Fred Ullrich, BA
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3834
Email: fred-ullrich@uiowa.edu
Health Management and Policy
University of Iowa
College of Public Health
Iowa City, IA 52242
- Current Projects - (1)
- Completed Projects - (2)
- Publications - (97)
Current Projects - (1)
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RHCs and CAHs Participating in SSP: Characteristics of the Providers and Communities
This project describes characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the Medicare Shared Savings Program (SSP), and the communities they serve. Comparisons will be made to RHCs and CAHs not participating in the SSP.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Critical Access Hospitals (CAHs), Healthcare financing, Medicare, Rural Health Clinics (RHCs)
Completed Projects - (2)
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Assessing the Stability of Rural Pharmacy Services
This project's goals include deepening our understanding of economic forces beyond the immediate control of local pharmacies that are affecting their ability to remain in business, assessing the future of sole community retail pharmacies in rural places, and exploring alternative modalities for delivering pharmacy services in the absence of retail pharmacy businesses.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health services, Pharmacy and prescription drugs, Telehealth
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How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
This project examined the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project provided policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Care management, Health reform, Health services, Hospitals and clinics, Medicare
Publications - (97)
2024
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Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 09/2024
This brief presents financial performance trends of hospitals who participated in Medicare's Shared Savings Program (SSP) from 2011 to 2018. Trends in six financial outcomes are compared between SSP and non-SSP hospitals over time and between rural and urban hospitals. -
Changes in Rural Pharmacy Presence 2023
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2024
This data brief continues the RUPRI Center's series of reports exploring the availability of retail pharmacy services in rural areas of the U.S. It provides information on rural communities that have kept, lost, or gained a retail pharmacy between 2018 and 2023. -
Profiling Social Needs Activities in Publicly Traded Medicare Advantage Organizations
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 08/2024
This article reviews how six major Medicare Advantage (MA) companies address social determinants of health (SDOH) through supplemental benefits. It analyzes public reports, highlighting MA growth, SDOH activities, and plan initiatives. -
Medicare Advantage Plan Growth in Rural America: Availability of Supplemental Benefits
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2024
This policy brief compares availability of Medicare Advantage plans providing supplemental health-related benefits and special supplemental benefits for the chronically ill in metropolitan, micropolitan, and noncore counties. -
Nursing Home Closures and Access to Post-Acute Care and Long-Term Care Services in Rural Areas
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 01/2024
Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. In this study, researchers estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures.
2023
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Medicare Advantage Enrollment Update 2023
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 11/2023
This policy brief continues RUPRI Center's annual update of Medicare Advantage (MA) enrollment including the changes in enrollment in types of MA plans, and health policy changes that may have had an impact. -
Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2023
This brief identifies patterns and trends in Medicare Advantage participation (penetration rates, number of plans, and enrollment), both within and across metropolitan and nonmetropolitan counties. -
Differences in the Merit-Based Incentive Payment System (MIPS) Performance of Clinicians in Metropolitan and Nonmetropolitan Counties in 2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2023
This brief describes rural clinician performance in the Merit-based Incentive Payment System in 2018, testing the supposition that they did not do as well as their urban counterparts. -
Spatial Clustering of COVID-19 Mortality Rates Across Counties and by Noncore, Micropolitan, and Metropolitan County Characteristics, December 2020–January 2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2023
This policy brief identifies spatial clusters of high COVID-19 mortality rates across counties in the United States between December 2020 and January 2021 and describes the characteristics of counties with high COVID-19 mortality rates. -
COVID-19 Vaccination Rates
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 03/2023
This rural data brief provides a longitudinal examination of completion of primary COVID-19 vaccination series in the age-eligible population in metropolitan, micropolitan, and noncore counties. -
Financial Risk Acceptance Among Rural Health Care Providers Participating in the Quality Payment Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2023
This policy brief summarizes non-metropolitan and metropolitan providers' participation in different Centers for Medicare & Medicaid Services Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. -
Changes in Service Offerings Post-System Affiliation in Rural Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 01/2023
This policy brief aims to understand the range of effects on service offerings after rural hospitals become part of, or leave, a regional or national healthcare system. -
COVID-19 Mortality Rates Across Noncore, Micropolitan, and Metropolitan Counties by Community Characteristics, December 2020-January 2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 01/2023
This policy brief examines differences in COVID-19 mortality rates across rural-urban designations and stratifications by geography, county-level sociodemographic factors, and county-level healthcare factors. -
Medicare Advantage Enrollment Update 2022
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 01/2023
The 2022 report continues the RUPRI Center's annual series of Medicare Advantage (MA) enrollment updates. In addition to tracking overall and nonmetropolitan/metropolitan enrollment, this brief also reports on changes in enrollment in types of MA plans and considers policy changes from previous years that may have impacted MA plan enrollment.
