University of Minnesota Rural Health Research Center

Products

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

For a complete list of publications from the Center, which may include older publications and publications funded by other sources, please see the Center's website.

2017

  • Regulating Network Adequacy for Rural Populations: Perspectives of Five States
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2017
    The purpose of this study was to examine how five geographically-diverse states with significant rural populations define "network adequacy" and the degree to which they consider rural issues when regulating networks.
  • Identifying Adverse Drug Events in Rural Hospitals: An Eight-State Study
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    Analyzes the prevalence of Adverse Drug Events (ADEs) in rural hospitals, including both CAHs and rural PPS hospitals, related to four categories of drugs: steroids, antibiotics, opiates / narcotics, and anticoagulants in 2013 for eight states. It also examines whether or not these hospitals' ADE rates varied based on hospital characteristics.
  • Medical Barriers to Nursing Home Care for Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    This policy brief describes barriers rural residents with complex medical care needs may face when seeking placement in a nursing home and identifies potential policy strategies to overcome them.
  • Resources to Reduce Adverse Drug Events in Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    This policy brief provides resources that could be used to decrease Adverse Drug Events (ADEs) in rural hospitals.
  • Closure of Hospital Obstetric Services Disproportionately Affects Less-Populated Counties
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2017
    This policy brief describes the scope of obstetric unit and hospital closures resulting in loss of obstetric services in rural U.S. counties from 2004 to 2014.
  • State Variability in Access to Hospital-Based Obstetric Services in Rural US Counties
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2017
    This policy brief describes state-level variations in 1) the availability of hospital-based obstetric services, and 2) the scope of obstetric unit and hospital closures resulting in the loss of obstetric services in rural U.S. counties from 2004 to 2014.

2016

  • Rural-Urban Differences in Insurer Participation for Marketplace-Based Coverage
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2016
    This policy brief examines the differences between rural and urban counties in terms of the number and composition of insurers in Federally-Facilitated Marketplaces.
  • Quality Measures and Sociodemographic Risk Factors: The Rural Context
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    This policy brief aims to inform discussions concerning whether or not to adjust provider quality measures for differences in patient characteristics by examining how rurality and key sociodemographic variables might affect quality-of-care outcomes.
  • State Variations in the Rural Obstetric Workforce
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    Many types of staff are necessary to successfully run an obstetrics unit. Rural hospitals face unique staffing challenges. This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
  • Medicare Costs and Utilization Among Beneficiaries in Rural Areas
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 03/2016
    This study assesses the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum. It also examines the relationships between rural beneficiaries’ service utilization and health care delivery market structure and evaluates strategies and policies to address high costs in rural areas.

2015

  • Rural Hospital and Physician Participation in Private Sector Quality Initiatives
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles 12 initiatives, half focused on physician quality improvement and half focused on hospital quality improvement.
  • Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    The Hospital Readmissions Reduction Program reduces Medicare payments for hospitals with excess rates of patient readmissions for certain conditions. It assesses rural/urban differences in the proportion of hospitals penalized under the program over time and whether condition-specific hospital readmission rates differ for rural/urban hospitals.
  • Differences in Part D Plans Offered to Rural and Urban Medicare Beneficiaries
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 07/2015
    This brief analyzes how the plan options available to rural and urban beneficiaries differ in terms of premiums, deductibles, and copayments, as well as differences in plan options within rural areas.
  • Rural and Urban Differences in Choice of and Satisfaction with Medicare Part D Plans
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 07/2015
    This brief examines whether rural Medicare beneficiaries are satisfied with their Medicare Part D drug plans and whether there is a difference in beneficiary satisfaction and plan selection experience by rurality.
  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2015
    This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals and analyzes current patterns of non-local delivery by rural women's health insurance status and residential rurality.
  • Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 01/2015
    This study’s purpose was to examine the relationship between nurse staffing levels and care quality in rural nursing homes and to assess potential differences between hospital-based and freestanding rural nursing homes.

