Medicare

Publications

Listed by publication date. You can also view these publications alphabetically.

2008

• 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.

2006

• 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.
• Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare
  Date: 05 / 2006
  This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes, and to ascertain whether there are agency characteristics that are associated with better or worse outcomes. This study found rather small differences in the quality of care provided by home health agencies in rural and urban areas. Findings from the multivariate analyses indicated that rural agencies performed better on measures of improvement in walking, transferring, and dressing, whereas urban agencies performed better on measures of improvement in pain frequency and medication management. Rural or urban location had only a modest effect on functional performance scores. Rural and urban agency differences in rates of unplanned urgent care and hospital admissions were not statistically significant after controlling for other agency characteristics, region of country and characteristics of the health care market.
• Geographic Access to Health Care for Rural Medicare Beneficiaries
  Author(s): Leighton Chan, L. Gary Hart, David C. Goodman
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Medicare, Physicians
  Citation: Journal of Rural Health 22(2),140-146
  Date: 2006
  Describes the results of a study comparing the travel times, distances, and physician specialty mix of all Medicare patients living in Alaska, Idaho, North Carolina, South Carolina, and Washington.

2005

• Trends in Skilled Nursing and Swing-bed Use in Rural Areas, 1996-2003
  Author(s): Kathleen Dalton, Jeongyoung Park, Ann Howard, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health services, Hospitals and clinics, Medicare
  Report Number: Working Paper No. 83
  Date: 12 / 2005
  Examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a period of dramatic change in Medicare payments for both acute and post-acute care, focusing on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment. The authors examined changes in the number and types of facilities providing this level of care, and computed comparative statistics on Medicare utilization, case mix, ancillary service use and per diem costs across the three different institutional settings where inpatient skilled nursing services can be provided-freestanding SNFs, hospital-based units, and swing beds in acute care hospitals.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Report Number: Rural Policy Brief Vol. 10, No. 3 (PB2005-3 )
  Date: 11 / 2005
  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.
• Revisions to Medicare's Disproportionate Share Payment Policy to Incorporate Bad Debt and Charity Care
  Author(s): Julie A. Schoenman, Janet P. Sutton, Lan Zhao
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Date: 09 / 2005
  Investigates the impact of possible changes to the Medicare disproportionate share (DSH) payment policy, designed to incorporate information on the hospital's uncompensated care burden as well as to improve the payment formulae. DSH payments were computed for individual study hospitals under six alternative models, and compared to the payments now made under current law. For each alternative, the authors examined the overall financial impact by type of hospital and the characteristics of hospitals that would experience either large payment increases or decreases relative to the current system. These analyses are intended to help policymakers evaluate the likely impact of revising the DSH payment methodology.
• Geographic Access to Health Care for Rural Medicare Beneficiaries
  Author(s): Leighton Chan, L. Gary Hart, David C. Goodman
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Medicare
  Report Number: Working Paper No. 97
  Date: 04 / 2005
  This study looked at where Medicare beneficiaries of five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care. Findings from this study suggest that rural residents do not rely on urban areas for the majority of their care. Those living in small and isolated rural areas have decreased geographic access to health care providers, particularly specialists, and rely heavily on generalists for the majority of their care. Additionally, results of the study suggest that these individuals have few visits overall and must travel longer distances to access certain types of care. These findings have policy implications for geographic reimbursement differentials, telehealth networks, and graduate medical education. Report available upon request by contacting rhrc@fammed.washington.edu.
• Home Health Payment Reform: Trends In The Supply Of Rural Agencies And Availability Of Home-Based Skilled Services
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare
  Report Number: Policy Analysis Brief, W Series No. 6
  Date: 03 / 2005
  Findings from this study suggest that changes in home health reimbursement were associated with dramatic reductions in the supply of home care agencies; however those reductions appear to have occurred primarily during the time in which the Interim Payment System was in place. Although proportionately fewer rural agencies closed between 1998 and 2000, the closure of a rural agency may have a greater impact on access since many communities are experiencing critical shortages of providers. In the post-PPS period, agency supply became more stable, but closure rates were higher among rural agencies.
• 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.
• 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.
• Barriers Associated With the Delivery of Medicare Reimbursed Diabetes Self-Management Education
  Author(s): M. Paige Powell, Saundra H. Glover, Janice C. Probst, Sarah B. Laditka
  Research center: South Carolina Rural Health Research Center
  Topics: Chronic diseases and conditions, Medicare
  Citation: Diabetes Educator, 31(6), 890-9
  Date: 2005
  Describes the results of a study to explore the barriers that practitioners face in providing diabetes self-management education (DSME) to Medicare beneficiaries, with a special focus on barriers faced by rural providers. Barriers identified for rural providers include costs, reporting requirements, the shortage of designated specialists, fewer resources, high application fees for ADA recognition, staffing/institutional support, amount of Medicare reimbursement, lack of hours covered, and transportation.

