Associations
  Author(s): Keith J. Mueller, Lisa Bottsford
  Report Number: Rural Policy Brief Vol. 10, No. 2 (PB2005-2 )
  Date: 08 / 2005
  Topic: Medicare Part D
  Keeping with their organizational missions to improve and promote the health of rural Americans, state offices of rural health and state rural health associations have an inherent interest in helping beneficiaries access necessary health care services, including prescription medications. Implementation of Part D creates an opportunity to help beneficiaries through leadership, by connecting beneficiaries and those who serve them to resources that will help them react appropriately to changes in the program.
• Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
  Author(s): Gary Cochran, PharmD, SM, Katherine Jones, PhD, PT, Liyan Xu, MS, Keith Mueller, PhD
  Citation: This issue brief presents the findings of a national survey whose purpose was to describe the prevalence of evidence-based safe medication practices, including the use of voluntary medication error reporting, in the nations smallest hospitals. A key finding is that hospitals with an average daily census of six or more patients were more likely to report having adopted safe medication practices than were hospitals with an average daily census of five or fewer patients. Findings from this research reveal considerable opportunity for improvement in hospitals with 49 or fewer beds to achieve evidence-based standards of medication safety.
  Report Number: Issue Brief 2008-1
  Date: 04 / 2008
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality
  
• Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
  Author(s): Andrew F. Coburn, Charles W. Fluharty, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Report Number: Special Monograph
  Date: 02 / 2001
  Topics: Health policy, Medicare
  Provides a framework to help shape proposals to redesign Medicare to the benefit of rural beneficiaries and providers. Chapters focus on equity, quality, choice, access, and cost. Each chapter outlines the current situation, analyzes the implications of various approaches to changing the program, and makes recommendations for developing a Medicare program of greatest benefit to rural residents. Report produced by the RUPRI Rural Health Panel.
• Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
  Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Date: 08 / 2000
  Topics: Health policy, Medicare
  With this paper, the RUPRI Rural Health Panel is presenting a well-defined framework for what should be included in any discussion of Medicare policies.
• Regional Variation in Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
  Author(s): Li-Wu Chen, Wanqing Zhang, Junfeng Sun, Keith J. Mueller
  Report Number: Policy Brief No. PB2007-5
  Date: 12 / 2007
  Topics: Chronic diseases and conditions, Health care financing, Health policy, Hospitals and clinics
  Estimates and documents the regional magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals.
• Reliance on Independently Owned Pharmacies in Rural America
  Author(s): Michael D. Shambaugh-Miller, Nicole Vanosdel, Keith J. Mueller
  Report Number: Rural Policy Brief No. 2007-6
  Date: 11 / 2007
  Topic: Pharmacy and prescription drugs
  Policy brief providing locations of independently owned pharmacies in rural America that are the sole sources of access to local pharmaceutical services. In over 2,000 rural communities, the only local pharmacy is independently owned, and in 1,044 of those communities, there is no other pharmacy within 10 miles. The information in this brief lays a foundation for analyzing vulnerability of pharmacy services in rural America and identifies the questions that research and policy activities should address. State maps show the locations of communities with only one pharmacy, independently owned.
• Report on Enrollment: Rural Medicare Beneficiaries in Medicare+Choice Plans
  Author(s): Brandi Shay, Timothy McBride, Keith Mueller
  Date: 06 / 2000
  Topic: Medicare
  This policy brief describes the experience to date with the Medicare+Choice program, focusing on changes in enrollment and plan formation through Fall 1999. Report produced by the RUPRI Rural Health Panel.
• Rural Assessment of Leading Proposals to Redesign the Medicare Program
  Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Date: 05 / 2000
  Topics: Health policy, Medicare
  This Policy Paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" (S. 1895, introduced by Senator Breaux and others) and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed, specifically how they affect rural Medicare beneficiaries and rural providers of health care services. Report produced by the RUPRI Rural Health Panel.
