Curt D. Mueller, PhD

Phone: 410.786.5049
E-mail: curt.mueller@cms.hhs.gov

5433 33rd Street NW
Washington, DC

Completed Projects

Advantages and Disadvantages of Hospital-Based Emergency Medical Services in Rural Areas, Lead researcher
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, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Health Care Financing Administration (HCFA)
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Involvement of State Offices of Rural Health in Emergency Preparedness Activities, Lead researcher
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.

National Rural Hospital Flexibility Program Tracking Project: Perceptions of Community Physicians, Lead researcher
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

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

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

Publications

• Anticipating the 1997 State Children's Health Insurance Program: What's Current in Five Rural States?
  Author(s): Jennifer Dunbar, Curt Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Date: 01 / 1998
  This study examines aspects of of existing children's health insurance or health services to low-income, uninsured children. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Attention from the Top? Roles of State Offices of Rural Health Policy in Preparing for Bioterrorism and Other Health System Emergencies
  Author(s): Curt D. Mueller, A. Ketchel, L. Silver
  Research center: Walsh Center for Rural Health Analysis
  Topic: Emergency preparedness
  Date: 07 / 2006
  Presents results from a follow-up survey of directors of state offices of rural health on emergency preparedness in rural communities. A telephone survey was used to identify state office involvement with emergency preparedness (EP) activities. Findings indicate that the nature of involvement varied considerably across states. Among the most pressing needs were for improvements in communication and for additional EP training, especially for EMS and hospital personnel. Most offices were involved in activities related to development of an emergency preparedness response plan encompassing the state (71 percent) or development of a plan for regions within the state (55 percent). Over half of state office directors reported involvement in assessment of training needs of emergency personnel and in assessing EP of rural hospitals. Almost half of state offices participated in assessment of rural public health system preparedness capabilities. Sixty-one percent of offices assisted in development of capabilities for the electronic exchange of information among health care providers and public health officials serving rural areas, and 48 percent of rural offices were engaged in activities in support of development of a system for receipt of urgent reports or information by providers on a 24-hour-7-day basis.
• Capital Needs of Small Rural Hospitals
  Author(s): Jeffrey Stensland, Julie Schoenman, Curt Mueller, Andrew Singer
  Research center: Walsh Center for Rural Health Analysis
  Topics: Capital funding, Hospitals and clinics
  Date: 05 / 2002
  Examines the capital situation of rural hospitals with fewer than 50 beds to determine the total cost of bringing each facility into compliance with current laws, as well as the facilities' cost of borrowing and ability to borrow. Key results include: 38 percent report having deficiencies that, by law, require renovation or remodeling; the median cost of correcting those deficiencies is $1,000,000; most hospitals will need to, and have the ability to, borrow funds to correct the deficiencies; and the hospitals that report being unable to obtain loans tend to be older, low-volume hospitals with operating losses. Study concludes that due to the poor financial condition of hospitals that lack the ability to borrow, a new federal loan program does not appear to be the answer to their capital needs. Rather, improving access to capital depends on improving hospital profitability. The authors offer three options. 1) Medicare policy could provide hospitals in regions with very few patients an adjustment that would allow low-volume hospitals to earn a profit on Medicare patients. 2) Medicare policy could be adjusted to allow Medicare to directly pay a portion of hospitals' charity care and bad debt burdens. 3) Policy makers could set up a technical assistance program operated at the state level to assist rural hospitals in improving their financial condition.
• 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
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, 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, Medicare Advantage (MA)
  Date: 12 / 2005
  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.
• Essential Research Issues in Rural Health: The State Rural Health Directors' Perspective
  Author(s): Michael J. O'Grady, Curt D. Mueller, Gail R. Wilensky
  Research center: Walsh Center for Rural Health Analysis
  Topic: Health policy
  Report Number: Policy Analysis Brief W Series, Vol. 5 No. 1
  Date: 03 / 2002
  Policy brief describes the key issues confronting state rural health directors. Five issues were repeatedly raised by directors from a wide variety of states: workforce, telemedicine, emergency medical services, mental health, and lack of local data.
• Establishing a Fair Medicare Reimbursement for Low-Volume Rural Ambulance Providers
  Author(s): Penny E. Mohr, C. Michael Cheng, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Emergency medical services (EMS), Health care financing, Medicare
  Date: 07 / 2001
