Ira Moscovice, PhD

Director, University of Minnesota Rural Health Research Center

Phone: 612.624.8618
Fax: 612.624.2196
Email: mosco001@umn.edu

Rural Health Research Center
University of Minnesota
Division of Health Policy and Management
420 Delaware Street SE, MMC 729
Minneapolis, MN 55455


Current Projects - (2)

Measuring the Quality of Swing-Bed Care in Critical Access Hospitals
This project will identify quality measures to be used by Critical Access Hospitals to assess the quality of care provided to their swing-bed patients, and recommend appropriate uses of the measures.
Research center: University of Minnesota Rural Health Research Center
Topics: Hospitals and clinics, Quality
Rural Implications of Quality-Based Physician Payment Reform
The purpose of this project is to assess existing national data about the quality of care provided by rural physicians, and to determine what additional information will be needed as CMS moves towards inclusion of all physicians in payment reforms based on quality.
Research center: University of Minnesota Rural Health Research Center
Topics: Physicians, Quality

Completed Projects - (45)

Affordable Care Act Outreach and Enrollment: Case Studies of Rural Hospitals in Four States
The purpose of this project is to identify best practices used by rural hospitals to educate uninsured rural patients and consumers about available health insurance coverage options and to assist them in enrolling in a Qualified Health Plan or Medicaid.
Research center: University of Minnesota Rural Health Research Center
Topics: Health insurance and the uninsured, Hospitals and clinics, Medicaid and S-CHIP
Analysis of Critical Access Hospital Inpatient Hospitalizations and Transfers from CAHs to Other Acute and Post-Acute Care Settings Using State Inpatient Databases
The purpose of this project is to analyze Critical Access Hospital (CAH) inpatient hospitalizations and transfers from CAHs in order to help inform the development of quality indicators for CAHs, especially quality indicators focused on the transfer process.
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality, Technology
Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services
This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided.
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services, Healthcare financing, Networking and collaboration
Are Part D Plans Meeting the Needs of Rural Medicare Beneficiaries?
The purpose of this project is to assess whether the Medicare Part D prescription drug plans available in rural counties are sufficient to meet the needs of rural Medicare beneficiaries.
Research center: University of Minnesota Rural Health Research Center
Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
Assessing Pent-Up Demand for Rural Medicare Beneficiaries
The purpose of this project is to estimate the amount of pent-up demand of rural Medicare beneficiaries who enter risk plans.
Research center: University of Minnesota Rural Health Research Center
Topic: Medicare
Assessing the Rural Relevance of Hospital Outpatient Quality Measures
The purpose of this project is to: 1) determine the diagnoses that are most commonly treated and the procedures most commonly performed in rural hospital outpatient settings; and 2) to evaluate the rural relevance of the proposed new CMS outpatient quality measures and other potential outpatient quality measures.
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Quality
Beyond Simple Ranking: Identifying and Empirically Testing Alternative Approaches for Recognizing Quality in Rural Hospitals
The purpose of this project is to explore several alternative methods for assessing the relative quality of hospitals using data from the Hospital Quality Incentive Demonstration Project and Hospital Compare.
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Quality
Critical Access Hospital Participation in the Hospital Quality Alliance and Initial Quality Measure Results
This project examined 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 presented 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.
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
Critical Access Hospital Readiness for CMS Value-Based Purchasing
The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals.
Research center: Upper Midwest Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Healthcare financing, Quality
Developing a Quality Performance Measurement System for Critical Access Hospitals
This project continues to support activities related to quality performance measurement relevant for Critical Access Hospitals. By the end of 2005, the technical expert panel had reviewed the findings of the initial field test of the small rural hospital quality measure set and made recommendations for revisions.
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
Developing Quality Measures and Communication Strategies for Rural Patient Transfers
The purpose of this project is to quantify the complexity of the coordination of patient care in rural health care systems and to expand our work on developing quality measures for rural patients whose care is transferred between providers.
Research center: Upper Midwest Rural Health Research Center
Topic: Quality
Developing Relevant Quality Indicators for Rural Hospitals
Research center: University of Minnesota Rural Health Research Center
Topics: Hospitals and clinics, Quality
Effect of Type and Timeliness of Post-Acute Care on Preventable Hospital Readmissions for Rural Medicare Beneficiaries
The purpose of this project is to: 1) determine how location of hospitals used for initial admissions by rural patients affects readmission rates; 2) assess how the use of swing beds affects rural patients' readmissions; and 3) examine the impact of the type and timeliness of post-acute care, including home health care, skilled nursing, and physician visits, on readmissions for rural patients.
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Medicare
Federal Rural Health Outreach Grant Program: The Impact and Sustainability of Grantees
Research center: University of Minnesota Rural Health Research Center
Topics: Health services, Networking and collaboration
Has the Medicare Part D Program Improved Medication Access and the Health Status of Rural Beneficiaries?
This project will use Medicare Current Beneficiary Survey data to assess the impact of the Medicare Part D Program on medication access and the health status of rural Medicare beneficiaries.
Research center: University of Minnesota Rural Health Research Center
Topics: Medicare Advantage (MA), Medicare Part D, Pharmacy and prescription drugs
Health Information Technology and Quality in Rural Hospitals
