Michael Meit, MA, MPH

Director, Walsh Center for Rural Health Analysis

Phone: 301.634.9324
E-mail: meit-michael@norc.org

NORC Walsh Center (formerly ProjectHOPE)

Current Projects

Augmenting Efforts for a Tool to Predict Post-Event Rural Population Surge
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topic: Emergency preparedness
The Walsh Center is developing a tool to predict post-event rural population surge following public health emergencies, with funding originating from CDC. To enhance predictive accuracy of this tool and to more generally inform rural preparedness efforts, this project will gather information using key informant and survey methodologies.

Development of a Web-Based Spatial Analysis Tool to Predict Post-Event Rural Population Surge
Research center: Walsh Center for Rural Health Analysis
Funders: Centers for Disease Control and Prevention (CDC), National Association of County and City Health Officials (NACCHO)
Topics: Emergency preparedness, Technology
Through this project the Walsh Center will develop a cadre of tools to assist rural jurisdictions in planning for population surge following an urban disaster. Resources include a web-based modeling tool for rural emergency planners to assess likely population surge, and a planning guidelines document.

Effect of Travel Distances on Access to Obstetric Care and Birth Outcomes in Rural Communities
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Maternal and child health, Physicians, Women
This study will assess whether the availability of obstetric providers in rural areas is sufficient to meet the need for obstetric care by measuring the distance patients must travel to obtain prenatal care and delivery and by examining health outcomes related to labor and delivery.

Exploring the Black Box: Design and Implementation Issues of P4P for Rural Physicians
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Physicians
Information about how pay-for-performance (P4P) payment systems work in ambulatory care settings, and in particular, how rural physicians might be affected, is scarce. This study employs qualitative research methods to explore the design and implementation of P4P systems and to investigate effects of P4P on rural physicians in a variety of settings.

Monitoring Medicare Hospital Outpatient Payments: Trends and Evidence of Impacts of Payment Policy
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
This project documents trends in the provision of Medicare hospital outpatient services under both the new outpatient prospective payment system (OPPS) and cost-based mechanism used for critical access hospitals, and assesses evidence on the impacts of Medicare OPPS on Medicare and total outpatient revenue.

Outpatient Payment Policy Under Medicare: Recent Policy Developments from the Rural Perspective
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Hospitals and clinics
This study was designed to examine outpatient payment options for rural hospitals, the advantages and disadvantages of each, and their potential impact on hospital revenue and rural access to health services.

Quality Improvement Organizations' Contributions to Rural Hospital Performance
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health information technology, Hospitals and clinics, Quality
This qualitative study is designed to gather information on best-practices in Quality Improvement Organization (QIO)-rural hospital partnerships. Specifically, this study will identify successful and replicable examples in which QIOs have worked with rural and critical access hospitals to improve processes of care, implement health information technology and promote organizational safety culture.

Stay or Leave: Evidence from a Cohort of Young Rural Physicians
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Physicians, Workforce
This project aims to improve understanding of the dynamics of physician practice location decision making by examining and analyzing changes in practice locations for a sample of rural physicians.

Completed Projects

Achieving Equity in Disproportionate Share Payments to Rural Hospitals: An Examination of MedPAC's Revised Disproportionate Share Formula
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Hospitals and clinics, Legislation and regulation

Advantages and Disadvantages of Hospital-Based Emergency Medical Services in Rural Areas
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Hospitals and clinics
This project sought to clarify issues surrounding hospital decisions to acquire and maintain ownership of community ambulance services.

Alternatives to the 96-Hour Rule for Critical Access Hospitals
Research center: Walsh Center for Rural Health Analysis
Funder: Health Care Financing Administration (HCFA)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Analysis of Substance Abuse and Mental Health Disparities in the Appalachian Region and Access to Treatment Services, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Appalachian Regional Commission (ARC)
Topics: Health disparities, Mental health, Substance abuse
This project used both quantitative and qualitative methods to analyze substance abuse and mental health issues within the Appalachian region, as well as between Appalachia and the broader United States.

Burdens of HIPAA on Rural Hospitals
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Legislation and regulation

Declining Access to Hospital-based Obstetric Services in Rural Areas: Causes and Impact
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Hospitals and clinics, Legislation and regulation, Maternal and child health, Women
This study examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. It examines potential causes for this trend and explores the effects of medical malpractice reforms.