  National study of ambulance transport costs looks at the advantages and disadvantages of several options for Medicare to compensate low-volume rural ambulance providers. Among its conclusions: many low-volume rural volunteer EMS providers will benefit from the new Medicare fee schedule; a volume-based premium offers a disincentive for small providers to grow and take advantage of economies of scale; and cost-based reimbursement for a select class of rural providers would not over- or under-pay vulnerable providers. Report available on request.
• How State Rural Health Directors Obtain Policy-Relevant Research Information
  Author(s): Michael J. O'Grady, Curt D. Mueller, Gail R. Wilensky
  Research center: Walsh Center for Rural Health Analysis
  Topic: Health policy
  Report Number: Policy Analysis Brief W Series, Vol. 5 No. 2
  Date: 03 / 2002
  Policy brief summarizes how information pertinent to rural health policy activities of the state offices is obtained. The primary sources of policy-relevant information identified by directors are: the Internet, information sharing with others, and strategic partnerships with organizations outside the traditional health policy arena. The study also found that the organizational location of the state's office of rural health may affect the level of resources available for information gathering. The brief identifies steps to ensure that needed information can be accessed in the future: 1) state offices should have and maintain adequate resources to ensure ready access to electronic forms of information; 2) state offices should continue to share information on sources of health policy research; and 3) study further the implications of organizational form of state offices on resources available for getting needed information.
• Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Full Report)
  Author(s): Jennifer L. Dunbar, Harvey I. Sloane, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Date: 11 / 1999
  The State Children's Health Insurance Program (CHIP) provides states with an important source of funding for helping low-income, uninsured children overcome financial barriers to medical care. There is considerable interest among federal policy makers and rural advocates that CHIP may be especially important in providing coverage to children living in rural areas. This study qualitatively assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Policy Brief)
  Author(s): Jennifer L. Dunbar, Harvey I. Sloane, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Date: 11 / 1999
  The State Children's Health Insurance Program (CHIP) provides states with an important source of funding for helping low-income, uninsured children overcome financial barriers to medical care. This policy analysis brief assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Medicare Reforms: The Rural Perspective
  Author(s): Curt Mueller, Sheila J. Franco, Gail Wilensky
  Research center: Walsh Center for Rural Health Analysis
  Topics: Medicare, Pharmacy and prescription drugs
  Date: 04 / 2000
  Discusses Medicare reforms considered by the National Bipartisan Commission on the Future of Medicare (created by the Balanced Budget Act of 1997 - BBA), including prescription drug coverage, funding graduate medical education, and increasing the eligibility age. To request a copy, contact the Walsh Center at 301-951-5070.
• Perspectives Of Rural Hospitals On Bioterrorism Preparedness Planning
  Author(s): Claudia L. Schur, Marc L. Berk, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Emergency preparedness, Hospitals and clinics
  Report Number: Policy Analysis Brief W Series No. 4
  Date: 04 / 2004
  Representatives from several rural hospitals met to discuss various aspects of bioterrorist preparedness in terms of workforce and training, physical capacity and supplies, communication, and coordination with other entities. Three main themes emerged from the discussion: 1) Bioterrorism resources have the potential to improve the rural health care delivery system, 2) A "cookie-cutter" model does not work for rural hospitals, and 3) Strategies for coping with a bioterrorist event need to be practical and have dual use.
• Potential Supply-Side Implications of the BBA Limits on Reimbursement to Provider-Based Rural Health Clinics
  Author(s): Julie A. Schoenman, C. Michael Cheng, Bonnie B. Blanchfield, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topic: Rural Health Clinics (RHCs)
  Date: 06 / 2000
  This policy analysis brief examines whether provider-based (typically hospital operated) rural health clinics are likely to close due to the reimbursement cap introduced by the Balanced Budget Act of 1997 (BBA). For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy
  Author(s): Julie A. Schoenman, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Long term care, Medicare
  Citation: Journal of Rural Health, 21(2), 122-130
  Date: 2005
  Examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. The authors conclude that rural hospitals are not disproportionately harmed by the post-acute-care transfer policy. An expanded policy may even benefit rural hospitals by recognizing their lower use of post-acute-care and readjusting DRG weights so that they are paid more appropriately when providing the full course of inpatient care.
• 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
  Research centers: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Report Number: Walsh W Series No. 6, RUPRI P2004-6
  Date: 08 / 2004
  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.