The purpose of this project is to: 1) examine the adoption of health information technology (HIT) among rural hospitals and identify hospital and market characteristics that facilitate or impede HIT diffusion; 2) measure the effect of HIT on clinical quality in rural hospitals; and 3) identify technologies that may be promoted to improve quality of care in rural areas.
Research center: Upper Midwest Rural Health Research Center
Topics: Health information technology, Hospitals and clinics, Quality
High Quality Rural Hospitals and Post-Acute Care Providers
This project will use several large longitudinal national databases to model alternative ways of identifying high quality rural hospitals, analyze factors related to quality in rural hospitals, and examine the relationship between the quality of care provided by rural hospitals and the quality of care provided by nursing homes and home health agencies within rural communities.
Research center: University of Minnesota Rural Health Research Center
Topics: Hospitals and clinics, Quality
Hospitalizations of Rural Children for Ambulatory Care Sensitive Conditions
This project uses state inpatient discharge data from six states, data from the Area Resource File and the AHRQ Pediatric Quality Indicators to examine Ambulatory Care Sensitive Condition admission rates for rural children.
Research center: Upper Midwest Rural Health Research Center
Topics: Children, Chronic diseases and conditions
Identifying Adverse Drug Events and Improving Patient Safety in Rural Hospitals
This study identifies rates of adverse drug events (ADEs) and opportunities to improve patient safety in Critical Access Hospitals (CAHs) and non‐CAH rural hospitals.
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Hospitals and clinics, Pharmacy and prescription drugs, Quality
Impact of Expansion of Ambulatory Surgery Centers on Rural Hospitals and Communities
This project will examine the extent of freestanding ambulatory surgery center (ASC) expansion into rural communities between 1998 and 2005, the market factors driving that expansion, and the impact of ASCs on the operational and financial viability of rural hospitals located in the same communities.
Research center: Upper Midwest Rural Health Research Center
Topics: Health services, Healthcare financing
Impact of Health Insurance Coverage on Native Elder Health: Implications for Addressing the Health Care Needs of Rural American Indian Elders
This project examined the types of health insurance coverage of rural Native American elders ages 55 and older, and examine how different types of health insurance coverage and lack of health insurance coverage impact access to health care services among Native American elders by geographic location (rural frontier, rural non-frontier and urban).
Research center: Upper Midwest Rural Health Research Center
Topics: Aging, American Indians and Alaska Natives, Frontier health, Health insurance and the uninsured, Minority health, Rural statistics and demographics
Impact of Hospitalists on Inpatient and Primary Care in Rural Communities
This project will analyze primary data from a survey of rural hospitals about their use of hospitalists along with several sources of secondary data to examine why and how hospitalists are being used in rural hospitals and the impact of their use.
Research center: Upper Midwest Rural Health Research Center
Topic: Hospitals and clinics
Impact of Private Sector Quality Initiatives on Rural Providers and Patients
The purpose of this project is to assess the impact of private sector quality reporting and quality improvement initiatives on rural providers and on the quality of care provided to rural patients.
Research center: University of Minnesota Rural Health Research Center
Topic: Quality
Impact of the CMS Value-Based Purchasing and Readmission Reduction Programs on Rural Hospitals
The purpose of this project is to assess the initial impacts of the Value-Based Purchasing (VBP) and Readmission Reduction Programs on rural Prospective Payment System (PPS) hospitals.
Research center: University of Minnesota Rural Health Research Center
Topic: Hospitals and clinics
Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
The purpose of this project is to describe successful telepharmacy activities and to analyze policy issues related to the implementation of telepharmacy projects in rural hospitals. These policy issues include the potential impact of telepharmacy use on the quality of pharmaceutical services and medication safety for rural patients.
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Telehealth
Measuring Quality Performance in CAHs
The purpose of the project is to update our previous analyses of CAH participation in Hospital Compare, analyze trends over time, and explore additional sources of quality data for CAHs.
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
National Rural Hospital Flexibility Program Tracking Project: Analysis of CAH Quality Improvement (QI) Strategies
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
National Rural Hospital Flexibility Program Tracking Project: Analysis of the Financial Impact of Conversion on Critical Access Hospitals (CAHs) and the Medicare Program
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Healthcare financing
Nursing Workforce Impact on Rural Hospital Performance Improvement in the Hospital Quality Incentive Demonstration Project
The purpose of this project is to examine the impact of nurse staffing on hospital performance improvement in the CMS/premier Inc. Hospital Quality Incentive Demonstration project with specific interest in whether and how this relationship differs in rural hospitals as compared to urban hospitals.
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Quality, Workforce
Obstetric Care Practice Models and Quality in Rural Hospitals
The project will examine current obstetric practice models in rural hospitals and assess the prospects for implementation of new policy recommendations for reducing primary cesarean rates and non-medically indicated inductions of labor in rural hospitals.
Research center: University of Minnesota Rural Health Research Center
Topics: Maternal and child health, Quality
Patient Assessments and Quality of Care in Rural Hospitals
This study will 1)analyze the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care; and 2) assess whether rural patients' perspectives of hospital quality of care are related to quality measures focused on the provision of recommended care for medical conditions.
Research center: Upper Midwest Rural Health Research Center
Topics: Health services, Quality
Pay-for-Performance and Quality Improvement in Rural Hospitals