2022
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The Impact of Medicare Shared Savings Program Participation on Hospital Financial Performance: An Event-Study Analysis
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 10/2022
This study evaluated the extent to which Medicare Shared Savings Program participation affected hospital financial outcomes, including patient revenue, operating margin, different revenue source shares, and allowance and discount rate. -
Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2022
Since the 2014 implementation of Health Insurance Marketplaces (HIMs), considerable changes have been observed in the number of insurance companies offering plans across the United States. This policy brief describes changes in HIM plan issuers over the 2014-2022 period with an emphasis on variation across metropolitan and non-metropolitan places. -
Medicare Beneficiary Access to Prescription Drugs in Rural Areas
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2022
Declines in the number of retail pharmacies in rural areas have raised concerns about beneficiary access to prescription medications when their local pharmacy closes. The purpose of this policy brief is to identify the types of pharmacies used by beneficiaries in rural areas with limited or no access to local pharmacies. -
Rural and Urban Pharmacy Presence – Pharmacy Deserts
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2022
This policy brief continues the RUPRI Center's ongoing examination of the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e. pharmacy deserts) based on metropolitan/nonmetropolitan locations. -
Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2022
Independently owned retail pharmacies in rural areas experienced a higher rate of closure than micropolitan and metropolitan areas. Closures have raised concerns about access to prescription medications as well as pharmacist-provided primary care services, which are often the sole source in rural areas for obtaining health services. -
Nursing Homes in Rural America: A Chartbook
Chartbook
RUPRI Center for Rural Health Policy Analysis
Date: 07/2022
Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties. -
Medicare Accountable Care Organization Characteristics Associated With Participation in 2‐Sided Risk
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2022
This study examined the associations of accountable care organization (ACO) characteristics with the likelihood of participation in 2-sided risk tracks in the Medicare Shared Savings Program. Small and rural ACOs were found to be less prepared to transition into 2-sided risk tracks than their urban counterparts.
