Keith J. Mueller, PhD

Director, RUPRI Center for Rural Health Policy Analysis

Phone: 319.384.1503
Email: keith-mueller@uiowa.edu

Health Management and Policy
University of Iowa
145 N. Riverside Drive
Iowa City, IA 52242


Current Projects - (3)

Assessing the Impact of Medicaid Policy Changes
Goals of this project include: 1) clearly articulating the rural considerations in Medicare reform by synthesizing information on the impact of Medicare on rural people, places, and providers; 2) assessing the impact of specific proposals to reform Medicare; and 3) analyzing the effects of market-based reform on rural populations, focusing on specific provisions of Medicare reform proposals.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Medicaid and S-CHIP
What Does Healthcare Delivery System Reconfiguration Portend for Rural Health?
The purpose of this project is to understand the dynamic relationships between healthcare system changes and healthcare network configurations that involve rural providers.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Quality
What Makes Successful Rural Accountable Care Organizations Successful?
The U.S. Department of Health and Human Services plans to shift at least 50% of traditional Medicare spending into alternative payment models by 2018. Affordable Care Organizations (ACOs) represent a popular model in both the Medicare and Medicaid programs. This study used multiple methods to find what makes a successful ACO.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Medicare, Quality

Completed Projects - (33)

Access to Services Across a Continuum of Care for Rural Beneficiaries
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Health services
After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Hospitals and clinics, Quality
Analysis of the Effects of Federal Debt Reduction and Long Term Budget Adjustment on Rural Health Care Delivery
The RUPRI Center for Rural Health Policy Analysis will examine suggested changes in Medicare and Medicaid as stated in proposals to reduce spending as part of achieving deficit reduction.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Health services, Medicaid and S-CHIP, Medicare
Analysis Related to Health Care Reform Issues
The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Health services, Healthcare financing
Analyzing the Variation in the Performance of Accountable Care Organizations Serving Rural Medicare Beneficiaries
The goals of this project are to characterize ACOs that operate in rural areas, describe the models being used to organize those ACOs, and to test relationships of those characteristics to performance measures related to financial success and quality. The study will identify potential changes in legislative and regulatory policies that could strengthen the utility of the ACO model to achieve high performing rural healthcare delivery organizations.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Healthcare financing, Legislation and regulation, Medicare, Quality
Assessing Rural Implications of Changes in Insurance Markets
The goal of this project is to understand and predict changes in the insurance market in which rural people will participate and how state and national policies might influence activity in that market. The specific objectives of the project are to analyze state policies designing and implementing health insurance exchanges and to model the behavior of health insurance plans as regards entering and exiting rural markets.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health insurance and the uninsured, Health services
Assessing the Community Impact of the MMA
This project will measure the community-level impacts of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and will provide feedback to policymakers regarding the impact of the MMA on its policy targets (providers and beneficiaries), in the context of rural places.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Legislation and regulation, Medicare, Medicare Part D
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
Assessment of Small Rural Hospital Activities to Report Medication Errors
This research will determine how small rural hospitals have responded to the environmental pressure to improve patient safety and quality by implementing safe medication practices and by reporting and monitoring medication errors.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality
Changing the Medicare Program According to the Principles of Managed Competition
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Medicare
Characteristics of Low-volume Communities
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Healthcare financing, Legislation and regulation, Medicare
Comments on Regulatory and Contractor Reform Legislation
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Legislation and regulation, Medicare