2004

• Assessment Of Barriers To The Delivery Of Medicare Reimbursed Diabetes Self-Management Education In Rural Areas
  Author(s): M. Paige Powell, Saundra H. Glover, Janice C. Probst, Sarah B. Laditka
  Research center: South Carolina Rural Health Research Center
  Topics: Chronic diseases and conditions, Medicare
  Date: 09 / 2004
  Explores the barriers that rural practitioners face in providing diabetes education services to Medicare beneficiaries. Survey results from a random sample of ADA-recognized diabetes education facilities indicated that insufficient Medicare reimbursement, staffing, institutional support as well as the ADA recognition process all constituted barriers to diabetes self-management education in rural areas. Executive summary available online.
• 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.
• 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.
• Exploring the Impact of Medicare's Post-Acute Care Transfer Payment Policy on Rural Hospitals
  Author(s): Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Report Number: Policy Analysis Brief W Series No. 5
  Date: 07 / 2004
  Describes a change in Medicare post-acute transfer payment policy and its impact on rural and urban hospitals. Includes data on the financial impact and hospital discharge behavior before and after the change. A full report is also available.
• Rural Implications of Medicare's Post-Acute Care Transfer Payment Policy
  Author(s): Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Long term care, Medicare
  Date: 06 / 2004
  Beginning in October 1998, Medicare began to pay acute-care hospital cases in 10 DRGs as transfers instead of discharges when the patient is discharged to a targeted post-acute care (PAC) provider after a short inpatient stay. This study examines the behavioral and financial impacts of the initial 10-DRG policy, and projects the likely financial impact of extending the policy to cover additional DRGs or discharges to swing beds. Key findings: 1) Hospitals' discharge behavior did not change significantly in ways that would suggest a strategic response to the PAC transfer payment policy; 2) Based on simulation, less than 5 percent of all cases discharged from the additional DRGs would receive the PAC transfer payment instead of the full DRG payment. Medicare revenue earned by rural hospitals would fall by more than $1,100 for each transfer case.; and 3) Expanding the transfer policy to cover swing beds would result in a relatively small financial impact. A policy brief is also available.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Report Number: Rural Policy Brief Vol. 9, No. 4 (PB2004-4 )
  Date: 05 / 2004
  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.
• Medicare Home Health Care in Rural America (Brief)
  Author(s): Sheila J. Franco
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare
  Report Number: Policy Analysis Brief W Series No. 1
  Date: 01 / 2004
  This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies. Findings demonstrate that urban agencies, either directly or through their branch offices, play an important role in providing home health care to rural Medicare beneficiaries. A full report is also available.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Report Number: Policy Paper P2004-1
  Date: 01 / 2004
  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.
• Do Rural Elders Have Limited Access to Medicare Hospice Services?
  Author(s): Beth A. Virnig, Ira S. Moscovice, Sara B. Durham, Michelle M. Casey
  Research centers: Minnesota Rural Health Research Center , Upper Midwest Rural Health Research Center
  Topics: Aging, Hospice and palliative care, Medicare
  Citation: Journal of the American Geriatrics Society, 52(5), 731-5
  Date: 2004
  The authors examined whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries. Rates of hospice care before death were negatively associated with degree of rurality. The lowest rate of hospice use, 15.2% of deaths, was seen in rural areas not adjacent to an urban area. The highest rate of use, 22.2% of deaths, was seen in urban areas. Rural areas adjacent to urban areas had an intermediate level of hospice use (17.0% of deaths). Hospices based in rural areas had a smaller number of elderly patients each year than hospices based in urban areas, and were more likely to have very low volumes. The authors conclude that the consistently lower use of Medicare hospice services before death and smaller sizes of rural hospices suggests that the combination of Medicare hospice payment policies and hospice volumes are problematic for rural hospices. Adjusting Medicare payment policies might be a critical step to assure availability of hospice services for terminally ill beneficiaries regardless of where they live.
• Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas
  Author(s): Leighton Chan, L. Gary Hart, Thomas C. Ricketts III, Shelli K. Beaver
  Research center: WWAMI Rural Health Research Center
  Topics: Medicare, Physicians
  Citation: Journal of Rural Health, 20(2), 109-117
  Date: 2004
  The Medicare Incentive Payment (MIP) program provides a 10 percent bonus payment to physicians who treat patients in Health Professional Shortage Areas (HPSAs). This paper examines the experience of five states (Alaska, Idaho, North Carolina, South Carolina, and Washington) with the Medicare Incentive Payment (MIP) program. This study determines the program's expenditures, utilizations, and which types of physicians received payments. Results show that physicians eligible for the bonus payments often did not claim them, and physicians who likely did not work in approved HPSA sites, claimed the bonus payments and received them.