2014

  • The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014
    This brief details rural hospital obstetric staffing patterns in nine states by critical access hospital status. The purpose was to examine obstetric practice models in rural hospitals, providing information to rural hospitals with obstetric care units regarding workforce and informing policymakers about the context in which the hospitals operate.
  • Successful Health Insurance Outreach, Education, and Enrollment Strategies for Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014
    This brief offers best practices for hospitals to use in health insurance outreach/enrollment based on interviews with administrators, staff, and community reps at 11 rural hospitals. It also discusses certified application counselors and the importance of collaborative community partnerships in conducting insurance enrollment outreach/education.
  • Does Rurality Affect Observation Care Services Use in CAHs for Medicare Beneficiaries?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2014
    This brief describes the use of observation services across levels of rurality by Medicare beneficiaries in critical access hospitals, the demographics and health status of patients receiving these services, and the characteristics of their observation stays.
  • Observation Care Services for Medicare Beneficiaries in Rural Hospitals: Policy Issues and Stakeholder Perspectives
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2014
    This brief describes the findings of a qualitative study aimed at gaining a greater understanding of the rural policy context surrounding the use of observation care services by Medicare beneficiaries from 2010 to 2013.
  • Which Medicare Patients Are Transferred from Rural Emergency Departments?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2014
    A brief from the University of Minnesota Rural Health Research Center analyzes transfers of Medicare beneficiaries who received emergency care in a critical access hospitals or rural hospitals and were transferred to other hospitals for care.

2013

2007

  • State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 10/2007
    Explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural health care infrastructure and discusses which activities were considered most successful by State Flex Coordinators. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2007

    Policy brief examining the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database. A full report is also available. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.

  • Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results: Briefing Paper
    University of Minnesota Rural Health Research Center
    Date: 04/2007
    Examines the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • The State Flex Program at 10 Years: Strengthening Critical Access Hospitals and Rural Communities
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2007
    To understand the priorities and accomplishments of state Flex Grant Programs, members of the Flex Monitoring Team asked Flex Coordinators to identify and discuss their states' three most successful initiatives in the past two years. Interviews were conducted during February 2007 with Flex Coordinators and State Office of Rural Health staff (SORH) in all 45 states. The listed publication is a policy brief; the full report will be available in the fall of 2007. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Rural Hospital Emergency Department Quality Measures: Aggregate Data Report
    University of Minnesota Rural Health Research Center
    Date: 03/2007
    Reports findings from a project that tested emergency department quality measures in a voluntary sample of critical access hospitals (CAHs) in Washington State. The quality measures that were tested focused on patients presenting to the emergency department with chest pain/acute myocardial infarction (AMI, or heart attack) or trauma, and patients seen in the emergency department who were transferred to another hospital for care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • The Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 02/2007
    Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Exploring the Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 01/2007
    Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.

2006

  • The Current Status of Health Information Technology Use in CAHs
    University of Minnesota Rural Health Research Center
    Date: 05/2006
    Both the public and private sectors have focused considerable attention on health information technology (HIT) as a potential means of improving the quality, safety, and efficiency of health care. The purpose of this briefing paper is to assess the current status of HIT use in Critical Access Hospitals (CAHs) nationally. This project is part of the federal Office of Rural Health Policy's initiative to implement national performance measures for the Medicare Rural Hospital Flexibility Program. It was conducted by the Flex Monitoring Team in collaboration with the Technical Assistance and Services Center (TASC) at the Rural Health Resource Center in Duluth, Minnesota. Data for the study came from a national survey of CAHs conducted in March and April 2006. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • A Review of State Flex Program Plans, 2004-2005
    Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Date: 03/2006
    Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. Highlights recent trends in State Flex Program planning, development, and implementation. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • CAH Participation in Hospital Compare and Initial Results
    University of Minnesota Rural Health Research Center
    Date: 02/2006
    Examines the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presents the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia. Although CAHs do not face the same financial incentives as Prospective Payment System hospitals to participate, the Hospital Compare initiative provides an important opportunity for CAHs to assess and improve their performance on national standards of care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.

2005

  • Is Large Really Beautiful? Physician Practice in Small versus Large Scale Communities
    University of Minnesota Rural Health Research Center
    Date: 09/2005
    Examines the effect of community size on how physicians view their practices as reported by respondents to two waves (1996-97 and 1998-1999) of a national sample survey conducted as part of the Community Tracking Study (CTS). Results suggest that bigger is not necessarily better when it comes to physicians' perceptions of their practice. A key challenge is whether larger urban-based practices can be decomposed into smaller clinical microsystems that can benefit from the strengths of physician practices in small city or rural settings yet retain the presumed benefits of larger scale organizations.
  • Availability and Use of Capital by Critical Access Hospitals
    University of Minnesota Rural Health Research Center
    Date: 03/2005
    Examines the experiences of Critical Access Hospitals (CAHs) in meeting their capital needs. It focuses specifically on their efforts to obtain capital, the capital sources tapped through these efforts, how CAHs have used the capital they have been able to obtain over the past few years, and assesses their current capital needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.