This project will estimate the impact on rural hospitals in the U.S. of a pay-for-performance (PFP) program similar to the CMS-sponsored Premier, Inc. Hospital Quality Incentive Demonstration; synthesize the major factors that will influence the inclusion of rural hospitals in PFP programs; and make recommendations for the design of PFP programs that will appropriately reward rural hospitals for improving quality.
Research center: Upper Midwest Rural Health Research Center
Topics: Healthcare financing, Hospitals and clinics, Quality
Preventing Errors in Rural Hospitals
Research center: University of Minnesota Rural Health Research Center
Topics: Hospitals and clinics, Quality
Progress Toward Meaningful Use of Health Information Technology Among Rural Physician Practices
This project will assess progress toward the meaningful use of health information technology among rural physician practices, using several sources of data. This empirical analysis will be supplemented by a qualitative assessment of rural physician practices' experiences with the meaningful use of health IT, working with two quality improvement organizations (QIOs)/Regional Extension Centers (RECs).
Research center: University of Minnesota Rural Health Research Center
Topics: Health information technology, Physicians
Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
The purpose of this project is to continue to investigate the relationship between CAH financial performance and quality of care. UMN and UNC will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses.
Research centers: North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Healthcare financing, Quality
Quality Measures and Sociodemographic Risk Factors: The Rural Environmental Context
For three acute care conditions/diagnoses (potential examples include diabetes, congestive heart failure, COPD), this study will (1) identify the key socio-demographic variables that may affect quality adjustment for rural populations/providers; (2) identify data sources/strategies available for the above variables; and (3) identify the quality measures (e.g. readmission rates) that should be adjusted for socio-demographic variables for rural populations/providers and estimate the potential impact of those adjustments on quality measurement.
Research center: University of Minnesota Rural Health Research Center
Topics: Quality, Rural statistics and demographics
Role of Rural Hospitals in Community-Centered Systems of Care: Supporting Population Health Improvement for Rural Communities
This project will assess the degree to which rural hospitals engage in activities that facilitate community responsiveness and the provision of community-oriented services, using 1996 to 2004 data from the American Hospital Association Annual Survey and the Area Resource File.
Research center: Upper Midwest Rural Health Research Center
Topics: Health services, Hospitals and clinics
Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas
This project will describe emergency department (ED) staffing patterns in rural hospitals; determine how the certification, training, and experience of ED physicians and other providers in different ED staffing models vary; and assess the implications of rural ED staffing for the quality of emergency care in rural areas, continuity of care, and rural EDs' role as safety net providers.
Research center: Upper Midwest Rural Health Research Center
Topics: Emergency medical services (EMS), Hospitals and clinics, Quality, Workforce
Rural Hospital Flexibility Performance Monitoring Project- Grant Years 2003-2008
Under contract with the federal Office of Rural Health Policy, the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine are cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program). The monitoring project will assess the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development.
Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
Rural Hospital Obstetric Workforce, Procedure Utilization, and Quality of Care
This study examines the relationships between key aspects of the obstetric workforce in rural hospitals and procedure intensity and quality of maternity care in those hospitals.
Research center: University of Minnesota Rural Health Research Center
Topics: Maternal and child health, Quality, Women, Workforce
Rural Implications of Health Care Reform: Issues Related to Quality of Care, Health Information Technology and Care Coordination
The purpose of this project is to provide support to the Office of Rural Health Policy on rural health care reform issues.
Research center: Upper Midwest Rural Health Research Center
Topics: Health policy, Health services
Rural Women Giving Birth in Non-Local Hospitals: Implications for Obstetric Access and Quality
The purpose of this project is to: 1) analyze recent data from nine geographically diverse states on delivery by rural women at non-local hospitals; 2) characterize the roles of medical vs. non-medical factors in delivery at a non-local hospital by identifying lower-risk and higher-risk women using established criteria; and 3) analyze the relationship between delivery at a non-local hospital and obstetric quality.
Research center: University of Minnesota Rural Health Research Center
Topics: Hospitals and clinics, Quality, Women
Rural-Urban Differences in Insurer Participation, Premiums, Health Plan Provider Networks in Federal and State Marketplaces
This two-year project will: 1) measure rural-urban differences in the size, scope, and composition of provider networks affiliated with Marketplace plans; 2) analyze the relationships between provider network size and composition, other benefit design attributes, geographic rating area designations, and premiums; and 3) examine how rural and urban Marketplace-based plan enrollment is affected by plan availability and provider network size and scope.
Research center: University of Minnesota Rural Health Research Center
Topic: Health insurance and the uninsured
Successful Implementation of Medication Safety Initiatives in Rural Hospitals: The Role of Pharmacists and Technology
This project will assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, and will identify factors that facilitate successful implementation of medication safety practices in rural hospitals.
Research center: Upper Midwest Rural Health Research Center
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
What Constitutes An Adequate Provider Network For Rural Health Populations?
The purpose of this study is to develop norms/standards for provider network adequacy for rural populations (which may vary across different rural environments) that will be useful to consumers, providers, and policymakers in the decisions they face with respect to health plan choices, participation, and policies.
Research center: University of Minnesota Rural Health Research Center
Topic: Health insurance and the uninsured