Determinants of Quality of Care in Rural Communities: How Does The Health Care Infrastructure Affect Quality of Care in Rural America?
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Quality, Workforce

Effective Strategies for Achieving HIPAA Compliance Among Rural Hospitals
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Legislation and regulation

Financing Rural Public Health Activities in Chronic Disease Prevention and Health Promotion, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health care financing, Health promotion and disease prevention, Public health
This project describes the federal-state funding streams for selected local public health activities in the area of chronic disease prevention and health promotion, and assesses potential barriers to program implementation in less populated, local areas of a state.

Impact of CAH Conversion on Hospital Costs and Mix of Services
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services
This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.

Impact of the Home Health PPS on Access in Rural America
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Home health, Medicare Prospective Payment System (PPS)
This study is designed to help policymakers understand whether patterns of home care use in rural communities have been affected by the PPS. Analyses will provide information on the characteristics of the patients served, the number and mix of services rendered, and quality of care.

Implementing Clinical Preventive Services Recommendations in Rural Settings, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Agency for Healthcare Research and Quality (AHRQ)
Topics: Health promotion and disease prevention, Health services, Physicians
As part of a larger effort to evaluate the integration and delivery of the US Preventive Services Task Force (USPSTF) recommendations in different types of health plans through site visits and key informant interviews, Walsh Center staff conducted one site visit with a rural health plan to identify specific barriers and opportunities inherent to providing clinical preventive services to rural residents in rural settings.

Investments in Health Information Technology by Rural Hospitals
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health information technology, Hospitals and clinics
This study involved a national survey of rural hospitals conducted in late spring 2006 to gather data about readiness to adopt health IT, current use of different technologies, perceptions about the benefits and barriers to health IT adoption, future implementation plans, use of Federal programs designed to facilitate IT adoption, and interest in various health IT policy options.

Involvement of State Offices of Rural Health in Emergency Preparedness Activities
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topic: Emergency preparedness
This project will follow-up with the state offices of rural health (SORH) to identify their current involvement with preparedness in rural areas, particularly in the use of funds earmarked to bioterrorism preparedness.

Medicare Beneficiary Outcomes in Rural and Urban Home Health Agencies
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Home health, Medicare Prospective Payment System (PPS), Quality
This study will compare the performance of rural and urban home care agencies, and identify agency characteristics that contribute to better patient care outcomes.

Medicare Payment for Post-Acute Care Transfers
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Hospitals and clinics

National Rural Hospital Flexibility Program Tracking Project: Emergency Medical Services
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration

National Rural Hospital Flexibility Program Tracking Project: Perceptions of Community Physicians
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Physicians

Options for Structuring Disproportionate Share (DSH) Payments to Account for Uncompensated Care: Impact on Rural Hospitals
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Hospitals and clinics
This study will identify options for development of an equitable DSH payment adjustment that accounts for hospital uncompensated care costs and determine the financial impact of each of these proposals on rural hospitals, using simulations with data from Washington, West Virginia, Texas, and Iowa.

Post-Acute Care: A Rural and Urban Comparison
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Home health, Long term care, Medicare
This multi-phase analysis examines whether discharge patterns for and use of post-acute care services by rural and urban hospitalized Medicare beneficiaries differ and, if they do, what are the sources of these different patterns.

Public Health System Performance Measurement: Are Standards Applicable to Rural Communities?
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Legislation and regulation, Public health
This project aims to increase understanding of how public health governance affects the structure of public health services, and how this in turn influences the strategies adopted for meeting community public health needs in rural areas.

Rapid Response: Elimination of Bad Debt Payments to Rural PPS Hospitals
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
The purpose of this project is to examine: (1) the extent to which elimination of Medicare Bad Debt payments will reduce reimbursement to rural PPS hospitals and (2) how rural hospitals would respond to this reduction in reimbursement.

Roadmap for the Adoption of Health Information Technology in Rural Communities
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health information technology, Health services
This project developed a resource document intended to help rural health care providers of all types as they think about whether an investment in health information technology makes sense for them and work through various implementation issues. The document was distributed at the September 2006 conference entitled "Health Information Technology: A Rural Provider’s Roadmap to Quality," sponsored by ORHP.