2004

  • Sustaining Community Health Services Over Time: Models from the Rural Health Outreach Grant Program
    University of Minnesota Rural Health Research Center
    Date: 11/2004
    Discusses post-grant sustainability of services provided by recipients of Rural Health Outreach Grant Program projects. Based on site visits to a medical rehabilitation project in Wyoming, a prenatal outreach project in Maryland, and a community health center in Oregon.
  • Access to Dental Care for Rural Low Income and Minority Populations
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    Using data from the 1999 National Health Interview Survey, this study examines the relationships between rural residence, income, race/ethnicity, and access to dental care. The study confirms that rural-urban disparities in access to dental care persist, and finds significant differences by race/ethnicity and income within rural populations in utilization of dental care, affording needed dental care, and dental insurance.
  • Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    Describes the patient safety results from a national phone survey of 474 CAH administrators conducted in 2004. Survey respondents were queried regarding top patient safety priorities, familiarity with the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and implementation of initiatives related to the goals, factors that limit or support their ability to implement patient safety interventions, and pharmacist staffing and computer software to improve medication safety. The survey findings provide encouraging evidence of CAH interest in patient safety, but should be interpreted cautiously because of the significant number of CAHs which reported that financial resources, staff time, and technology are limiting factors in their ability to implement patient safety interventions. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    Describes quality improvement efforts in Critical Access Hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. Includes data on the use of clinical guidelines and quality measures in CAHs, and the role of Medicare Quality Improvement Organizations (QIOs). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • 2004 CAH Survey National Data
    University of Minnesota Rural Health Research Center
    Date: 08/2004
    As part of the monitoring efforts for the Medicare Rural Hospital Flexibility Program (Flex Program), the Flex Monitoring Team conducted a national telephone survey of 500 CAH administrators between January and April 2004. The purpose of the survey was to document the program-related experiences of CAHs over the past two years, in order to help shape public policy to improve the effectiveness of the Flex Program and CAHs. The CAH survey was developed by the Flex Monitoring Team members at the Universities of Minnesota, North Carolina, and Southern Maine and fielded by the Survey Research Center in the Division of Health Services Research and Policy at the University of Minnesota. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • A Synthesis of State Flex Program Plans 2003-2004
    University of Minnesota Rural Health Research Center
    Date: 05/2004
    Highlights recent trends in the development and implementation of State Flex Programs, whose goal it is to strengthen the rural healthcare infrastructure using CAHs as the hub of organized, local systems of care. A major portion of the FY2003 funding dollars continue to target state program infrastructure development; however, the role of this infrastructure is shifting from supporting conversions to the ongoing availability of appropriate health care services for communities served by CAHs (e.g., CAH performance improvement, EMS integration, systems development, and community engagement). States are pursuing these areas with a variety of strategies including the use of local, interstate, and regional collaborations to share lessons learned and advance their knowledge in key areas for success (e.g., performance and quality improvement, health information technology, and capital planning). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Measuring Rural Hospital Quality
    University of Minnesota Rural Health Research Center
    Date: 04/2004
    This paper seeks to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive to the rural hospital context. A conceptual model is developed for measuring rural hospital quality. Hospital quality measures from national and rural organizations are reviewed for their fit to rural hospitals, with a recommendation for an initial core set of quality measures relevant for rural hospitals with less than 50 beds. Finally, avenues for future quality measure development are suggested.
  • The Financial Benefits of Critical Access Hospital Conversion for FY 1999 and FY 2000 Converters
    University of Minnesota Rural Health Research Center
    Date: 01/2004
    Discusses the impact of conversion to Critical Access Hospital (CAH) status on the financial condition of rural hospitals one and two years after conversion. CAHs pre- and post-conversion revenues are compared, and CAH revenues are compared to small rural hospitals that did not convert to cost-based Medicare reimbursement.
  • Quality Improvement Strategies and Best Practices in Critical Access Hospitals
    University of Minnesota Rural Health Research Center
    Date: 01/2004
    Describes Critical Access Hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. Includes lists of changes made to staffing, training, equipment and other issues related to quality improvement.

