Timothy D. McBride, PhD

Phone: 314.935.4356
E-mail: tmcbride@wustl.edu

Washington University in St. Louis
One Brookings Drive
St. Louis, MO 63130

Current Projects (1)

Do Communities Make a Difference in Access? A National Study
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topic: Health services
This project will examine the effect of community-level resources on an individual's access to health care, particularly whether urban and rural individuals' access to health care differs, given community differences.

Completed Projects (6)

Estimating the Medicare+Choice Threshold Payment Rate, Lead researcher
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Medicare

Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?, Lead researcher
Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Health policy
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.

Impact of Medicare Advantage Plan Concentration on Choices and Competition in Rural Areas, Lead researcher
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Medicare, Medicare Advantage (MA)
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.

Implementation of the Medicare Prescription Drug Benefit: What is Available to Rural Beneficiaries?, Lead researcher
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Legislation and regulation, Medicare Part D
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.

Uninsurance and Welfare Reform in Rural America, Lead researcher
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health insurance and the uninsured, Poverty
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.

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

Publications (47)

• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Date: 03 / 2003
  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.
• April 2009 Rural Enrollment in Medicare Advantage: Growth in PPOs Outpacing Growth in PFFS
  Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare Advantage (MA), Medicare Part D
  Report Number: 2009-4
  Date: 05 / 2009
  Private fee-for-service (PFFS) plans dominate enrollment in rural areas and have accounted for much of the program's expansion since 2005. However, from December 2008 through April 2009 enrollment growth of preferred provider organization (PPO) plans, both nationally and in rural areas, was double the enrollment growth of PFFS plans.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health care financing, Legislation and regulation, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Date: 08 / 2000
  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.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Medicare, Pharmacy and prescription drugs
  Date: 01 / 2003
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Medicare
  Date: 10 / 2003
  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.
• Can Payment Policies Attract M+C Plans to Rural Areas?
  Author(s): Timothy McBride, Joan Penrod, Keith Mueller, Courtney Andrews, Micah Hughes
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Report Number: Rural Policy Brief Vol. 6, Number 8 (PB2001-8)
  Date: 05 / 2001
  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.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Medicare
  Date: 09 / 2001
  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.
• December 2009: Rural Medicare Advantage Enrollment Grows 15% in 2009
  Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA)
  Report Number: 2010-1
  Date: 01 / 2010
  Rural enrollment in Medicare Advantage (MA) and other prepaid plans grew by 15% from December 2008 to December 2009, faster than the 10% national growth rate. Preferred provider organization plans drove the increased enrollment in MA plans in rural areas in 2009, while private fee-for-service (PFFS) plans continued to dominate the market with over 50% of enrollment. This landscape could change in 2010 as rural Medicare beneficiaries will experience a decline in PFFS availability, as some insurers have announced plans to pull their PFFS plans from the market.
• 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
  Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  Date: 08 / 2000
  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.
• Eligible But Not Enrolled? Potential for Targeting Over a Half-Million Rural Medicare Beneficiaries for Enrollment in the Low-Income Subsidy Prescription Drug Program (Policy Brief)
  Author(s): Timothy D. McBride, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Part D
  Report Number: Brief No. 2008-5
  Date: 12 / 2008
  The Medicare Part D low-income supplement (LIS) is designed to help low-income persons access the prescription drug benefit with reduced premiums and lower out-of-pocket costs. To date, estimates suggest that almost 80% of the persons eligible for the LIS are participating in the program. But despite efforts by CMS and its partners to enroll as many eligible persons as possible, 5.6% of rural Medicare beneficiaries and 3.7% of urban Medicare beneficiaries are estimated to be eligible for but not enrolled in the LIS program. Information in this brief and the accompanying state tables could help CMS partners (including state and county agencies) target counties with high likelihood of identifying and enrolling LIS-eligible beneficiaries. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Report Number: Rural Policy Brief Vol. 8, Number 8 (PB2003-8)
  Date: 06 / 2003
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Medicare
  Date: 05 / 2003
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare Part D
  Report Number: Rural Policy Brief Vol. 12, No. 1 (PB2007-1)
  Date: 01 / 2007
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Medicare
  Date: 05 / 2003
  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.
• February 2010: A Dramatic Shift Away from Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment
  Author(s): Leah Kemper, Timothy D. McBride, M. Katherine Stone, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA), Pharmacy and prescription drugs
  Report Number: 2010-3
  Date: 03 / 2010
  In a reversal of recent trends, private fee-for-service (PFFS) enrollment fell dramatically in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas (excluding other prepaid plans) fell slightly in early 2010 for the first time in years. Nationwide, enrollment in preferred provider organization and health maintenance organization plans grew, offsetting the decline in PFFS enrollment and contributing to a slight growth in total MA enrollment in 2010.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Medicare Advantage (MA)
  Citation: Journal of Rural Health, 21(2), 105-113
  Date: 2005
  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.
• Impact of the Recession on Rural America: Rising Unemployment Leading to More Uninsured in 2009
  Author(s): Timothy McBride, Leah Kemper
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Health policy
  Report Number: 2009-6
  Date: 06 / 2009
  The 2008-09 recession has impacted the United States in many profound ways, but perhaps most dramatically through increased unemployment. Job loss for many means loss of employer-sponsored health insurance or ability to purchase individual insurance. Some individuals can obtain coverage through Medicaid or private health insurance, but many remain uninsured. This brief presents the results of state and county analysis of unemployment rates nationally in urban and rural (non-metropolitan) areas over the period 2007-February 2009 and discusses the impact of rising unemployment on uninsurance in rural areas.
• Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
  Author(s): Timothy D. McBride, Courtney Andrews
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Poverty
  Report Number: Rural Policy Brief Vol. 10, No. 6 (PB2005-6 )
  Date: 12 / 2005
  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
  Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Pharmacy and prescription drugs
  Date: 06 / 2000
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Date: 02 / 2002
  This brief discusses the Medicare+ Choice plan and how it has failed to meet the health issues of Americans.
• July 2009: Rural Enrollment in Medicare Advantage Continues to Grow
  Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA), Medicare Prospective Payment System (PPS)
  Report Number: 2009-8
  Date: 08 / 2009
  Rural enrollment in Medicare Advantage continues to grow, with growth in the last 18 months led by the growth of preferred provider organization (PPO) plans. Despite the growth in PPO plans, private fee-for-service plans continue to dominate enrollment in rural areas and have accounted for much of the program's growth since 2005.
• June 2011: Rural Medicare Advantage Enrollment Update
  Author(s): Leah Kemper, Lisa Pollack, Abigail Barker, Timothy D. McBride, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA)
  Date: 09 / 2011
  Shows increases in enrollment into Medicare Advantage plans in rural America. The enrollment is concentrated in plans offered by three firms, especially in the types of plans with high rural enrollment which are preferred provider organizations and private fee-for-service plans.
• March 2011: Growth in PPOs Dominates the Rural MA Market in 2011
  Author(s): Leah Kemper, Lisa Pollack, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA)
  Report Number: Brief No. 2011-3
  Date: 04 / 2011
  From March 2010 to March 2011, rural Medicare Advantage (MA) enrollment in preferred provider organization plans grew from 28% (396,006 enrollees) to 46% (702,315 enrollees) of total enrollment, while rural MA enrollment in private-fee-for-service plans fell from 38% (530,678 enrollees) to 16% (249,499 enrollees).
• May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
  Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Part D, Medicare Prospective Payment System (PPS)
  Report Number: 2009-7
  Date: 06 / 2009
  A changing landscape is emerging for rural Medicare Advantage (MA) enrollment in 2009 as rapid growth in preferred provider organization (PPO) plan enrollment is coupled with a decline in the growth rate of enrollment in private fee-for-service (PFFS) plans. Enrollment in MA plans has continued to climb in 2009, but it has been impacted by the slowed rate of growth in PFFS plans, which cover over half of MA enrollees in rural areas. The growth in PPO enrollment in recent months is likely tied to changes in policy that have encouraged the growth of new PPO plans, enrollment in existing PPO plans, and expansions of the service areas of existing plans.
• Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
  Author(s): Timothy D. McBride, Tanchica L. Terry, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare Part D
  Report Number: Rural Policy Brief Vol. 10, No. 8 (PB2006-8 )
  Date: 04 / 2006
  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 Physician Payment Policy and the Rural Perspective (Final Report)
  Author(s): A. Clinton MacKinney, Keith J. Mueller, Timothy D. McBride
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Date: 11 / 2008
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Physicians
  Report Number: Rural Policy Brief Vol. 11, No. 2 (PB2006-2 )
  Date: 09 / 2006
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Physicians
  Report Number: Rural Policy Brief Vol. 8, No. 9 (PB2003-9)
  Date: 10 / 2003
  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.
• Patterns of Health Insurance Coverage Among Rural and Urban Children
  Author(s): Andrew F. Coburn, Timothy McBride, Erika Ziller
  Research center: Maine Rural Health Research Center
  Topics: Children, Health insurance and the uninsured
  Report Number: Working Paper No. 26
  Date: 11 / 2001