2003

• 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.
• Are There Geographic Disparities in Out-of-Pocket Spending by Medicare Beneficiaries?
  Author(s): Tiffany A. Radcliff, Gestur Davidson, Aram Dobalian,
  Research center: Minnesota Rural Health Research Center
  Topic: Medicare
  Date: 10 / 2003
  Describes a study comparing out-of-pocket spending among rural and urban Medicare recipients. Includes data on differences based on supplemental insurance coverage.
• 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.
• Medicare Payment Policies
  Author(s): Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Hospitals and clinics, Medicare, Physicians
  Date: 08 / 2003
  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 Issues
  Author(s): Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Date: 08 / 2003
  Overview of rural policy issues related to Medicare. Presentation made 8/26/03 in Casper, WY.
• Medicare Home Health Care in Rural America (Full Report)
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare
  Date: 06 / 2003
  This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies. Findings demonstrate that urban agencies, either directly or through their branch offices, play an important role in providing home health care to rural Medicare beneficiaries. Report available on request. A policy brief is also available.
• 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.
• Rural Beneficiaries' Projected Drug Coverage Under Three Medicare Prescription Drug Proposals
  Research center: Walsh Center for Rural Health Analysis
  Topics: Medicare, Medicare Part D
  Report Number: P 2003-1
  Date: 06 / 2003
  Estimates the expected increase in urban and rural Medicare beneficiaries eligible for drug coverage under three current Medicare prescription drug proposals. Also gives an estimate of the urban and rural per capita federal payments for drug coverage under the three proposals. Finds that total dollar impact of the three proposals is driven by their generosity. The costliest offers the greatest taxpayer-funded benefits. Per dollar of spending, the urban/rural division of federal drug outlays differs across the proposals. The Administration proposal would result in much higher per-capita federal drug spending in rural areas than urban ones. Congressional Republican and Democratic proposals show smaller rural-urban differences. Concludes that higher poverty and lower current drug coverage in rural areas affect projected spending under Medicare drug proposals. Per dollar of spending, the Administration's proposal to focus spending on near-poor without current coverage strongly favors rural areas. Congressional Democratic and Republican proposals subsidize coverage for all, including those currently with and without coverage. The urban-rural split of federal spending under those proposals depends on the extent to which the currently uninsured are willing to take up the newly offered benefit.
• 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 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.
• 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.
• Designing a Medicare Drug Benefit: Balancing Government-Based and Market-Based Approaches, the Implications for Rural Beneficiaries
  Research center: Walsh Center for Rural Health Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Date: 01 / 2003
  Examines the relationship between a variety of design characteristics of a Medicare prescription drug benefit and their likely impact on rural areas. The research is based on an analysis of three competing legislative proposals, the House passed proposal (HR 4954), the "Tripartisan" proposal (S 2729), and the Graham proposal (S 2625). In addition, there is an analysis of data from the Medicare Current Beneficiary Survey, pharmacy benefit managers, discussions with various state and federal policy makers, and reviews of published literature. The study finds that the different prescription drug proposals will have positive implications for rural areas and address the lack of access to Medicare+Choice drug coverage in rural areas. Rural pharmacies may see a change in revenue, but the actual result of the changes has not been studied.
• Medicare Physician Payment
  Author(s): A. Clinton MacKinney, Michael D. Shambaugh-Miller, Keith Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare, Physicians
  Date: 01 / 2003
  Resource-Based Relative Value Scale (RBRVS) has replaced the 25 year-old Medicare CPR charge system.
• 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.