2021
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Using CPT Charges as an Economic Proxy for Telehealth and Non-Telehealth Emergency Department Utilization
Policy Brief
Rural Telehealth Research Center
Date: 11/2021
This brief examines economic data on emergency department visits from unrelated rural hospitals. By using the reported Current Procedural Terminology code and associated charge, we explore the characteristics of the resulting dataset in terms of distribution and association with related variables. -
COVID-19 Cases and Vaccination Rates
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 09/2021
This data brief examines the relationship between vaccination rates, COVID-19 one-week incidence and metropolitan/nonmetropolitan location. Additional information is provided for Census regions and individual states. -
Medicare Advantage Enrollment Update 2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 09/2021
The RUPRI Center's annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. However, between 2020 and 2021 the rate of growth in nonmetropolitan counties was more than twice as large as that in metropolitan counties. -
Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2021
This data brief shows the spread of COVID-19 confirmed cases across the U.S., highlighting metropolitan and nonmetropolitan counties with confirmed cases of, and deaths from, COVID-19. -
County-Level 14-Day COVID-19 Case Trajectories
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2021
Many locations in the U.S. are relaxing their community-level COVID-19 mitigation measures. But one of the key "gating" indicators for doing this is a downward trajectory of new cases during a 14-day period. The rural data brief examines county-level 14-day trajectories for new confirmed COVID-19 cases. -
COVID-19 Cases and Deaths, Metropolitan and Nonmetropolitan Counties Over Time (Update)
Report
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2021
This data brief compares seven-day moving average COVID-19 incidence and mortality rates between metropolitan, micropolitan, and noncore counties in the U.S. The brief is updated twice a month. -
Medicare Advantage Enrollment Update 2020
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 05/2021
This annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. The percent of nonmetropolitan MA enrollees in Health Maintenance Organization (HMO) plans has increased every year since 2017. Metropolitan HMO enrollment has decreased every year since 2016. -
Availability of Supplemental Benefits in Medicare Advantage Plans in Rural and Urban Areas
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
This brief identifies differences in Medicare Advantage (MA) plans that include supplemental benefits available to rural and urban enrollees. By better understanding the variation in MA plan offerings across the country, policymakers can take appropriate action to improve the value of plans available in rural regions. -
Pharmacy Vaccination Service Availability in Nonmetropolitan Counties
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 02/2021
Pharmacies will play a role in administering the COVID-19 vaccination to the general public. But there are many rural locations in the U.S. where pharmacy resources are limited. This rural data brief examines the availability of pharmacies capable of delivering COVID-19 vaccinations in nonmetropolitan areas. -
Trends in Nursing Home Closures in Metropolitan and Nonmetropolitan Counties in the United States, 2008-2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
Nursing home closures have raised concerns about access to long-term services and supports in rural areas. This study examines trends in closures and characteristics of open and closed nursing homes in metropolitan and nonmetropolitan counties. Furthermore, this study identifies metropolitan and nonmetropolitan counties without any nursing homes. -
HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-Site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks
Journal Article
Rural Telehealth Research Center
Date: 01/2021
The Health Resources and Services Administration funded six grantees to provide telehealth services in rural emergency departments (tele-ED) and gather data for the telehealth evidence base. This paper examines trends across multiple tele-ED networks and heterogeneity in processes and outcomes.
2020
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Medicare Advantage Enrollment Update 2019
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 10/2020
The annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. However, the rate of growth has been higher in nonmetropolitan counties for the past two years. Local Preferred Provider Organization plans account for nearly half of nonmetropolitan MA enrollment. -
Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six Networks
Journal Article
Rural Telehealth Research Center
Date: 08/2020
In a cohort of 4,324 tele-ED cases across 26 months in 65 hospitals in 6 tele-ED networks, 20% were averted transfers, and 43% of those were then routinely discharged rather than being transferred. Averted transfers saved on average $2,673 in avoidable transport costs per patient, with 63.6% of these cost savings accruing to public insurance. -
Telepharmacy Rules and Statutes: A 3-Year Update for All 50 States
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 07/2020
This policy brief analyzed administrative rules and legislative statutes governing each state's pharmacy practice. Key features of telepharmacy regulations were investigated for comparative analysis. Twenty-one states currently authorize retail telepharmacy, but between these states the regulatory activity varies considerably. -
Process of Identifying Measures and Data Elements for the HRSA School-Based Telehealth Network Grant Program
Policy Brief
Rural Telehealth Research Center
Date: 06/2020
This brief details work to identify measures and develop data elements appropriate to school-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration's School-Based Telehealth Network Grant Program. -
Access to Medicare Part D Plans: A Comparison of Metropolitan and Nonmetropolitan Areas
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2020
This policy brief updates previous reports on rural activity in the Medicare Part D program. Comparisons are made across county type, within type of Part D plan (standalone and part of Medicare Advantage plans), and between the types of plans within county classifications. -