2003

  • Grantee Sustainability in the Rural Health Outreach Grant Program
    University of Minnesota Rural Health Research Center
    Date: 12/2003
    Describes a study of the post-grant experiences of 99 Rural Health Outreach Grant recipients. Focuses on the extent to which programs were able to maintain or expand services after their grants ended and characteristics that helped programs succeed in the post-grant period.
  • Are There Geographic Disparities in Out-of-Pocket Spending by Medicare Beneficiaries?
    University of Minnesota Rural Health Research Center
    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.
  • The Response of Local Health Care Systems in the Rural Midwest to a Growing Latino Population
    University of Minnesota Rural Health Research Center
    Date: 08/2003
    Reports on the case studies of rural communities in Iowa, Kansas, and Nebraska, documenting successful strategies that could be adopted by other communities facing challenges to their local rural healthcare system in meeting the needs of a growing Latino population. High rates of uninsurance for Latinos, along with language and cultural barriers to care, have contributed to difficulties accessing healthcare in these communities.
  • Rural Health Networks: Evolving Organizational Forms and Functions
    University of Minnesota Rural Health Research Center
    Date: 06/2003
    Discusses results of a survey of rural health networks. Includes information about the location, membership, relationships, governance and management, process and products of rural health networks.
  • Environmental Context of Patient Safety and Medical Errors
    University of Minnesota Rural Health Research Center
    Date: 03/2003
    Explores the environmental context of patient safety and medical errors with specific interest in rural settings. Reviews the patient safety/medical error literature, identifies unique features of rural health care organizations and their environment that relates to patient safety issues and medical errors. Discusses strategies for medical error reduction and prevention in rural health care settings.
  • Rural Hospitals: New Millennium and New Challenges
    University of Minnesota Rural Health Research Center
    Date: 02/2003
    Discusses the changes in rural hospitals that took place in the decade of the 1990?s and discusses some of the challenges that face rural hospitals in 2003. Includes discussion of rural hospitals' organizational structure, health service provision, payment/reimbursement, and financial performance.
  • The Financial Effects of Critical Access Hospital Conversion
    University of Minnesota Rural Health Research Center
    Date: 01/2003
    Describes how the first wave of conversions to Critical Access Hospital (CAH) status affected rural hospitals? financial performance and organizational structure.
  • Rate of Return on Capital Investments at Small Rural Hospitals
    University of Minnesota Rural Health Research Center
    Date: 01/2003
    Examines whether the aging of rural facilities, a major problem among rural hospitals, is due to a lower rate of return on capital investment at these hospitals. This paper also investigates whether membership in a hospital system improves access to capital and results in the updating of buildings and equipment. The study found that hospitals generally do no use system membership to overcome access to capital problems, most likely because investments are not readily available along this pathway. The study also found that hospitals generate 50 cents for every dollar invested in facility improvement. Although this is a way to generate revenue, the small hospitals will typically not be able to recover the costs spent in the improvement. These findings suggest that small hospitals, particularly the smallest and most rural hospitals, would need grants in order to adequately cover the costs of facility improvement.

2002

  • Implementing Quality Assessment and Performance Improvement Systems in Rural Health Clinics: Clinic and State Agency Responses
    University of Minnesota Rural Health Research Center
    Date: 08/2002
    Assesses the potential of a diverse set of Rural Health Clinics to comply with the quality assessment and performance improvement program (QAPI) requirements and the capacity of state agencies to provide RHCs with technical assistance in their QAPI implementation. Finds that more information and guidance on QAPI requirements is needed to make the program a success, and that to make QAPI useful to RHCs, RHCs need technical assistance in all aspects of quality assurance. Also finds that QAPI implementation could hamper care in resource-strapped RHCs if implementation is too costly or if clinics decide to withdraw from the RHC program because of QAPI.
  • Use of the Hospice Benefit by Rural Medicare Beneficiaries
    University of Minnesota Rural Health Research Center
    Date: 08/2002
    Identifies urban-rural differences in hospice use in rural service areas.
  • Rural Hospital Access to Capital: Issues and Recommendations
    University of Minnesota Rural Health Research Center
    Date: 07/2002
    Identifies federal and state programs that have assisted or could assist rural hospitals in meeting their capital needs; assesses whether rural hospital borrowers have difficulty in meeting their capital needs under existing grant, loan, and mortgage insurance programs; and discusses potential options for improving access to capital for rural hospitals. Offers regulatory, programmatic, and policy recommendations to improve the HUD 242 Program and the USDA Community Facilities Program-two federal programs that have been able to assist some of the less creditworthy hospitals over the last three decades.
  • Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
    University of Minnesota Rural Health Research Center
    Date: 06/2002
    This paper examines the financial incentives that rural hospitals have to conduct surgery and treat more complex medical conditions. The objective is to evaluate whether rural hospitals that offer broader services are more profitable than hospitals with very limited inpatient services. A low-volume adjustment considered by the Medicare Payment Advisory Commissions (MedPAC) is discussed.
  • Understanding Rural Hospital Bypass Behavior
    University of Minnesota Rural Health Research Center
    Date: 06/2002
    This study provides a descriptive analysis of rural hospital bypass behavior. Focuses on the extent to which patients admitted from rural areas are bypassing local facilities and whether there are changes in bypass patterns over time.
  • Access to Emergency Medical Services in Rural Areas: The Supporting Role of State EMS Agencies
    University of Minnesota Rural Health Research Center
    Date: 02/2002
    Reports the findings of a survey of state EMS directors regarding access to rural EMS; programs and initiatives by state EMS agencies that target rural and volunteer EMS providers; integration initiatives by rural EMS providers; issues in medical direction for rural EMS; and anticipated effects of the new Medicare fee schedule on rural EMS providers. Findings include: there is substantial state-by-state variation in the approach to EMS issues; EMS system development has not been a priority in state efforts; state EMS agencies address rural EMS provider needs in a limited manner; medical direction in rural EMS is a major issue in most states, but few states place a high priority on it; and EMS integration is sometimes seen as a panacea, but is not easily accomplished. Concludes that the time is right for a new national initiative to address EMS issues and to stimulate the development of EMS as a system, beyond its current fragmented state.

