2018 Rural Health Research Products

  • Assessing the Unintended Consequences of Health Policy on Rural Populations and Places
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    This paper explores the unintended consequences of health policy through an analysis of policy actions that have affected, or had the potential to affect, rural people, places, and/or providers in ways counteractive to policy intent.
  • The Rural Hospital and Health System Affiliation Landscape – A Brief Review
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    The shift from traditional fee-for-service to value-based payment requires major capital investment. In this paper, we examine rural hospital and health system motivations for affiliation and present a non-exhaustive list of common affiliation structures with representative examples.
  • Update: Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population, 2012-2015
    Policy Brief
    Rural and Underserved Health Research Center
    Delivery of pneumococcal vaccines to fee-for-service Medicare beneficiaries increased 380% from 2014-2015 as a result of uptake of pneumococcal conjugate vaccine (PCV13). However, a significant rural-urban disparity remains. Pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
  • Changes to the Merit-based Incentive Payment System Pertinent to Small and Rural Practices, 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This policy brief highlights key regulatory changes to the Merit-based Incentive Payment System that occurred in 2018. It discusses the implications of these changes with an emphasis on how these changes may affect small and rural practices.
  • Trends in Hospital System Affiliation, 2007-2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This policy brief updates a RUPRI Center brief published in 2014 and documents the continued growth in system affiliation by both metropolitan and non-metropolitan hospitals.
  • Cancer Mortality in Rural America: 1999-2016
    Policy Brief
    Southwest Rural Health Research Center
    This policy brief details the differences in mortality from cancer at various levels of rurality in America. The primary aim of this study was to understand the scope of cancer mortality in urban and rural areas of the U.S. Common cancer types—breast, cervical, lung, prostate, and colon—were analyzed over an 18-year period from 1999-2016.
  • Key Informant Perspectives on Rural Social Isolation and Loneliness
    Policy Brief
    University of Minnesota Rural Health Research Center
    This policy brief uses data from interviews with 22 key informants in 12 states, all of whom were experts on the issue of social isolation and/or rural health, to describe key challenges and opportunities related to rural social isolation.
  • Practical Implications: Opioid-Affected Births to Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    This publication provides two physicians’ reactions to research findings on rates of diagnosis of maternal opioid use disorder and infant neonatal abstinence syndrome at the time of childbirth for rural residents based on the type of hospital where the birth occurred.
  • Spread of Medicare Accountable Care Organizations in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This policy brief describes Medicare accountable care organization (ACO) growth in non-metropolitan U.S. counties from 2016 to 2017. This brief, which includes data through December 2017, follows a similar analysis released in October 2016 that described ACO trends from 2013 to 2015.
  • Resources for Caregiving in Rural Communities
    Policy Brief
    University of Minnesota Rural Health Research Center
    This policy brief describes resources that are being used across the country to support caregivers in rural communities.
  • Perspectives on Rural Caregiving Challenges and Interventions
    Policy Brief
    University of Minnesota Rural Health Research Center
    This brief presents findings from key informant interviews describing challenges and opportunities related to supporting informal caregivers in rural areas.
  • Rural Hospital Mergers from 2005 through 2016
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    This brief describes the number and geographic distribution of rural hospital mergers from 2005-2016.
  • Health Insurance Marketplaces: Issuer Participation and Premium Trends in Rural Places, 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This brief assesses changes from 2014 to 2018 in average Health Insurance Marketplace plan participation and pre-subsidy premiums in rural and urban places. Insurance carriers reduced participation across both, while the gap between average premiums in expansion and non-expansion states is widening at a similar rate in rural and urban counties.
  • Medicaid Income Eligibility Transitions among Rural Adults
    Policy Brief
    Maine Rural Health Research Center
    The Affordable Care Act allows Medicaid expansion to adults under 65 with income below 138% of poverty. Research suggests income shifts affecting Medicaid eligibility are common, but the rural impact is unclear. This national study examines rural and urban adults' annual income shifts above or below the Medicaid expansion eligibility threshold.
  • Non-Medical Opioid Use among Rural and Urban Pregnant Women, 2007-2014
    Policy Brief
    University of Minnesota Rural Health Research Center
    This policy brief presents data on rural-urban differences in non-medical opioid use among pregnant women to inform policy, programmatic, and clinical efforts to address this crisis.