Developing and Using a Classification Schema to Identify Sentinel Communities in the U.S.
This project will enable rural researchers to track the effect of current policies on rural communities, anticipate the effect of proposed policies, and demonstrate policy effects that link one sector to another.
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Health policy
Engagement of Rural Providers in Accountable Care Organizations (ACOs)
The RUPRI Center’s work assessing the development of ACOs in rural places including updating our data base showing the location of Medicare ACOs and using the data to create maps for each Census Region showing the counties in which Medicare ACOs have assigned beneficiaries.
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Health services
Establishing a Fair Payment for Rural Physicians
This project will analyze differences in physician payment as a function of practice location and simulate policy choices that change the current payment formula.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Physicians, Workforce
How Would Health Insurance Exchanges Work in Rural America?
The passage of the Patient Protection and Affordable Care Act (PPACA) of 2010 has created the potential for states to create health insurance exchanges (HIEs). This project will assess the potential of these plans to meet the needs of rural residents. Empirical work will establish baseline measures of choices available to rural residents and literature reviews will yield prospective analysis of how exchanges could operate to benefit rural residents.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health insurance and the uninsured, Health policy
Impact of Changing Medicare Advantage Landscape on Rural Enrollees
This project will explore three important questions related to Medicare Advantage (MA) plans. What is the impact of recent changes in the MA market on rural Medicare beneficiaries, providers and communities? In particular, how have recent changes in markets and payment policy led to changes in the choices of plans facing beneficiaries, and the quality of those plans (as defined by the coverage offered by the plans)? Finally, what is the likely impact of changes made in Medicare Advantage payment rates passed in the Patient Protection Affordable Care Act of 2010 (PPACA) on rural enrollment in MA plans in 2011 and beyond?
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Medicare, Medicare Advantage (MA)
Impact of Payment Policy on Access to Physician Care in Rural America
Profiles of physician practices will be constructed that specify the percent of payments derived from specific current procedural terminology (CPT) codes, dichotomized into evaluation and management (often considered to define primary care) or procedural. Differences across rural practices and between rural and urban practices will be analyzed, with implications for payment policies intended to reward rural primary care.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health services, Medicare, Physicians
Implementation of Health Reform Legislation in Rural America
The RUPRI Center has developed particular expertise, including the use of simulations, in how changes in public policy that are now part of the Patient Protection and Affordable Care Act (PPACA) affect the rural health care providers and communities. We have published policy briefs and papers related to Medicare Advantage and Part D plans, effects of insurance reform on the percentage of uninsured in rural areas, and effects of changes in physician payment on projected total income of rural primary care physicians. The purpose of this project is to take advantage of RUPRI's capacity for further simulation analysis and empirically based analyses of changes occurring as a result of the PPACA.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health insurance and the uninsured, Health policy, Medicare
Is Medicare Beneficiary Access to Primary Care Physicians At Risk?
This project examined the impact of changes in Medicare payment to physicians on access to care for rural beneficiaries.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Medicare, Physicians
J-1 Visa Project
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, International Medical Graduates (IMGs), J-1 Visa Waiver, Workforce
Medicare Advantage and Medicare Prescription Drug Plans in Rural Areas
The rapid growth in Medicare Advantage (MA) plans, as well as evidence that MA plans are being paid significantly more than traditional fee-for-service Medicare, has created the impetus for reform of the MA program, especially reductions in payment to MA plans. This project will continue the RUPRI Center's work in tracking and analyzing the trends in MA plan enrollment in rural areas, including changes in types of plans.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Medicare, Medicare Advantage (MA)
Medicare Modernization Act: Reality for Rural Beneficiaries and Providers