2001

  • Medicare Minus Choice: How HMO Withdrawals Affect Rural Beneficiaries
    University of Minnesota Rural Health Research Center
    Date: 10/2001
    Assesses the impact of Medicare HMO withdrawals and service reductions on rural Medicare beneficiaries.
  • Rural Hospitals' Ability to Finance Inpatient, Skilled Nursing, and Home Health Care
    University of Minnesota Rural Health Research Center
    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.
  • Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
    University of Minnesota Rural Health Research Center
    Date: 07/2001
    Describes the current status of rural retail pharmacies in the three states; examines the availability of pharmacy services in rural areas of the states; and analyzes regulatory and policy issues that affect the delivery of pharmacy services in rural areas. Among the findings are that pharmacy access problems in the states are not primarily due to closure of rural pharmacies in recent years; relief coverage is a major concern for many rural pharmacies; financial access to pharmacy services is a major concern in rural areas of the states; the financial viability of rural pharmacies is a key policy issue; and the addition of a Medicare prescription benefit may have a substantial negative impact on the financial status of rural pharmacies. Makes several recommendations pertaining to the capacity of colleges of pharmacy to produce an adequate supply of rural pharmacists; options for providing affordable relief coverage for rural pharmacists; financial access to prescription drug coverage for the elderly and other vulnerable populations; and the potential financial impact of a Medicare prescription benefit on rural pharmacies.
  • Rural Government Role in Medicaid Managed Care: The Development of County-Based Purchasing in Minnesota
    University of Minnesota Rural Health Research Center
    Date: 01/2001
    Describes the development and implementation in Minnesota of a model for rural county government participation in Medicaid managed care initiatives. The model-called County-Based Purchasing-allows county governments the option of functioning as direct purchasers of health care for the Medicaid beneficiaries in their area, accepting financial risk for service delivery. Concludes that if the model is to be used nationally, several issues must be addressed including, the federal approval process for similar initiatives, the relationship between state and county agencies, and sources of funding.

2000

  • Influence of Rural Residence on the Use of Preventative Health Care Services
    University of Minnesota Rural Health Research Center
    Date: 11/2000
    Study of the utilization of specific preventive healthcare services by rural women and men, and to assess the impact of rural residence, the availability of healthcare providers and technology, demographic factors, and health insurance status on the likelihood of obtaining the following preventive healthcare services: blood pressure screening, cholesterol screening, colon cancer screening, Pap smears, mammograms, flu shots, and pneumonia vaccinations.
  • Financial Viability of Rural Hospitals in a Post-BBA Environment
    University of Minnesota Rural Health Research Center
    Date: 10/2000
    This paper evaluates the financial viability of rural hospitals under the Balanced Budget Act of 1997 (BBA) and the Balanced Budget Refinement Act of 1999 (BBRA) Medicare payment policies. Estimates the number of hospitals that will become Critical Access Hospitals (CAHs) and estimates the number of beds at each hospital.
  • Why do Rural Primary-Care Physicians Sell Their Practices?
    University of Minnesota Rural Health Research Center
    Date: 06/2000
    This study evaluates why rural primary care physicians sell their practices. Examines the factors that led independent physicians to sell their practices to either non- local buyers, local hospitals or local physicians.
  • Strategic Choices of Rural Health Networks: Implications for Goals and Performance Measurement
    University of Minnesota Rural Health Research Center
    Date: 01/2000
    The purpose of this study is to obtain a greater understanding of rural health networks by classifying them according to their functions and purposes. Examples of performance measures that might be used for the different network types are given.