• Rural Beneficiary Need for a Medicare Drug Benefit Delivered Through the Rural Delivery System
  Author(s): Keith Mueller
  Date: 10 / 2002
  Topics: Aging, Pharmacy and prescription drugs, Poverty
  Elderly who live below the poverty level, seniors without prescription drug coverage, Medicare plans
• Rural Diabetes Care Management Programs: An Inventory of Sample Programs in Six States
  Author(s): Roslyn S. Fraser-Maginn, Anne M. Skinner, Sue Nardie, Keith J. Mueller
  Date: 12 / 2005
  Topic: Chronic diseases and conditions
  Developed to share key contact and program information with organizations that are interested in starting a chronic disease management (DM) program in their facility.
• Rural Enrollment in Medicare Advantage Continues to Grow Rapidly in 2008, Led by Private Fee-for-Service Plans
  Author(s): Yolonda Y. Campbell, Timothy D. McBride, and Keith Mueller
  Report Number: Brief No. 2008-3
  Date: 08 / 2008
  Topics: Medicare, Medicare Advantage (MA)
  Enrollment of rural beneficiaries into Medicare Advantage (MA) plans has more than quadrupled since the inception of the MA program at the beginning of 2006 and increased 35% in the last year. However, as a percent of all beneficiaries, the enrollment rate in rural areas remains well below the national enrollment rate. The tremendous growth in rural MA plans over the past two and a half years is mostly attributed to the spread of private fee-for-service plans across the country, which now account for 58% of rural Medicare eligibles. This policy brief provides findings about enrollment in the MA program in rural areas and across the United States and updates findings from analysis of the MA program presented in previous RUPRI Center policy briefs.
• Rural Enrollment in Medicare Advantage Growing Rapidly in 2007, Especially in Private Fee-for-Service Plans
  Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
  Report Number: Rural Policy Brief Vol. 12, No. 3 (PB2007-3 )
  Date: 07 / 2007
  Topic: Medicare Advantage (MA)
  Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas, with state and national data. Updates early findings from analysis of the Medicare+Choice/MA program presented in previous RUPRI Center policy briefs.
• Rural Enrollment in Medicare Advantage Is Concentrated in Private Fee-for-Service Plans
  Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
  Report Number: Rural Policy Brief Vol. 12, No. 2 (PB2007-2 )
  Date: 04 / 2007
  Topic: Medicare Advantage (MA)
  Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas. Includes rural and urban data on enrollment in Medicare Advantage and other pre-paid plans by type of plan. Also provides state-level information on MA enrollment.
• Rural Hospital HIPAA Readiness and Resource Needs
  Author(s): J. Patrick Hart, Wanqing Zhang, Jane L. Meza, Keith J. Mueller
  Report Number: Rural Policy Brief Vol. 8, No. 6 (PB2003-6)
  Date: 05 / 2003
  Topic: Hospitals and clinics
  Presents survey of rural hospitals regarding the extent of their preparation for HIPAA requirements and their need for resources to implement HIPAA requirements. Results shown by hospital size. Also includes information on financial and staff commitment levels.
• Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
  Author(s): Keith J. Mueller
  Date: 01 / 2001
  Topics: Health policy, Legislation and regulation, Medicaid and S-CHIP, Medicare
  Covers rural health policy, SCHIP Benefit Improvement Plan, and legislation.
• Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000: Concerns, Legislation, and Next Steps
  Date: 01 / 2001
  Topics: Health policy, Legislation and regulation, Medicaid and S-CHIP, Medicare
  Overview of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) as it impacts rural health.
• Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
  Author(s): Curt Mueller, Keith Mueller, Janet Sutton
  Report Number: Walsh W Series No. 6, RUPRI P2004-6
  Date: 08 / 2004
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Provides in chart form sections of the MMA which were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policymakers. The particular sections are cited and implications for rural health services are indicated. Most of the sections identified are concerned with access to prescription drug coverage and the impact of the proposed legislation on rural pharmacies. The primary focus is on rules that will affect providers of drug coverage; this policy paper does not focus on rural dimensions of coverage from the insurance providers' perspective.