Considerations for Defining Rural Places in Health Policies and Programs
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 05/2020
Rural definitions in statute and policy are used to direct resources to underserved people. But changes in population behavior and census processes have led to concern about historic methods of defining rural. This paper identifies key questions, reviews rural definitions, and discusses options for reconsidering rural definitions. -
Metropolitan/Nonmetropolitan COVID-19 Confirmed Cases and General and ICU Beds
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2020
The spread of COVID-19 across rural areas has fueled concern about the availability of healthcare resources for dealing with the pandemic. This brief looks at a single measure of healthcare resources – hospital beds – and reports of current COVID-19 cases in a single week to assess the impact on rural facilities. -
Health Care Professional Workforce Composition Before and After Rural Hospital Closure
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2020
This policy brief examines the composition of the local healthcare workforce before and after rural hospital closure to reveal any associations with discontinuation of inpatient services in rural communities. -
Measure and Data Element Identification for the HRSA Evidence-Based Tele-Behavioral Health Network Program and the HRSA Substance Abuse Treatment Telehealth Network Grant Program
Policy Brief
Rural Telehealth Research Center
Date: 04/2020
This brief details work to identify measures and develop data elements appropriate to tele-behavioral health, create an Excel-based tool, and collect data from grantees in the Health Resources and Services Administration's Evidence-Based Tele-Behavioral Health Network Grant Program and Substance Abuse Treatment Telehealth Network Grant Program. -
Rural Hospital Participation in Medicare Accountable Care Organizations
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2020
This policy brief summarizes national and regional rates of rural hospital participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs) and identifies factors associated with ACO participation. -
Identifying Measures and Data Elements for the HRSA Evidence-Based Tele-Emergency Network Grant Program
Policy Brief
Rural Telehealth Research Center
Date: 03/2020
This brief details multi-project work to identify measures and develop data elements appropriate to emergency department-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration Evidence-Based Tele-Emergency Network Grant Program. -
Emergency Department Telemedicine Consults Are Associated With Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients
Journal Article
Rural Telehealth Research Center
Date: 02/2020
Acute myocardial infarction (AMI) is a common, deadly emergency requiring rapid diagnosis and treatment. In this rural cohort, emergency department-based telemedicine was associated with improved timeliness of electrocardiogram and fibrinolysis. This study adds to evidence that telemedicine can improve timeliness of AMI care in rural hospitals. -
Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments
Journal Article
Rural Telehealth Research Center
Date: 01/2020
Sepsis is a life-threatening emergency, and timely "bundled" care improves survival. In this rural cohort, telemedicine in the emergency department (tele-ED) improved sepsis bundle adherence, including timely fluid resuscitation and antibiotic administration. Tele-ED may be a scalable intervention to improve sepsis emergency care in rural EDs.
2019
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Impact of the Medicare Disproportionate Share Hospital Payment Cap on Urban and Rural Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 12/2019
The Medicare Disproportionate Share Hospital payment adjustment is intended to compensate hospitals serving a disproportionate number of low-income patients. This policy brief describes the number and location of urban and rural hospitals affected by a 12% payment cap established by the Medicare Modernization Act of 2003. -
Strategic Choice in Developing Telemedicine - Observations From Three Organizations
Report
RUPRI Center for Rural Health Policy Analysis
Date: 12/2019
Advances in technology have made it easier to provide telemedicine services, but the actual value of telemedicine programs for health systems providing those services or for patients has not been firmly established. This paper explores organizational motivations of three large health systems for incorporating telemedicine patient care services. -
Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort
Journal Article
Rural Telehealth Research Center
Date: 11/2019
This was a study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication. The effect of tele-ED varied by network, suggesting network characteristics may influence the realized tele-ED benefit for stroke care. -
Medicare Advantage Enrollment Update 2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2019
This annual report on Medicare Advantage (MA) enrollment shows growth in the program in nonmetropolitan and metropolitan areas. The rate of metro enrollment is higher than in nonmetro areas, but the growth rate in the nonmetropolitan population is higher. There are also significant differences in metro/nonmetro MA enrollment by plan type. -
Pediatric Tele-Emergency Care: A Study of Two Delivery Models
Journal Article
Rural Telehealth Research Center
Date: 04/2019
This study describes two tele-emergency programs that provide care to pediatric populations. Qualitative descriptions of the two tele-emergency department (ED) models and key characteristics of the patient populations served by tele-ED are presented. The study informs others about evaluative measures and how tele-ED works in practice. -
Primary Care Clinician Participation in the CMS Quality Payment
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2019
Approximately 10% of primary care clinicians participate in Advanced Alternative Payment Models (A-APMs) and less than 30% of primary care clinicians participate in the Merit-Based Incentive Payment System. Metropolitan primary care clinicians are more likely to participate in A-APMs than nonmetropolitan primary care clinicians.