This project will focus on two areas of new activity in Medicare beneficiary participation in Medicare Advantage (MA) plans and prescription drug plans and implementation of the new Part D benefit through private health plans. We will describe enrollment into specific types of MA prescription drug plans and other prescription drug plans, and analyze differences across regions, states, and types of counties. We will also examine the impact of the transfer to Part D coverage on rural dual eligibles and their local pharmacies.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Medicare Advantage (MA), Medicare Part D
Medicare Reform: Rural Considerations
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Medicare Prospective Payment System (PPS), Medicare Wage Index
National Rural Hospital Flexibility Program Tracking Project Dissemination
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
Nationwide Analysis of New Entrants into Medicare+Choice Demonstrations
This project will examine the effects of recent changes in the Medicare+Choice program on enrollment in rural areas and on activities of rural-based health plans.
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Medicare
Patient-Centered Medical Home: A Model for Rural Physician Practices and Communities?
Rural practices will need to meet the expectations inherent in the patient-centered medical home (PCMH) model or lose any payment advantage that comes with participating as a PCMH. The goal of this project is to assess rural readiness to adopt services seen as part of a PCMH.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health services, Physicians
Pharmacy Services in Communities After the Only Local Pharmacy Closes
This project will investigate patterns of utilization of prescription drug and other health care services in rural communities in the years since the only local pharmacy closed. We will also examine changes in local economies and Medicare spending, trended to include time before closure through as many years possible after closure.
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Pharmacy and prescription drugs
Quality of Surgical Care services in Critical Access Hospitals (CAHs)
This project builds on prior work examining rural residents’ bypass behavior of their local CAH to hospitals outside their community. Using recently identified inpatient surgical procedures that are commonly performed in CAHs, we will examine and compare outcomes (e.g. post-surgical complication rates, adverse events) of these procedures between CAHs and non-CAHs.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Hospitals and clinics
Rural Inclusion in the Development of Health Insurance Exchanges
State plans for developing health insurance exchanges (HIEs) will be analyzed to determine likely benefits for rural residents and communities. Three elements of each plan will be described and assessed: strategies to seek out and enroll rural residents eligible for subsidized insurance coverage or categorically eligible for plans offered through exchanges; minimum standards for participating health plans, including access to essential services; and simulations of impact on availability of plans and enrollment of currently uninsured rural residents.
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Health insurance and the uninsured
Rural Provider Participation in a Statewide Health Information Project
Nebraska has recently constructed a communication infrastructure that links all the hospitals in the state with broadband, high-speed systems (using T1 lines to the Critical Access Hospitals). That infrastructure is considered to be the backbone for a statewide health information network being designed by a coalition of organizations. The aim of this project is to delineate reasons for rural providers to participate in the coalition by assessing the associated costs and benefits.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health information technology, Hospitals and clinics, Networking and collaboration
System Integration and Rural Provider Participation in Accountable Care Organizations (ACOs)
This project will develop a national descriptive database of both rural providers and larger (often urban) health systems participating in Medicare ACOs and health system networks. Case studies of four ACOs will generate an awareness of decisions being made that affect configuration of services in rural places and provide suggestions for further research with representative samples of ACOs.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Health services, Medicare
What Factors Explain Rural Residents Seeking Care Outside of the Rural Community?
This project will examine factors that explain rural residents seeking care outside of the rural community.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health services, Hospitals and clinics