2002

• Rural Dimensions of Medicare Reimbursement for Inpatient and Outpatient Institutional and Physician Services
  Research center: Walsh Center for Rural Health Analysis
  Topics: Medicare, Physicians
  Date: 12 / 2002
  Examines major Medicare payment policies from the rural perspective. Specifically, it summarizes major payment policies with explicit rural dimensions that directly affect physicians and hospitals, examines existing evidence on whether there are direct rural impacts of the policy, and looks at whether direct rural impacts are consistent with legislative and regulatory inten
• Accounting for Graduate Medical Education Funding in Family Practice Training
  Author(s): Frederick M Chen, RL Phillips Jr, R Schneeweiss, C Holly A Andrilla, L Gary Hart, GE Fryer Jr, S Casey, Roger A Rosenblatt
  Research center: WWAMI Rural Health Research Center
  Topics: Medicare, Physicians, Workforce
  Citation: Fam Med 2002;34(9):663-8
  Date: 10 / 2002
  Background and Objectives: Medicare provides the majority of funding to support graduate medical education (GME). Following the flow of these funds from hospitals to training programs is an important step in accounting for GME funding.
  Methods: Using a national survey of 453 family practice residency programs and Medicare hospital cost reports, we assessed residency programs’ knowledge of their federal GME funding and compared their responses with the actual amounts paid to the sponsoring hospitals by Medicare. Results: A total of 328 (72%) programs responded; 168 programs (51%) reported that they did not know how much federal GME funding they received. Programs that were the only residency in the hospital (61% versus 36%) and those that were community hospital-based programs (53% versus 22%) were more likely to know their GME allocation. Programs in hospitals with other residencies received less of their designated direct medical education payment than programs that were the only residency in the sponsoring hospital (-45% versus +19%).
  Conclusions: More than half of family practice training programs do not know how much GME they receive. These findings call for improved accountability in the use of Medicare payments that are designated for medical education.
• Arguing for Rural Health in Medicare: A Progressive Rhetoric for Rural America
  Author(s): Thomas Ricketts
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health policy, Medicare
  Date: 09 / 2002
  Examines how rural health policy is treated in the broader field of public policy, discusses the role of advocacy in developing rural health policy, and suggests ways to make that advocacy more effective. Specifically, the report explores the types of claims that rural advocates make, focusing in the context of Medicare policy, and determines to what extent those claims reflect a central them of fairness and inclusiveness in national polices versus claims that benefit special interests.
• Use of the Hospice Benefit by Rural Medicare Beneficiaries
  Author(s): Beth Virnig, Ira Moscovice, Sara Kind, Michelle Casey
  Research center: Minnesota Rural Health Research Center
  Topics: Hospice and palliative care, Medicare
  Date: 08 / 2002
  Identifies urban-rural differences in hospice use in rural service areas.
• 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
• Are Fundamental Changes to Medicare's Disproportionate Share Methodology Needed?
  Research center: Walsh Center for Rural Health Analysis
  Topic: Medicare
  Date: 06 / 2002
  Examines whether the Medicare disproportionate share percentage (DPP) is a useful predictor of Medicare costs per adjusted discharge and whether it is a good predictor of uncompensated care burdens. Findings indicate that the DPP is not a useful predictor of differences in the cost of treating Medicare patients (and is a statistically significant but weak predictor of uncompensated care burdens); the analysis does not support the contention that treatment of substantial numbers of low-income patients with public insurance directly causes hospitals to incur higher costs per discharge. It finds no support for basing DSH payments on DPP levels. The study concludes that if its results were confirmed in a national study of DSH payments, operating costs, and uncompensated care costs, there would be justification for fundamentally changing DSH payment methodology. Furthermore, since the results indicate that patient needs per adjusted discharge unit are unrelated to the DPP at both rural and urban hospitals, the authors see no rationale for differential treatment between rural and urban providers.
• Achieving Equity in Medicare DSH Payments to Rural Hospitals: An Assessment of the Financial Impact of Recent and Proposed Changes to the DSH Payment Formula
  Author(s): Janet Sutton, Jeffrey Stensland, Lan Zhao, Michael Cheng
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Date: 05 / 2002
  Examines how Benefits Improvement and Protection Act revisions to the qualifying and distribution formulas of the Medicare disproportionate share hospital (DSH) program are likely to affect rural hospital financial performance as measured by hospital operating and total margins. Also considers the effect of establishing a uniform DSH formula. The study shows that paying rural hospitals based on the rules used for urban hospitals would produce financial benefits that could improve access to care in rural communities. Notably, nearly one-fifth of financially distressed rural hospitals could have remained "in the black" and an even greater proportion could have received additional funds to cover costs incurred by treating indigent members of the community if rural hospitals had been paid in 1998 under the same DSH formula. Among the chief economic winners would be the smallest rural hospitals, which generally are in worse financial condition than other hospitals. Findings suggest that elimination of rural and urban disparities in DSH payment could strengthen the rural health care safety net. Report available on request.
• 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.
• Comments on Regulatory and Contractor Reform Legislation
  Author(s): Keith Mueller, Brandi Shay
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Medicare
  Report Number: Rural Policy Brief Vol. 7, No. 1 (PB2002-1)
  Date: 01 / 2002
  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.

