RUPRI Center for Rural Health Policy Analysis

Current Projects

• Causal Effect of Nursing Home Closure on Resident Outcomes in Rural Areas
  We will evaluate the causal impact of nursing home closure on two key outcomes: distance to the transitioned nursing home, and resident physical and mental health outcomes. We will compare the effect of closures on outcomes for rural and urban areas using resident-level data from 2010-2019 and advanced difference-in-differences regression methods.
  Topics: Aging, Health services, Healthcare access, Long-term care, Post-acute care, Quality
  
• Changes in Rural Health Insurance Coverage, 2019-2024
  This project uses secondary data sources to characterize changes in health insurance coverage during 2019-2024 for rural and urban people. The analysis will focus on changes associated with demographic, economic (particularly employment), and geographic characteristics, and will describe how exogenous changes (e.g., the economy, pandemic) as well as changes in federal policies impacted coverage.
  Topics: Healthcare access, Healthcare financing, Medicaid and CHIP, Medicare, Private health insurance, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured, Workforce
  
• Concordance Between Social Needs Screening Provision, Programming, and Partnerships in Rural PPS Hospitals
  This study will examine how rural Prospective Payment System (PPS) hospitals differ from urban hospitals concerning social needs screening practices and alignment between social needs screening performance and corresponding programs/strategies and/or community partnerships to address social needs.
  Topics: Health services, Hospitals and clinics, Medicare Prospective Payment System (PPS), Networking and collaboration, Social determinants of health
  
• Payer Mix of Rural Health Clinics and Federally Qualified Health Centers
  This project will assess the payer mix of the more than 5,000 Rural Health Clinics and 1,400 Federally Qualified Health Center grantees throughout the country. The analysis will include assessing trends overtime and across types and ownership for RHCs and across regions for FQHCs.
  Topics: Federally Qualified Health Centers (FQHCs), Medicaid and CHIP, Medicare, Private health insurance, Rural Health Clinics (RHCs), Uninsured and underinsured
  
• Retention and Expansion of Hospital Services Offered by Rural Hospitals After Enrollment in 340B
  The 340B Federal program is designed to provide hospitals with financial stability through provision of drug discounts which may, in turn, allow hospitals to maintain or expand their service line offerings. Using a series of event study analyses over an 11-year period, this study will examine the impact of enrollment in the 340B program on discontinuing services, maintaining services, and adding new services in eligible rural hospitals.
  Topics: Critical Access Hospitals (CAHs), Health services, Hospitals and clinics, Pharmacy and prescription drugs
  
• Rural Implications of Increased Medicare Beneficiary Enrollment in ACOs and MA Plans
  This project will leverage Centers for Medicare & Medicaid Services data showing the number of Medicare beneficiaries assigned to Accountable Care Organizations, in combination with enrollment in Medicare Advantage in rural counties, to describe implications for rural health care organizations.
  Topics: Health reform, Healthcare financing, Medicare, Medicare Advantage (MA)
  
• Rural Nursing Home Staffing, and Resident Health, Closure, and Financial Performance
  There are concerns about availability and quality of care provided in nursing homes in rural areas. This project aims to evaluate staffing levels and shortages, the health status of residents, closures, and financial performance of rural nursing homes both before and during the COVID-19 pandemic.
  Topics: Aging, Long-term care, Post-acute care
  
• Rural-based Accountable Care Organizations Accepting Downside Risk
  The RUPRI Center will update its studies of rural provider participation in accountable care organizations, including differences between those who exit the program, those who remain, and those who enter. In particular, this project will address participation decisions made after a rule change in July 2019 that requires conversion to two-sided risk.
  Topics: Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), Health reform, Hospitals and clinics, Legislation and regulation, Medicare
  
• Rural-Urban Differences in Medicare Advantage Plan Quality Scores
  This project updates previous RUPRI Center publications focused on rural-urban differences in access to, and enrollment in, Medicare Advantage plans with four- and five-star quality ratings.
  Topics: Health services, Healthcare financing, Medicare, Medicare Advantage (MA)
  
• The Changing Landscape of Medicare Advantage in Rural America
  The recent rapid growth in Medicare Advantage (MA) enrollment, particularly in counties with very little previous activity, has made MA a "hot issue" in rural health policy. This project will provide deeper knowledge of the MA marketplace including the firms offering MA plans and the beneficiaries who are enrolling.
  Topics: Healthcare financing, Medicare, Medicare Advantage (MA)
  
• Variation in Wages and Employment of Administrative Staff in Rural Hospitals and Nursing Homes
  This study examines employment levels and wages for administrative staff such as dietary, housekeeping, and maintenance workers across healthcare and non-healthcare settings in rural and urban areas.
  Topics: Hospitals and clinics, Long-term care, Post-acute care, Rural statistics and demographics, Workforce