  • Gender Differences in Social Isolation and Social Support among Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    This policy brief uses identifies gender differences in social isolation and social support among older rural residents and provides ways to reduce social isolation in rural communities.
  • Insuring Rural America: Health Insurance Challenges and Opportunities
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    This brief discusses a series of policy considerations in three main categories: policies related to rural insurance risk, policies related to provider networks, and policies related to rural payment rates and structures.
  • Different Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute versus Community-entry Home Health in Rural Areas
    Policy Brief
    WWAMI Rural Health Research Center
    This study describes differences between rural, fee-for-service Medicare beneficiaries who are admitted to home health from the community (community-entry) and those who are admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live.
  • Addressing Commuting as a Public Health Issue: Strategies Should Differ by Rurality
    Policy Brief
    University of Minnesota Rural Health Research Center
    This policy brief estimates the rate of solo and long (greater than 30 minutes) solo car commutes by rurality and urban adjacency and identifies differences in factors that relate to commuting behavior.
  • Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Rural pharmacies play an important role in health service delivery to rural populations. This RUPRI Center brief updates previous findings on the continued decline in the number of independently owned rural pharmacies since the implementation of Medicare Part D. This brief provides follow-up data on rural pharmacy closures through March 2018.
  • Average Beneficiary CMS Hierarchical Condition Category (HCC) Risk Scores for Rural and Urban Providers
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    This brief investigates potential differences in urban and rural Centers for Medicare & Medicaid Services (CMS) hierarchical condition category (HCC) risk scores at the provider’s patient panel level.
  • Rural Health Clinic Participation in the Merit-Based Incentive System and Other Quality Reporting Initiatives: Challenges and Opportunities
    Policy Brief
    Maine Rural Health Research Center
    This brief discusses the Merit-Based Incentive Payment System (MIPS) within the context of past and current Rural Health Clinic (RHC) quality reporting initiatives and assesses options for encouraging RHCs to voluntarily participate in MIPS.
  • Availability of Respiratory Care Services in Critical Access and Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    This policy brief describes the availability of respiratory care services and respiratory therapists in Critical Access Hospitals (CAHs) and in rural and urban Prospective Payment System (PPS) hospitals.
  • What Makes Physician Assistant (PA) Training Programs Successful at Training Rural PAs?
    Policy Brief
    WWAMI Rural Health Research Center
    While a majority of physician assistant (PA) programs identify production of rural PAs as an important program goal, many only have limited rural recruitment and training activities. This study identified PA program characteristics and training activities that are strongly associated with the production of a high proportion of rural graduates.
  • Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    The purpose of this brief is to compare uncompensated care in rural and urban hospitals and to describe how it varies across regions of the country.
  • Medicaid Managed Care and the Rural Exception: A Review of Issues and Perspectives from the Field
    Policy Brief
    Rural and Minority Health Research Center
    To examine the intersection of state Medicaid procedures with rural populations, we conducted a review of Medicaid waivers current as of September 2017. This was supplemented with calls to State Offices of Rural Health (SORHs), state Medicaid offices, and other relevant stakeholders in an attempt to understand the process of waiver development.
  • Rural and Urban Provider Market Share of Inpatient Post-Acute Care Services Provided to Rural Medicare Beneficiaries
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    The purpose of this brief is to characterize rural providers’ market share of inpatient post-acute care services provided to rural Medicare beneficiaries.
  • Market Characteristics Associated with Rural Hospitals' Provision of Post-Acute Care
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    This brief uses data from Medicare cost reports, the Provider of Services File, and the U.S. Department of Agriculture to provide a window into current hospital-based post-acute care offerings by summarizing both hospital- and market-level factors that are associated with rural hospitals that provided post-acute care between 2012 and 2015.
  • Health Care Utilization Patterns of Rural Medicaid Recipients, 2012, 35 States
    Policy Brief
    Rural and Minority Health Research Center
    The purpose of this brief is to examine inpatient and other institutional encounters among individuals enrolled in Medicaid prior to expansion in 2014, using enrollment and claims data from the Medicaid Analytic Extract Files. All Medicaid-covered individuals, institutionalized and living in the community, are included.
  • Characteristics of Rural Medicaid Recipients, 2012, 35 States
    Policy Brief
    Rural and Minority Health Research Center
    The purpose of this brief is to examine the characteristics of Medicaid enrollees prior to Medicaid expansion in 2014, using enrollment and claims data from the Medicaid Analytic Extract Files. This sample allowed for a detailed examination of Medicaid populations in the pre-Medicaid expansion period.