2018
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Changes to the Merit-Based Incentive Payment System Pertinent to Small and Rural Practices, 2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
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. -
The Rural Hospital and Health System Affiliation Landscape – A Brief Review
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
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. -
Trends in Hospital System Affiliation, 2007-2016
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
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. -
Spread of Medicare Accountable Care Organizations in Rural America
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2018
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. -
Organizational Attributes Associated With Medicare ACO Quality Performance
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 07/2018
Peer-reviewed paper evaluating associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance. -
Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 07/2018
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. -
Organizational Attributes With Medicare ACO Quality Performance
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2018
Cross-sectional and longitudinal analyses of Medicare Shared Savings Program Accountable Care Organizations' (ACOs') quality performance found rural ACOs' score was comparable to those in other categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher post-hospitalization follow-up rates had better performance. -
Telepharmacy Rules and Statutes: A 50-State Survey (Journal Article)
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2018
Peer-reviewed paper identifying state-enacted regulations and legislation authorizing use of community telepharmacy initiatives and describing implications for patients in underserved rural communities. Also provides a table listing states that permit telepharmacy, and pilot programs and waivers that enable telepharmacy initiatives. -
Medicare Accountable Care Organization Growth in Rural America, 2014-2016
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2018
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.
2017
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Rural-Urban Enrollment in Part D Prescription Drug Plans: June 2017 Update
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 12/2017
As of June 2017, the percentage of rural enrollment in Part D plans, which include stand-alone prescription drug plans (PDPs) and Medicare Advantage with Prescription Drug (MA-PD) plans, lags urban enrollment despite significant growth overall in the number of Medicare beneficiaries with prescription drug coverage through Medicare Part D plans. -
Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2017
This policy brief provides information about the potential impact of scheduled changes in Medicaid Disproportionate Share Hospital (DSH) payment on hospitals in 47 states. We expect variation across states, because of differences in state policies allocating DSH payments, as well as geographic variation by census region. -
Financial Issues Challenging Sustainability of Rural Pharmacies
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 08/2017
Findings from a survey of rural lone community retail pharmacies about issues perceived as a threat to their sustainability. Reimbursement issues were cited as being most immediate and of highest magnitude. -
Medicare Advantage Enrollment Update 2017
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2017
Reports on the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) plans and other prepaid enrollment plans. Compares national and rural MA enrollment, and variability by state. -
Issues Confronting Rural Pharmacies After a Decade of Medicare Part D
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2017
This brief reports on a survey of very rural independent pharmacies designed to assess threats to their sustainability. Major, immediate issues included delays in updates to maximum allowable costs (MACS), charges for remuneration fees, competition from mail order pharmacies; and, status as a "non-preferred pharmacy" for Medicare Part D plans. -
Telepharmacy Rules and Statutes: A 50-State Survey
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2017
This is summary analysis reviews administrative rules and legislative statutes governing the practice of telepharmacy in all 50 states. Telepharmacy is specifically authorized in 23 states and 16 states have no rules or legislation authorizing telepharmacy. Other states have pilot programs or waivers that would enable telepharmacy.