  Assesses differences in the patterns of insurance coverage and uninsured spells among rural and urban children in 20 states. Also examines the implications of those differences for the design and implementation of public insurance programs. Among its findings: Although the average duration of new uninsured spells was shorter among rural than urban children, rural children were more likely to experience protracted spells of uninsurance. Rural children were also more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Medicare
  Report Number: Special Monograph
  Date: 02 / 2001
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Medicare
  Date: 08 / 2000
  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.
• Report on Enrollment: Rural Medicare Beneficiaries in Medicare+Choice Plans
  Author(s): Brandi Shay, Timothy McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Date: 06 / 2000
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Medicare
  Date: 05 / 2000
  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 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA)
  Report Number: Brief No. 2008-3
  Date: 08 / 2008
  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. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare Advantage (MA)
  Report Number: Rural Policy Brief Vol. 12, No. 3 (PB2007-3 )
  Date: 07 / 2007
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare Advantage (MA)
  Report Number: Rural Policy Brief Vol. 12, No. 2 (PB2007-2 )
  Date: 04 / 2007
  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 Enrollment in Medicare Advantage: Growth Slows in 2008
  Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA)
  Report Number: 2009-1
  Date: 03 / 2009
  The rate of growth of enrollment in the Medicare Advantage program decreased significantly in 2008, compared to previous years. In addition, the growth rate in preferred provider organization plans in rural areas now exceeds that in private fee-for-service plans. This policy brief updates earlier findings from analysis of the MA program reported by the RUPRI Center.
• Rural Medicare Advantage 2011: Enrollment Trends and Plan Characteristics
  Author(s): Leah Kemper, Lisa Pollack, Abigail Barker, Timothy D. McBride, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA)
  Date: 10 / 2011
  This paper report findings from analysis of the Centers for Medicare and Medicaid Services data to examine the trends and geographic variations in Medicare Advantage (MA) plan enrollment, premiums and market concentration by firm. MA enrollment in rural areas remains strong and continues to grow in 2011, despite the recent shift in enrollment from private fee-for-service plans to preferred provider organization plans. The data presented in this policy brief provide an overview of the Medicare Advantage program in rural America and highlight key rural/urban differences within the program.
• Rural Medicare Advantage: Modest Enrollment Growth in 2010
  Author(s): Leah Kemper, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA), Medicare Prospective Payment System (PPS)
  Date: 08 / 2010
  Despite a slight drop in enrollment and a dramatic shift in the landscape of the rural Medicare Advantage (MA) market in early 2010, MA plans have experienced modest growth in enrollment in rural areas over the last two quarters of 2010. The majority of the growth is concentrated in preferred provider organization plans, counteracting a decline in private fee-for-service plan enrollment.
• Rural Physicians' Acceptance Of New Medicare Patients
  Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride, Jane L. Meza, Liyan Xu
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Physicians
  Report Number: Rural Policy Brief Vol. 9, No. 5 (PB2004-5 )
  Date: 08 / 2004
  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.
• Rural-Urban Comparison of a Building Blocks Approach to Covering the Uninsured (Policy Brief)
  Author(s): Timothy McBride
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health insurance and the uninsured, Health policy
  Report Number: 2009-5
  Date: 06 / 2009
  A range of proposals are now being considered to reform the health care system, specifically to provide access to health insurance coverage for the uninsured. Proposals include a range of public-private approaches, typically called "building blocks" approaches, which build upon our current system of health insurance to provide access to health insurance for all Americans. This brief uses a RUPRI health insurance model to compare the effects of a building blocks approach on health insurance coverage and health spending, focusing on the geographic differences (by metropolitan and non-metropolitan) of this approach.
• September 2010: Rural Medicare Advantage Enrollment Update
  Author(s): Leah Kemper, Lisa Pollack, Timothy D. McBride, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Medicare Advantage (MA)
  Report Number: No. 2010-6
  Date: 11 / 2010
  Rural enrollment in Medicare Advantage (MA) plans grew to nearly 1.5 million enrollees in September 2010 (15% of eligible Medicare beneficiaries), while national MA enrollment grew to over 11.5 million (25%). Rural Medicare beneficiaries will find fewer options for MA health insurance coverage in 2011- an average of 16 MA plans to choose from, compared with 24 plans on average in 2010.
• 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
  Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
  Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs
  Citation: Journal of Rural Health, 21(3), 194-197
  Date: 2005
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Date: 03 / 2001
  
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Report Number: PB 2002-4
  Date: 08 / 2002
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare Advantage (MA)
  Report Number: Rural Policy Brief No. 2007-7
  Date: 10 / 2007
  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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Health care financing
  Report Number: Rural Policy Brief Vol. 10, No. 7 (PB2005-7 )
  Date: 11 / 2005
  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.