Rural Dimensions of Medicare Payment Policies
Research center: Walsh Center for Rural Health Analysis
Topics: Health policy, Medicare

Rural Dimensions of Medicare Payment Policies
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicare

Rural Perspective on Restructuring Medicare
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicare, Pharmacy and prescription drugs

Understanding the Roles of the Rural Hospital in Responding to Bioterrorist Attacks and Other Emergencies
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency preparedness, Hospitals and clinics

Volunteer Labor and the Organizational Structure of Rural Emergency Medical Services (EMS) Providers
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Workforce

Publications

• Critical Access Hospitals' Experience with Medicare Advantage Plans
  Research centers: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Hospitals and clinics, Medicare Advantage (MA)
  Date: 03 / 2008
  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.
• Delivering the U.S. Preventive Services Task Force Recommendations in a Rural Health Plan
  Author(s): Alycia Infante, Michael Meit
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health promotion and disease prevention, Health services
  Report Number: Research Brief, W Series No. 8
  Date: 02 / 2007
  Explores the challenges that one health plan faces in delivering the U.S. Preventive Services Task Force (USPSTF) recommendations to its rural patient population.
• Evaluation of the U.S. Preventive Services Task Force Recommendations for Clinical Preventive Services
  Author(s): Alycia Infante, Michael Meit, Thomas Briggs, Caitlin Oppenheimer, Jennifer Benz
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health promotion and disease prevention, Health services
  Report Number: Final Report
  Date: 02 / 2007
  Reports findings addressing the adoption, integration, delivery, and dissemination of the U.S. Preventive Services Task Force (USPSTF) recommendations for clinical preventive services in different types of health plans.
• Financing Rural Public Health Activities in Prevention and Health Promotion (Final Report)
  Author(s): Michael Meit, Lorraine Ettaro, Benjamin Hamlin, Bhumika Piya
  Research center: Walsh Center for Rural Health Analysis
  Topics: Chronic diseases and conditions, Health care financing, Health promotion and disease prevention, Public health
  Date: 06 / 2008
  Final Report of a study to determine whether the flow of federal resources, from federal agencies, through states, and to communities, is influenced by state and local level public health infrastructure.
• Rural Public Health Financing: The Relationship Between Infrastructure and Local Program Funding (Policy Brief)
  Author(s): Michael Meit, Lorraine Ettaro, Benjamin Hamlin, Bhumika Piya
  Research center: Walsh Center for Rural Health Analysis
  Topics: Chronic diseases and conditions, Health care financing, Health promotion and disease prevention, Public health
  Report Number: W Series No. 14
  Date: 06 / 2008
  The purpose of this study was to describe how federal funds for selected chronic disease prevention and health promotion activities are distributed to local health departments and non-governmental organizations at the local level and to identify infrastructure-related barriers that rural agencies may face in securing and using funds for such purposes. A central hypothesis was that the availability of federal funding for chronic disease prevention and health promotion activities may vary based on state and local public health infrastructural differences.
• Spontaneous Evacuation Following a Dirty Bomb or Pandemic Influenza: Highlights from a National Survey of Urban Residents’ Intended Behavior
  Author(s): Michael Meit, Thomas Briggs, Alene Kennedy, Janet Sutton, Jacob Feldman
  Research center: Walsh Center for Rural Health Analysis
  Topic: Emergency preparedness
  Report Number: W Series No. 12
  Date: 11 / 2007
  Reports results of a national survey to assess the evacuation intentions of urban citizens following emergency scenarios. Includes information on how likely it would be for evacuees to go to a rural or urban area. Discusses the potential impact of an urban evacuation on rural areas.
• Urban-to-Rural Evacuation: Planning for Population Surge (Final Report)
  Author(s): Michael Meit, Alene Kennedy, Thomas Briggs
  Research center: Walsh Center for Rural Health Analysis
  Topic: Emergency preparedness
  Date: 08 / 2008
  To date, rural emergency planning efforts have focused more on addressing the needs of rural residents and have not accounted for potential population surge from neighboring urban areas in the event of disaster. In many areas, rural infrastructure and capacities are likely to be stretched thin or possibly overwhelmed. This study assessed the likelihood of urban evacuation to rural areas and provides recommendations for rural planning and response.
• Urban-to-Rural Evacuation: Planning for Population Surge (Policy Brief)
  Author(s): Michael Meit, Alene Kennedy, Thomas Briggs
  Research center: Walsh Center for Rural Health Analysis
  Topic: Emergency preparedness
  Report Number: Policy Analysis Brief W Series No. 9
  Date: 04 / 2007
  Discusses disaster planning and how rural preparedness officials face significant informational, organizational, and infrastructural constraints in their abilities to prepare for a potential population surge from urban areas.