2016
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Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2016
Provides an analysis of the differences in Accountable Care Organization (ACO) performance on the quality measures among the Medicare Shared Saving Program ACOs with varying levels of rural presence. Findings suggest that ACOs with significant rural presence have performed as well as, if not better than, urban ACOs in delivering quality care. -
Spread of Accountable Care Organizations in Rural America
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 10/2016
This brief updates a RUPRI Center analysis of the presence of Medicare Accountable Care Organizations (ACOs) in rural areas of the US in 2013. Using participation data through 2015, the current brief finds that there has been broad growth in the number of places where ACO participating providers can be found, including rural locations. -
Medicare Advantage Enrollment Update 2016
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 09/2016
This annual brief examines Medicare Advantage (MA) enrollment data from March 2015 and March 2016. It shows that enrollment in MA and other prepaid plans increased, both nationally and in non-metropolitan areas, but the rate of growth has slowed compared to previous years. -
Financial Performance of Rural Medicare ACOs
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 08/2016
Assesses the financial performances of rural accountable care organizations (ACOs) based on different levels of rural presence. -
Medicare Accountable Care Organizations: Beneficiary Assignment Update
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2016
This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services Accountable Care Organization regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Understanding ACO beneficiary assignment policies is dire in managing ACO providers and beneficiaries. -
Variation in Primary Care Service Patterns by Rural-Urban Location
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 03/2016
Examines primary care physician service patterns by rural-urban location and discusses effect on recruitment strategies for primary care providers in rural communities. -
Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 02/2016
Examines how Critical Access Hospitals perform compared to Prospective Payment System hospitals on measures of quality.
2015
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Rural Bypass for Elective Surgeries
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 11/2015
Describes the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distribution of volume among Critical Access Hospitals (CAHs) that offer elective surgical services, and factors predictive of bypass. -
Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs With Rural Presence
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2015
In this policy brief, we present the findings of a survey of 27 rural accountable care organizations, focusing on characteristics important to their formation and operation. -
Characteristics of Rural Communities With a Sole, Independently Owned Pharmacy
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2015
This brief describes the populations of rural communities with single independently owned pharmacies. About 2.7 million people, more than 25% of whom live below the poverty level, live in 663 rural communities with sole independently owned pharmacies. For about 70% of these rural communities, the next closest pharmacy is more than 10 miles away. -
A Rural Taxonomy of Population and Health-Resource Characteristics
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2015
This brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics and discusses how this classification tool can be utilized by policymakers and rural communities. -
Developmental Strategies and Challenges for Rural Accountable Care Organizations
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2015
This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs. -
Surgical Services in Critical Access Hospitals, 2011
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2015
This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
2014
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The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 07/2014
This policy brief describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices portion of the Medicare Physician Fee Schedule on rural primary care providers' practice revenue from Medicare. -
Facilitating the Formation of Accountable Care Organizations in Rural Areas
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 07/2014
This brief shows characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions. The findings can help rural providers interested in forming/participating in an ACO assess the status and potential gaps of their core structures and capabilities. -
Update: Independently Owned Pharmacy Closures in Rural America
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2014
This brief examines the closure of independently owned rural pharmacies in the United States from 2003 to 2013 and its effects on rural Americans' access to medications and other pharmacy services. This report is an update to past publications from RUPRI. -
Extent of Telehealth Use in Rural and Urban Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2014
This brief provides discussion with statistics on the use of telehealth in rural hospitals and the opportunities telehealth can bring to supporting healthcare in rural communities. -
Trends in Hospital Network Participation and System Affiliation, 2007-2012
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 2014
Network participation and system affiliation are two ways for hospitals to build and/or access necessary capacities to engage in the transformation to an integrated, patient-centered, pay-for-value care delivery model. This brief tracks trends in network participation and system affiliation among U.S. general community hospitals from 2007 to 2012.