Publications - (146)

  • 2012 Rural Medicare Advantage Quality Ratings and Bonus Payments
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2014

    Analyzes differences in rural Medicare Advantage (MA) quality ratings and payments and suggests reasons why quality ratings vary by geography. Overall, the quality rating of MA plans in rural areas is lower than in urban areas, a result of the availability of, and enrollment in, different types of MA plans.

  • 2014: Rural Medicare Advantage Enrollment Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2015

    Rural Medicare Advantage (MA) and other prepaid plan enrollment in March 2014 was nearly 1.95 million, or 20.3 percent of all rural Medicare beneficiaries, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million (20.4 percent) in October 2014. MA enrollment increased in both rural and urban areas despite reductions in payment and the conclusion of the MA bonus payment demonstration at the end of 2014.

    Some rural counties were reclassified, due to a change in population, and nearly 10 percent of the previously rural MA population is now considered urban; however, the percentage of the rural Medicare beneficiaries enrolled in MA did not change significantly. The majority of growth in rural MA enrollment was in Preferred Provider Organization plans, with over 56 percent of enrollment, while nearly a third of beneficiaries were enrolled in Health Maintenance Organization plans.

  • 2016 Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Cumulative county-level enrollment rates in Health Insurance Marketplaces (HIMs) in metropolitan and non-metropolitan areas of each state, defined as the percentage of “potential market” participants selecting plans, are presented as of March 2016. States are separated by Medicaid expansion status.
  • Accountable Care Organizations in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2013
    Reports that Medicare Accountable Care Organizations (ACOs) currently operate in 16.7% of all U.S. non-metropolitan counties.
  • Affordable Insurance Exchanges and Enrollment: Meeting Rural Needs
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2012
    Reviews the principal characteristics of exchanges that will affect how well they meet the needs of rural residents, including the structure, governance, and process for enrollment.
  • After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2017
    A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
  • Analysis of Availability of Medicare+Choice, Commercial HMO, and FEHBP Plans in Rural Areas: Implications for Medicare Reform
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2003
    Examines viability of introducing private competition into the Medicare program. Discusses availability of Medicare+Choice1 (M+C), commercial HMO, and Federal Employees Health Benefits Program (FEHBP) plans in rural (nonmetropolitan) counties.
  • An Analysis of the Agreement of Financial Data between the Medicare Cost Report and the Audited Hospital Financial Statement
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2004
    Few studies have examined the discrepancies between the Medicare Cost Report (MCR) and the audited hospital financial statement (FS). Findings from this study, which focused on the MCR and FS for rural hospitals, suggest that relying on a single source of financial data to assess the financial performance of rural hospitals may be inappropriate.
  • April 2009 Rural Enrollment in Medicare Advantage: Growth in PPOs Outpacing Growth in PFFS
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2009
    Private fee-for-service (PFFS) plans dominate enrollment in rural areas and have accounted for much of the program's expansion since 2005. However, from December 2008 through April 2009 enrollment growth of preferred provider organization (PPO) plans, both nationally and in rural areas, was double the enrollment growth of PFFS plans.
  • 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.
  • Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
  • Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results?
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2005
    Explores how predictions of changes in hospital financial performance differ when comparing results using data from the Medicare Cost Report (MCR) to data from the audited hospital financial statement (FS). Results indicate that using the MCR rather than FS data is more valid.
  • 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
    The Patient Protection and Affordable Care Act created the Primary Care Incentive Payment Program (PCIP). For the years 2011 through 2015, if certain evaluation and management services represent 60% or more of Medicare allowable charges, then the provider qualifies for a 10% bonus calculated on the primary care portion of allowable charges. Based on analysis of 2009 Medicare claims data, more than 70% of rural primary care physicians (PCP) and non-physician practitioners (NPP) qualify for payments. The average incentive payment for qualifying rural PCPs would result in an additional $8,000 in Medicare patient revenue per year. For qualifying NPPs, the result is an additional $3,000 in Medicare patient revenue per year.
  • Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2003
    This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
  • Availability and Use of Health Plan Choices in Rural America: Medicare+Choice, Commercial HMO, and Federal Employees Health Benefit Program Plans
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2003
    Discusses availability of Medicare + Choice (M+C), commercial HMO, and Federal Employee Health Benefit Program (FEHBP) insurance plans, and the potential impact of M+C service delivery area changes on health care access in rural areas.
  • Care Across the Continuum: Access to Health Care Services in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2003
    Proposes that a continuum of care serve as the framework with which to consider rural healthcare policies, focusing on people and on places where people live rather than on the wants of providers and constituencies. The continuum of care describes the breadth of healthcare services in seven stages, from personal behavior to palliative care. The framework helps establish which healthcare services should be provided locally and which provided at a distance, emphasizing seamless linkages between all stages of the continuum.
  • Care Across the Continuum: Access to Health Care Services in Rural America (2006)
    RUPRI Center for Rural Health Policy Analysis
    Date: 2006
    The article is divided into 3 sections: 1) basic principles that determine services to be included in the continuum and how success in providing those services is judged; 2) definition of the continuum and its basic stages based on the health systems research literature; 3) applications of the continuum and policy implications of the framework.
  • Care Coordination in Rural Communities Supporting the High Performance Rural Health System
    Report

    Date: 06/2015

    Care coordination has emerged as a key strategy under new healthcare payment and delivery system models that aspire to achieve Triple Aim objectives—better patient care, improved population health, and lower per capita cost. Achieving these objectives requires conceptualizing and planning care delivery in a new way that not only involves coordinating medical care, but helping people get the care and the support services they need to address the “upstream” social determinants of health. In rural places, these are especially important considerations. While care coordination models vary, all include multidisciplinary teams and networks, a person-centered focus, and timely access to and exchange of information. The purpose of this paper is to examine care coordination programs and processes that affect rural people and places to discover what is happening now in rural communities, how different programs and approaches are working, who benefits, and make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.