Publications - (72)

  • 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.
  • 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.
  • Birth Volume and the Quality of Care in Rural Hospitals
    University of Minnesota Rural Health Research Center
    Date: 2014
    Evaluates obstetric care quality in low-, medium-, and high-volume areas by using hospital discharge data.
  • 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.
  • Care Transitions: "Time to Come Home"
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 03/2011

    Examines care coordination with a focus on the transitions from inpatient care back to the rural community and suggests ways of measuring the quality of care coordination on discharge from the hospital.

  • Care Transitions: "Time to Come Home" (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 03/2011
    Looks at care coordination for rural patients, with a focus on transitions from inpatient care back to the rural community and suggests ways of measuring the quality of care coordination on discharge from the hospital.
  • Case Studies of Regional Extension Centers Serving Rural Practices: Minnesota and North Dakota
    University of Minnesota Rural Health Research Center
    Date: 11/2013
    Focuses on the HIT Regional Extension Center serving Minnesota and North Dakota and its experiences working with rural physician practices in the two states.
  • Case Studies of Regional Extension Centers Serving Rural Practices: North Carolina
    University of Minnesota Rural Health Research Center
    Date: 11/2013
    Presents a case study focusing on the North Carolina HIT Regional Extension Center and its experience working with rural physician practices in the state.
  • Comparing Rural and Urban Medicare Part D Enrollment Patterns and Prescription Drug Coverage Rates
    University of Minnesota Rural Health Research Center
    Date: 05/2013

    Examines Medicare Part D enrollment rates in rural and urban areas and the resulting impact on rural beneficiaries' overall prescription drug coverage rates.