2013
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Assessing the Impact of Rural Provider Service Mix on the Primary Care Incentive Payment Program
RUPRI Center for Rural Health Policy Analysis
Date: 12/2013
Under the Primary Care Incentive Payment Program (PCIP), if certain evaluation and management services represented 60% or more of Medicare allowable charges, the provider qualified for a 10% bonus calculated on the primary care portion of allowable charges. This brief assesses the impact of the rural provider service mix on the PCIP. -
Demographic and Economic Characteristics Associated With Sole County Pharmacy Closures, 2006-2010
RUPRI Center for Rural Health Policy Analysis
Date: 11/2013
This policy brief describes demographic and economic characteristics associated with counties experiencing closure of their sole pharmacy. -
Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study
RUPRI Center for Rural Health Policy Analysis
Date: 08/2013
This policy brief identifies factors that contributed to the closing of six rural pharmacies in various states and describes how the affected communities adapted to losing locally based services. -
The Frontier Extended Stay Clinic Model: A Potential Health Care Delivery Alternative for Small Rural Communities
RUPRI Center for Rural Health Policy Analysis
Date: 08/2013
This policy brief describes how the Frontier Extended Stay Clinic model may be appropriate in rural communities beyond the five original demonstration sites. -
Accountable Care Organizations in Rural America
RUPRI Center for Rural Health Policy Analysis
Date: 07/2013
This policy brief reports that Medicare Accountable Care Organizations currently operate in 16.7% of all U.S. non-metropolitan counties. -
Rural Implications of the Primary Care Incentive Payment Program
RUPRI Center for Rural Health Policy Analysis
Date: 06/2013
This policy brief reports on eligibility among rural primary care providers for the Primary Care Incentive Payments established in the Patient Protection and Affordable Care Act. -
Rural Pharmacy Closures: Implications for Rural Communities
RUPRI Center for Rural Health Policy Analysis
Date: 01/2013
This study documents the closure of local retail pharmacies in which the pharmacist was the only clinical provider available in the community at the time the pharmacy closed. This brief describes the characteristics of the communities and retail pharmacies in question. -
Are Primary Care Practices Ready to Become Patient-Centered Medical Homes?
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 2013
Measures the readiness of rural primary care practices to be eligible as patient-centered medical homes (PCMHs) by comparing PCMH readiness scores with metropolitan and nonmetropolitan primary care practices.
2012
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Stand-Alone Prescription Drug Plans Dominated the Rural Market in 2011
RUPRI Center for Rural Health Policy Analysis
Date: 09/2012
This report shows that as of May 2011, 59.1% of rural Medicare beneficiaries were enrolled in Medicare Part D through insurance plans that provide coverage for prescription medications. It also provides further detail, including urban and rural enrollment by type of plan and by state.
2011
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Patient-Centered Medical Home Services in 29 Rural Primary Care Practices: A Work in Progress
RUPRI Center for Rural Health Policy Analysis
Date: 09/2011
This brief discusses responses from 29 rural physician practices. When asked about the use of specific policies/procedures included as criteria to certify patient-centered medical homes, fewer of them would qualify in each of five domains, including access to care, population-based, quality, care management, and clinical information management. -
Use of Health Information Technology in Support of Patient-Centered Medical Homes Is Low Among Non-Metropolitan Family Medicine Practices
RUPRI Center for Rural Health Policy Analysis
Date: 04/2011
Are physician practices, especially non-metropolitan primary care practices, ready to become patient-centered medical homes? We use a nationwide survey of physician practices to partially answer this question, focusing on the use of health information technology.
2009
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Loss of Community Pharmacies Since 2006: State Experiences
RUPRI Center for Rural Health Policy Analysis
Date: 04/2009
This brief presents the latest data from a continuous monitoring of the status of rural pharmacies by the RUPRI Center. The brief includes a table showing the data by state.
2008
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Independently Owned Pharmacy Closures in Rural America
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 07/2008
This brief focuses on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community.