  • A Case Study of Developments in Rural Health in Difficult Economic Times: Leake County, Mississippi
    RUPRI Center for Rural Health Policy Analysis
    Shows how health care providers and others in Leake County, MS are faring during the 2008-2010 economy and period of diminishing access to care, escalating health care costs, and gaps in quality.
  • A Case Study of Developments in Rural Health in Difficult Economic Times: Nemaha County, Nebraska
    RUPRI Center for Rural Health Policy Analysis
    Shows how health care providers and others in Nemaha County, NE are faring during the 2008-2010 economy and period of diminishing access to care, escalating health care costs, and gaps in quality.
  • A Case Study of Developments in Rural Health in Difficult Economic Times: Walthall County, Mississippi
    RUPRI Center for Rural Health Policy Analysis
    Shows how health care providers and others in Walthall County, MS are faring during the 2008-2010 economy and period of diminishing access to care, escalating health care costs, and gaps in quality.
  • Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2013
    Policy brief identifies factors that contributed to the closing of six rural pharmacies in different states and describes how the affected communities adapted to losing locally based services.
  • Changing Rural and Urban Enrollment in State Medicaid Programs
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Medicaid enrollment growth in 36 states is analyzed by rural and expansion status, pre- and post-ACA. Enrollment growth was larger in expansion states but did take place in most states, with significant state-level variation in both groups. Metropolitan areas generally had higher growth than micropolitan and rural areas.
  • Changing Rural Populations and Impact on Public Policy
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    Population movement in rural areas and health policy issues
  • 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 ACOs focusing on characteristics important to their formation and operation. We find that a majority of responding ACOs were formed from pre-existing integrated delivery systems and had physician and hospital participants with prior risk-sharing and quality-based payment experience. In addition, physician groups played a leading role in the formation and management of the ACOs.

  • Characteristics of Rural Communities with a Sole, Independently Owned Pharmacy
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015

    In this policy brief, we characterize the population of rural communities with a single independently owned pharmacy. We find that over 2.7 million people, over 25 percent of whom live below the federal poverty level, reside in 663 rural communities with a sole independently owned pharmacy in 2014. For about 70 percent of these rural communities, the next closest pharmacy is more than ten miles away.

  • Chronic Disease Management Systems (Registries) in Rural Health Care
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2006
    A Chronic Disease Management System (CDMS) is a tool that helps providers collect and analyze patient information to promote quality care. This study shows that CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology.
  • Comments on Regulatory and Contractor Reform Legislation
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2002
    Informs policy and reports the rural issue of following the passage of the Medicare Regulatory and Contracting Reform Act of 2001. Findings consist of responses from interviews with a range of healthcare professionals and experts.
  • Comments on the June 2001 Report of the Medicare Payment Advisory Commission: Medicare in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2001
    Comments on and critiques the findings in MedPAC's Medicare in Rural America. The authors believe that while the MedPAC report helps set a framework for analysis, it is not a definitive treatise on the role of Medicare in rural health. Among its findings: most of MedPAC's recommendations would have positive impacts on health care for rural beneficiaries, others would do no harm, others could be strengthened, and a few, particularly those relating to access to services, "suffer from disparities and weaknesses." Report produced by the RUPRI Rural Health Panel.
  • Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 12/2005
    Summarizes the experience of Critical Access Hospital (CAH) administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans.
  • The Cost of Inaction to Rural Communities: The Urgent Need for Health Care Reform Leake County, Mississippi
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2009
    The U.S. healthcare crisis is especially strong in rural communities. The experience of Leake County, a rural Mississippi county, embodies these problems. Report available by contacting the Center.
  • The Cost of Inaction to Rural Communities: The Urgent Need for Health Care Reform Nemaha County, Nebraska
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2009
    The U.S. healthcare crisis is especially strong in rural communities. The experience of Nemaha County, a small county located in southeastern Nebraska, illustrates the reach of these problems into counties that are somewhat stable during times of economic turbulence. Report available by contacting the Center.
  • The Cost of Inaction to Rural Communities: The Urgent Need for Health Care Reform Walthall County, Mississippi
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2009
    The U.S. healthcare crisis is especially strong in rural communities. The experience of Walthall County, a small county located in southwestern Mississippi, exemplifies these problems. Report available by contacting the Center.
  • The Current and Future Role and Impact of Medicaid in Rural Health
    Rural Policy Analysis and Applications
    Date: 09/2012
    Outlines and describes the current Medicaid program and its importance to rural America. Also discusses rural implications of program expansion, including whether and how states choose to implement changes.
  • December 2009: Rural Medicare Advantage Enrollment Grows 15% in 2009
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2010
    Rural enrollment in Medicare Advantage (MA) and other prepaid plans grew by 15% from December 2008 to December 2009, faster than the 10% national growth rate. Preferred provider organization plans drove the increased enrollment in MA plans in rural areas in 2009, while private fee-for-service (PFFS) plans continued to dominate the market with over 50% of enrollment. This landscape could change in 2010 as rural Medicare beneficiaries will experience a decline in PFFS availability, as some insurers have announced plans to pull their PFFS plans from the market.
  • Definition of Rural in the Context of the MMA Access Standards for Prescription Drug Plans
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 09/2004
    Assesses how the definition of rural affects the potential impact of the specific access standards in the Proposed Rule to implement Title I of the MMA, and finds that the congressional objective to achieve convenient access to pharmacies (other than mail order) would be more fully realized if the Proposed Rule definition of rural is changed.
  • 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. Reports between May 2006 and December 2011 there were 296 rural communities that lost their only retail pharmacy, and nine communities that lost their only two pharmacies.