2001

• Rural Hospitals' Ability to Finance Inpatient, Skilled Nursing, and Home Health Care
  Author(s): Jeffrey Stensland, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Health care financing, Home health, Hospitals and clinics, Long term care, Medicare
  Date: 10 / 2001
  Surveys 448 rural hospitals to see how they are restructuring in light of the Balanced Budget Act of 1997. Among its findings: the most popular strategy for small rural hospitals is to convert to Critical Access Hospital status-35 percent of those surveyed have done so; despite the closing of some facilities, the vast majority of rural patients still have access to one or more skilled nursing facilities and one or more home health agencies; and to help preserve access to care, policy makers should consider paying a portion of the bad debt and charity care expenses that Critical Access Hospitals incur when treating non-Medicare patients.
• Medicare Minus Choice: How HMO Withdrawals Affect Rural Beneficiaries
  Author(s): Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topic: Medicare
  Date: 10 / 2001
  Asseses the impact of Medicare HMO withdrawals and service reductions on rural Medicare beneficiaries.
• 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.
• 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.
• 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
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Medicare
  Date: 06 / 2001
  Reasons to change Medicare payment policies and a new framework for making appropriate changes.
• 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.
• 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
  
• 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.
• Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000: Concerns, Legislation, and Next Steps
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Legislation and regulation, Medicaid and S-CHIP, Medicare
  Date: 01 / 2001
  Overview of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) as it impacts rural health.
• Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
  Author(s): Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Legislation and regulation, Medicaid and S-CHIP, Medicare
  Date: 01 / 2001
  Covers rural health policy, SCHIP Benefit Improvement Plan, and legislation.

2000

• Background on the Wage-related Portion of the Medicare DRG Payments
  Author(s): Kathleen Dalton
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health care financing, Medicare
  Date: 09 / 2000
  Discusses how to calculate Medicare diagnostic related group (DRG) payments. Includes examples and a diagram of how to calculate a DRG payment.
• 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.
• 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.
• 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.
• Rural and Urban Patterns of Home Health Use: Implications for Access Under the Interim Payment System
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare
  Date: 03 / 2000
  This policy analysis brief compares patterns of home health utilization among rural and urban Medicare beneficiaries in order to estimate the potential impact of an interim payment system (IPS) on access to home care in rural areas of the country. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.

1999

• Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
  Author(s): Laura-Mae Baldwin, Roger A Rosenblatt, Schneeweiss R,Denise M Lishner, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Medicare, Physicians
  Citation: Journal of Rural Health, 15(2), 240-251
  Date: 1999
  Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas. This study compared the number of patients, outpatient visits, and inpatient visits per physician in the different specialties, diagnosis clusters, patient age and sex, and procedure frequency and type for board-certified rural and urban physicians in 12 ambulatory medical specialties. Overall, 14.4 percent of physicians in the 12 specialties practiced exclusively in rural Washington, with great variation by specialty. Rural physicians were older and less likely to be female than urban physicians. Rural physicians saw larger numbers of elderly patients and had higher volumes of outpatient visits than their urban counterparts. For all specialty groups except general surgeons and obstetrician-gynecologists, the diagnostic scope of practice was specialty-specific and similar for rural and urban physicians. Rural general surgeons had more visits for gastrointestinal disorders, while rural obstetrician-gynecologists had more visits out of their specialty domain (e.g., hypertension, diabetes) than their urban counterparts. The scope of procedures for rural and urban physicians in most specialties showed more similarities than differences. While the fund of knowledge and outpatient procedural training needed by most rural and urban practitioners to care for the elderly is similar, rural general surgeons and obstetrician-gynecologists need training outside their traditional specialty areas to optimally care for their patients.

Related Topics

These related topics also list publications:

• Medicare Advantage (MA) (8 items)
• Medicare Part D (14 items)
• Medicare Prospective Payment System (PPS) (15 items)
• Medicare Wage Index (9 items)