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


Completed Projects - (1)

  • 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

Publications - (36)

  • 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.
  • Are Primary Care Practices Ready to Become Patient-Centered Medical Homes?
    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 (PCHMs) by comparing PCHM readiness scores with metropolitan and nonmetropolitan primary care practices.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Financial Issues Challenging Sustainability of Rural Pharmacies
    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.
  • Financial Performance of Rural Medicare ACOs
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2016
    Assesses the financial performances of rural accountable care organizations based on different levels of rural presence.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2016
    This brief provides an analysis of the differences in ACO performance on the quality measures among the Medicare Shared Saving Program (MSSP) ACOs with varying levels of rural presence. Findings suggest that ACOs with a significant rural presence have performed as well as, if not better than, urban ACOs in delivering quality care.
  • 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.
  • 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.
  • 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.
  • Rural Bypass for Elective Surgeries
    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 CAHs that offer elective surgical services, and factors predictive of bypass.
  • 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.
  • 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.
  • Spread of Accountable Care Organizations in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2016
    This policy brief updates a RUPRI Center analysis of the presence of Medicare ACO’s in rural areas of the United States 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.
  • 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.
  • Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
    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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Using Tele-emergency to Avoid Patient Transfers in Rural Emergency Departments: An Assessment of Costs and Benefits
    Rural Telehealth Research Center
    Date: 03/2017
    Findings on the financial impact and other benefits of using tele-emergency to avoid patient transfers are explored. Conclusions include that factoring in the cost of tele-emergency, it still saves nearly $4,000 in transportation and indirect patient costs.
  • Variation in Primary Care Service Patterns by Rural-Urban Location
    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.