    Twenty-five counties lost their sole community pharmacy between May 2006 and December 2010. Among these:

    • The average population density is 10.4 persons per square mile, compared to 87.4 for the United States.
    • The average population decreased by 1.6% between 2000 and 2010. Excluding the largest county, the average decrease was 2.4%.
    • The population age 65 years and older increased 5.4% between 2000 and 2010. Excluding the largest county, the 65-and-older population increased 2.1%.
    • The average change in the percentage of persons in poverty increased by 0.6 points between 2000 and 2010, from 15.5% to 16.1%, compared to a 4.0 point increase (11.3% to 15.3%) for the United States.
    • The average percentage of people younger than 65 years without health insurance was 24.6% in 2010, compared to 16.2% for the United States.
    • Nineteen of the 25 counties were designated “whole county” Health Professional Shortage Areas (HPSAs), meaning there was a shortage of primary medical care physicians across the entire county.
    • The average number of active doctors per 1,000 persons was 0.44, compared to 2.86 for the United States. Six of the 25 counties (24%) had no active MDs or DOs in 2010.

    Recommendations: Policy makers might weigh the benefit of improved reimbursement policies to sole county pharmacies against the cost of little to no access to primary care health services, such as patient assessments, immunizations, and medication therapy management services, among rural residents.

  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Developmental Strategies and Challenges for Rural Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015

    This Policy Brief shares insights into initial strategic decisions and challenges of four Accountable Care Organizations (ACOs) with a rural presence, one from each census region (West, Midwest, Northeast, and South). Semi-structured on-site interviews were conducted with ACO leaders and key stakeholder group representatives (e.g., board members, physicians). The four ACOs were formed as a step toward a value-driven rural delivery system, recognizing that ACO participation may not have a short term return on investment. Common value-enhancing strategies included care management, post-acute care redesign, medication management, and end-of-life care planning. The four ACOs also emphasized the importance of access to data for population health management, care management, and provider participation. 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

    Describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices (GPCIs) portion of the Medicare Physician Fee Schedule (MPFS) on rural primary care providers’ practice revenue from Medicare. Using rural primary care provider Medicare claims from 2009 linked to the 2013 MPFS relative value units (RVUs), the 2013 GPCIs for non-metropolitan localities, and the GPCI updates from the Pathway for SGR Reform Act of 2013, we developed a revenue model to derive estimates of Medicare-related average revenue in 2013 and change-in-average-revenue percentage due to the GPCI updates for 50 non-metropolitan localities. Holding the conversion factor (CF) and RVUs fixed, we found that changes to the GPCIs made between January 1, 2013 and March 31, 2014 resulted in an average 0.12% (median 0.18%) increase in Medicare-derived revenue to rural primary care practices. Without the GPCI work floor reinstatement, however, primary care practices in rural areas would have been disproportionately negatively impacted through lower Medicare-related revenues.