  • Critical Access Hospital Swing-Bed Quality Measures: Findings from Key Informant Interviews
    Policy Brief
    University of Minnesota Rural Health Research Center
    This study examines how Critical Access Hospitals (CAHs) are currently assessing the quality of care provided to their swing-bed patients.
  • Geographic Variation in the 2016 Profitability of Urban and Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    This study describes the geographic variation in 2016 profitability of critical access hospitals (CAHs), other rural hospitals (Medicare Dependent Hospitals, Sole Community Hospitals, and rural Prospective Payment System (PPS) hospitals denoted as “ORH”), and urban PPS hospitals by census region, census division, and state.
  • Diabetes-Related Hospital Mortality in Rural America: A Significant Cause for Concern
    Policy Brief
    Southwest Rural Health Research Center
    This brief is the third in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The aim of this study was to examine trends and rates of diabetes-related deaths for persons hospitalized in the U.S., with emphasis on differences across the urban-rural continuum and across census regions.
  • Medicare Accountable Care Organization Growth in Rural America, 2014-2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    This RUPRI Center data report describes Medicare accountable care organization (ACO) growth in non-metropolitan U.S. counties from 2014 to 2016. ACOs are the most widespread of the Centers for Medicare & Medicaid Services (CMS) value-based payment programs and demonstrations.
  • Residential Settings and Healthcare Use of the Rural "Oldest-Old" Medicare Population
    Policy Brief
    Maine Rural Health Research Center
    This study used Medicare Current Beneficiary Survey data to profile rural/urban Medicare beneficiaries ages 85 & older. Rural adults in this age group are more likely to be disabled and live alone in the community or in nursing homes and less likely to live in assisted living facilities. Findings highlight rural needs for community-based services.
  • Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
    Policy Brief
    Rural and Underserved Health Research Center
    The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.
  • Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
    Policy Brief
    Rural and Underserved Health Research Center
    While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
  • Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population
    Policy Brief
    Rural and Underserved Health Research Center
    Using 2014 Medicare data, we found a significant disparity in pneumococcal vaccine service delivery to fee-for-service Medicare beneficiaries. Although primary care providers delivered the majority of pneumococcal vaccines to this population, pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
  • Challenges Related to Pregnancy and Returning to Work after Childbirth in a Rural, Tourism-Dependent Community
    University of Minnesota Rural Health Research Center
    This case study highlights challenges related to pregnancy and returning to work after childbirth in a rural, tourism-dependent community in Minnesota.
  • Distance and Networks: A Regional Analysis of Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Using 2015-16 data on 15 Midwestern states, we examine the possibility that geographic distance to care plays a role in insurance issuer participation, premiums, and enrollment success through its effect on network adequacy and assess the moderating role that state-level policies on network adequacy standards and Rating Area design may have.
  • Range Matters: Rural Averages Can Conceal Important Information
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    This short brief uses three examples to demonstrate how focusing on averages without also considering the data range can conceal important information: 1) average rural hospital profitability, 2) distance from closed rural hospitals to the next closest hospital, and 3) HIV prevalence by county.
  • Illicit Drug and Opioid Use Disorders among Non-Metropolitan Residents
    Policy Brief
    Rural and Underserved Health Research Center
    We provide estimates of the prevalence of illicit drug and opioid use disorders among non-metropolitan adults ages 18-64. Prevalence rates did not decline from 2011-2013 to 2014-2015 despite the implementation of major substance use treatment policies. Of particular concern, heroin use disorder prevalence increased in recent years.
  • Perceived Treatment Need and Utilization for Illicit Drug and Opioid Use Disorders in Non-Metropolitan Areas
    Policy Brief
    Rural and Underserved Health Research Center
    The vast majority of non-metropolitan adults 18-64 who satisfy criteria for an illicit drug use or opioid use disorder do not perceive a need for treatment or receive formal substance use treatment. Despite policies to increase treatment access during the 2008-2015 study period, we found few changes in perceived treatment need and utilization.
  • Access to Care: Populations in Counties with No FQHC, RHC, or Acute Care Hospital
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    To help provide a quick understanding of how many people may have more limited access to primary care and where they live, this brief focuses on three main primary care providers in rural areas (Federally Qualified Health Centers, Rural Health Centers, and acute care hospitals).