• Rural Physicians' Acceptance Of New Medicare Patients
  Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride, Jane L. Meza, Liyan Xu
  Report Number: Rural Policy Brief Vol. 9, No. 5 (PB2004-5 )
  Date: 08 / 2004
  Topics: Medicare, Physicians
  Findings from analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians indicate that: 1) The trend among all physicians is to not accept new Medicare patients, 2) The percentage of physicians in both urban and rural areas who are accepting new Medicare patients is declining, 3) Physicians practicing in rural areas not adjacent to urban areas are the most likely to accept new Medicare patients, and 4) Findings also indicate that the negative implications of not taking the necessary steps to reverse the small but important decline in physician willingness to take new Medicare patients may be most serious in rural communities.
• State Updates on Medicare Advantage Enrollment
  Date: 12 / 2007
  Topics: Medicare Advantage (MA), Rural statistics and demographics
  Contains reports for each state with the number of persons enrolled in Medicare Advantage and prepaid plans in December 2005 and September 2007 in rural and urban areas.
• Status and Future of Health Care Delivery in Rural Wyoming
  Date: 06 / 2007
  Topics: Health services, Rural statistics and demographics, Workforce
  Provides findings from an analysis of health care service delivery in rural Wyoming. Includes an overview of Wyoming's population and the health care service delivery system. Covers workforce recruitment and retention, the economic impact of the health care system, and other topics.
• Status and Future of Health Care Delivery in Rural Wyoming: A Summary Report
  Date: 2007
  Topic: Health services
  Provides recommendations for improving the health care delivery system in rural Wyoming.
• Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
  Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary K. Wakefield
  Citation: Journal of Rural Health, 21(3), 194-197
  Date: 2005
  Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs
  The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that congressional staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects.
• Update on Medicare+ Choice: Rural Medicare Beneficiaries Enrolled in Medicare+ Choice Plans through October 2000
  Author(s): Timothy McBride, Courtney Andrews, Keith Mueller
  Date: 03 / 2001
  Topic: Medicare
  
• Update on Medicare+ Choice: Rural Medicare Beneficiaries Enrolled in Medicare+ Choice Plans through September 2001
  Author(s): Timothy McBride, Courtney Andrews, Alexie Makarkin, Keith Mueller
  Report Number: PB 2002-4
  Date: 08 / 2002
  Topic: Medicare
  Medicare+ Choice Plans, counties enrolled, and data available
• Update on Rural Enrollment in Medicare Advantage: Growth Continues
  Author(s): Timothy D. McBride, Keith J. Mueller
  Report Number: Rural Policy Brief No. 2007-7
  Date: 10 / 2007
  Topic: Medicare Advantage (MA)
  Provides findings about rural enrollment in the Medicare Advantage (MA) program and other pre-paid plans, with state and national data. Updates early findings from analysis of the Medicare+Choice/MA program presented in previous RUPRI Center policy briefs. Detailed data about MA enrollment and plans are available at: http://www.unmc.edu/ruprihealth/Pubs/PB2007-7%20Tables%20110507.pdf.
• Why are Health Care Expenditures Increasing and Is There a Rural Differential?
  Author(s): Timothy D. McBride
  Report Number: Rural Policy Brief Vol. 10, No. 7 (PB2005-7 )
  Date: 11 / 2005
  Topic: Health care financing
  Rising health care expenditures have in recent years been a burden for rural persons, rural employers, and taxpayers. Several factors have contributed to rising health care expenditures, including changes in the health care needs of the population, rising income of the population, insurance-induced demand, provider price changes, and technological change. Some of these factors have disproportionately affected rural areas, and rural areas have in recent years seen higher increases in some expenditure categories such as physician office-based visits and prescription drugs. Those differences suggest strategies to contain health expenditure increases may be different in rural areas and may be best determined on a local basis.