    Key Findings:

    • Overall Medicare Part D enrollment rates increased from 55.5% in 2006, the first year of the program, to 61.4% in 2009. Annual increases were between 1 and 5 percentage points.
    • Rural Part D enrollment rates consistently lagged behind urban rates by 2 to 4 percentage points, increasing from 53.7% in 2006 to 58.6% in 2009, compared to urban rates increasing from 56.0% to 62.3%, respectively.
    • Geographic disparities in prescription coverage have greatly diminished over time: by 2009, prescription drug coverage rates topped 90% in both rural and urban areas. Rates of continuous uninsurance are approaching all-time lows of 7% in rural areas and 4% in urban areas.
    • Independent of geographic location, there is strong evidence of less-healthy beneficiaries enrolling in the Part D program, and no evidence of the Part D program crowding out private prescription drug coverage.
  • 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.
  • 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 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.
  • 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.

    Key Findings:

    • Standalone Medicare Part D prescription drug plans (PDPs) available to beneficiaries varied little in premiums, copays, deductibles, the availability of enhanced plans, and gap coverage across urban and rural areas.
    • The average deductible and average premium for available MA-PDPs varied significantly among the three geographic areas. Urban areas had the lowest costs, followed by more-densely populated and less-densely populated rural areas.
  • Do Rural Elders Have Limited Access to Medicare Hospice Services?
    University of Minnesota Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 05/2004
    Examines whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries.
  • Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?
    University of Minnesota Rural Health Research Center
    Date: 02/2016
    Evaluates the personal experiences with choosing a Part D plan among rural residents. This study examines the geographic differences in Part D enrollees’ opinion of the plans decision-making process.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Health Information Technology Policy and Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Health information technology (HIT) is a key component of plans to reform the health care system. HIT adoption among smaller rural providers has lagged behind larger urban providers, and the vast majority of research on HIT has focused on its adoption and impact in urban institutions. This brief summarizes the implementation status of key HIT applications in Critical Access Hospitals and other rural hospitals, and discusses policies for encouraging HIT adoption in rural hospitals.

  • Hospital Size, Uncertainty and Pay-for-Performance
    Upper Midwest Rural Health Research Center
    Date: 02/2007
    Examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. Using data from the Premier Hospital Quality Incentive Demonstration and the Centers for Medicare and Medicaid Services' Hospital Compare, the report found that the smallest hospitals would, on average, experience five to seven times more uncertainty than the largest hospitals concerning their true relative performance for heart failure, pneumonia, and acute myocardial infarction. The authors conclude that all estimates of rank need to include adequate measures of uncertainty of those estimates.
  • The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 10/2010

    Uses a retrospective analysis of data on rural hospital, ambulatory surgery center (ASC), and market characteristics for the years 1997 through 2006 to assess the impact of freestanding ASCs on rural hospital performance.

  • The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 10/2010
    Describes the impact of Ambulatory Surgery Centers (ASCs) on rural hospital markets.
  • Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Brief)
    Upper Midwest Rural Health Research Center
    Date: 11/2006
    Overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration (HQID) project.
  • Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 09/2006
    Reports the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
  • Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
    Upper Midwest Rural Health Research Center
    Date: 08/2007
    The Tennessee Rural Hospital Patient Safety Demonstration project included: 1) the implementation of three patient safety initiatives in eight rural Tennessee hospitals using a collaborative model and 2) an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives. Staff from the Tennessee Hospital Association, Q-Source (the state quality improvement organization), BlueCross BlueShield of Tennessee and the University of Southern Maine all provided technical assistance and resources to the hospitals. The Upper Midwest Rural Health Research Center evaluated the project. Executive summary available online. Full report available on request by contacting raasc001@umn.edu.
  • 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.
  • Location of Childbirth for Rural Women: Implications for Maternal Levels of Care
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    This study looks into the rate at which rural women give birth at nonlocal hospitals. Approximately 75% of rural women gave birth at local hospitals. However, after controlling for clinical complications, rural Medicaid beneficiaries were less likely to give birth at nonlocal hospitals, implying a potential access challenge for this population.
  • 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.
  • 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.
  • 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.
  • Minimum Distance Requirements Could Harm High-Performing CAHs and Rural Communities
    North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2015
    Compares the effect of location on critical access hospitals’ size, quality of care, and financial strength. Discusses implications of minimum distance requirements on critical access hospitals.
  • Nurse Staffing and Rural Hospital Performance
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 12/2010

    Examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.

  • Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 01/2015

    Current federal minimum staffing levels for certified nursing homes require one RN for at least eight hours per day, seven days per week, and one licensed nurse (RN or LPN) on duty the rest of the time. State minimum staffing level requirements for nursing facilities vary considerably. Consequently, nurse skill mix and nurse staffing levels per resident may vary significantly across facilities, making it important to consider these variables.

    The purpose of this study was 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.

  • 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 policy brief describes obstetric staffing patterns in rural hospitals in nine states by Critical Access Hospital (CAH) status. The purpose of this study was to examine current obstetric practice models in rural hospitals, with a goal of providing timely and useful information to rural hospitals with obstetric care units regarding the obstetric workforce and to inform policymakers involved in shaping healthcare about the context in which rural hospitals operate.

    Key Findings:

    • In the nine states we studied, almost two-thirds of the 244 rural hospitals (64.3%) had more than one type of clinician providing obstetric care. The most frequent combinations were obstetricians working with certified nurse midwives (CNMs) (17.2% of hospitals) and obstetricians working with family physicians (15.6%).
    • Critical Access Hospitals (CAHs) were significantly more likely than rural non-CAHs to have family physicians and general surgeons attending deliveries, and significantly less likely to have obstetricians attending deliveries.
    • When asked about the challenges they face staffing rural obstetric units, survey respondents most frequently cited census variability, retention and recruitment, maintenance of skills and competencies, and staffing arrangements (scheduling, taking call, unit coverage, etc.).
  • Obstetric Services and Quality among Critical Access, Rural, and Urban Hospitals in Nine States
    University of Minnesota Rural Health Research Center
    Date: 06/2013
    Compares the characteristics and quality of obstetric care in Critical Access Hospitals, other rural hospitals, and their urban counterparts.
  • Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 12/2005
    To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
  • Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
    Upper Midwest Rural Health Research Center
    Date: 2006
    Reports the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.
  • Potentially Preventable Readmissions in Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 08/2009

    A hospital's potentially preventable readmission rate is a quality indicator receiving considerable attention from policymakers and payers. Using 3-M algorithm software and Medicare inpatient claims data from five states, this brief examines potentially preventable readmission rates for rural and urban hospitals, and discusses the rural implications of policy initiatives to reduce readmission rates.

  • Prioritizing Patient Safety Interventions in Small Rural Hospitals
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 12/2006
    Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
  • Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
    University of Minnesota Rural Health Research Center
    Date: 2005
    Hospices in rural settings face challenges in the provision of hospice care as a result of their location and the size of their service area population. To ascertain the challenges that hospices face in serving rural communities, researchers conducted in-depth case studies of four different models of hospice care in rural areas. The authors describe strategies used by the case study hospices and recommend policies that could increase access to hospice care for rural Medicare beneficiaries and other rural residents. National initiatives to improve end-of-life care need to consider the special challenges faced by rural hospices.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.

    Key Findings:

    • Less than one in five respondents felt “extremely confident” that they had made the best plan decision. Residents in more-densely populated rural areas were significantly less likely than those in urban areas to be extremely confident.
    • Respondents in more-densely populated rural counties reported significantly lower satisfaction levels with their Part D plans than those in urban counties.
  • Rural Emergency Department Staffing: Implications for the Quality of Emergency Care Provided in Rural Areas (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 06/2007

    The purpose of this project was to describe rural emergency department staffing nationally and to assess the potential implications of staffing for the quality of emergency care provided in rural areas. A national telephone survey of a random sample of rural hospitals with less than 100 beds was conducted in June to August 2006. The study found that the majority of rural hospitals use more than one type of staffing to cover their Emergency Department (ED), including combinations of physicians on their own medical staff, contracts with emergency physician management groups and with individual physicians, and physician assistants and nurse practitioners. The study concluded that it is important to ensure that the family physicians, internists, PAs, NPs and nurses who staff rural EDs have the expertise and technical skills needed to provide optimal ED care, and that rural ED staff may benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams. Report available upon request by contacting the Center.

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Rural Issues Related to Bundled Payments for Acute Care Episodes
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Bundling Medicare payments, i.e., providing a fixed payment for a set of acute and post-acute services, has been proposed as a way of encouraging providers to find innovative, cost reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address these challenges.

  • Rural Issues Related to Comparative Effectiveness Research and Dissemination
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Comparative effectiveness research, which compares the costs and benefits of different treatments for specific diseases or conditions, has the potential to improve the quality and reduce the costs of health care. This brief describes strategies for expanding clinical research in rural environments; implementing practice guidelines in rural settings; and improving access to current evidence-based information for rural health professionals and patients.

  • The Rural Obstetric Workforce in US Hospitals: Challenges and Opportunities
    University of Minnesota Rural Health Research Center
    Date: 03/2015
    Describes the healthcare and clinician types who are delivering babies in rural hospitals, such as family physicians, general surgeons, obstetricians, and midwives. Discusses the relationship between hospital birth volume and staffing models.
  • Rural Primary Care Practices and Meaningful Use of Electronic Health Records: The Role of Regional Extension Centers
    University of Minnesota Rural Health Research Center
    Date: 2014
    Examines the role Regional Extension Centers (RECs) play in assisting rural physician practices implement electronic health records (EHRs).
  • 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 to analyze current patterns of non-local delivery by rural women's health insurance status and residential rurality.

    Key Findings:

    • In nine geographically-diverse states with substantial rural populations, 25.4% of rural pregnant women delivered their babies in non-local hospitals in 2010 and 2012.
    • Rural women living in more densely populated rural areas were less likely to give birth in a non-local hospital (19.5%) than those in less densely populated rural areas, either next to a metropolitan area (35.9%) or not (33.7%).
    • Privately-insured rural women were more likely to give birth in non-local hospitals than rural women who were covered by Medicaid (28.6% vs. 22.5%).
    • Rural women with Medicaid coverage were more likely than privately-insured women to deliver their babies in a hospital where more than half of all births were covered by Medicaid (63.8% vs. 36.7%).
  • Rural-Urban Differences in Obstetric Care 2002-2010 and Implications for the Future
    University of Minnesota Rural Health Research Center
    Date: 01/2014
    Measures obstetric care in both rural and urban hospitals to find if trends differ from rural and urban hospital locations.
  • Rural-Urban Differences in Satisfaction with Medicare Part D: Implications for Policy
    University of Minnesota Rural Health Research Center
    Date: 01/2016
    Examines the difference in rural and urban satisfaction with Medicare Part D coverage by using data from the 2012 Medicare Current Beneficiary Survey. The research found that rural residents have lower satisfaction with their coverage.
  • 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.
  • 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.
  • The Use of Hospitalists by Small Rural Hospitals: Results of a National Survey
    University of Minnesota Rural Health Research Center
    Date: 06/2014
    Examines reasons for using hospitalists, characteristics of hospitalist practices, and the impacts of hospitalist use in rural settings.
  • The Use of Hospitalists in Small Rural Hospitals
    Upper Midwest Rural Health Research Center
    Date: 04/2012
    This policy brief describes the results of a survey of small rural hospitals that use hospitalists, who are physicians, physician assistants or nurse practitioners who assume responsibility for patient care during inpatient hospital stays.
  • 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.
  • Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    The Centers for Medicare & Medicaid Services’ (CMS) Hospital Readmissions Reduction Program reduces Medicare payments for hospitals determined to have “excess” rates of patient readmissions for specific conditions. The purpose of this project was to assess rural-urban differences in the proportion of hospitals that received penalties under the Readmissions Reduction Program over time, and whether condition-specific hospital readmission rates differed for rural and urban hospitals.
  • Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
    University of Minnesota Rural Health Research Center
    Date: 08/2016
    Analyzes the reasons behind hospital- and county-level factors for rural obstetric unit closures.
  • 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.
  • Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 09/2011

    This report and policy brief will (1) assess the financial and quality challenges and potential unintended consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; (2) explore the possible impact on quality of care delivered under a facility-physician bundled payment system; and (3) describe potential modifications to current bundling proposals and additional steps CMS could take that will help address rural-specific issues. Report available by contacting the Center.