  • Elements of Successful Rural Diabetes Management Programs
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2006
    Reports findings from a study about local innovations implemented by rural chronic disease management programs. Using diabetes as a proxy for all chronic diseases, the authors explored how local innovations overcame challenges of the rural setting, such as low income, cultural differences, and long travel distances, to provide effective and efficient disease management.
  • Eligible But Not Enrolled? Potential for Targeting Over a Half-Million Rural Medicare Beneficiaries for Enrollment in the Low-Income Subsidy Prescription Drug Program (Policy Brief)
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2008
    The Medicare Part D low-income supplement (LIS) is designed to help low-income persons access the prescription drug benefit with reduced premiums and lower out-of-pocket costs. To date, estimates suggest that almost 80% of the persons eligible for the LIS are participating in the program. But despite efforts by CMS and its partners to enroll as many eligible persons as possible, 5.6% of rural Medicare beneficiaries and 3.7% of urban Medicare beneficiaries are estimated to be eligible for but not enrolled in the LIS program. Information in this brief and the accompanying state tables could help CMS partners (including state and county agencies) target counties with high likelihood of identifying and enrolling LIS-eligible beneficiaries. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research. Report available by contacting the Center.
  • Enrollment in FEHBP Plans In Rural America: What Are The Implications For Medicare Reform?
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2003
    Recent proposals to reform the Medicare program and add an outpatient prescription drug benefit have used the Federal Employees Health Benefits Program (FEHBP) as the model for how private plans could be incorporated into the Medicare program. This policy brief presents information showing how FEHBP is functioning in rural areas of the country. Enrollment patterns into the various options available in the FEHBP, descriptions of the choices typically available in rural areas, and location of primary care providers used by plans in a sample of rural communities is presented.
  • Enrollment in FEHBP Plans in Rural Areas
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    Study of health plan enrollment decisions made by rural retirees and federal workers. Discusses how a Federal Employees Health Benefit Program (FEHBP) plan may work when applied to Medicare. Report available by contacting the Center.
  • Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2007
    Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United States.
  • Enrollment in the Federal Employees Health Benefit Program (FEHBP): State and County-Level Enrollment Analysis
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    Information on Federal Employees Health Benefit Program (FEHBP) enrollment in rural counties, including the number of health insurance plans available and number of enrollees. FEHBP is being considered as a model for involving private insurers in Medicare. Rural FEHBP enrollment choices may provide insights into how a similar program might work for Medicare. Report available by contacting the Center.
  • The Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 2007
    Describes first-hand reports from rural pharmacist-owners about their experiences with Medicare Part D plans in the first 7 months of 2006 in order to gain a more thorough understanding of the challenges faced by rural independent pharmacies as a result of program implementation.
  • The Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 11/2006
    Case study describing first-hand reports from 12 rural independent pharmacists in seven states about their experiences with Medicare Part D plans (PDPs) in the first seven months of 2006. The rural independent pharmacists interviewed are experiencing major changes in payment, administrative burden, and interaction with patients as a result of the shift of patients into Medicare Part D plans. Previously, these patients were mostly non-covered cash or Medicaid-covered clients. Two consequences are apparent in the data collected: 1) Payment per prescription is lower from Medicare PDPs than from either non-covered cash or Medicaid, and in some instances payment from PDPs is less than the combined cost of stocking the medications and dispensing them, representing a reduction in revenue; and 2)The number of plans that provide Part D benefits greatly exceeds the two payment sources pharmacists previously dealt with, representing an increase in administrative burden for independent pharmacies. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
  • Extent of Telehealth Use in Rural and Urban Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014

    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

    Presents characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions (West, Midwest, Northeast, and South). Semi-structured interviews were conducted on-site with ACO leaders and representatives of key stakeholder groups (e.g., board members, physicians, information technology managers). Four organizational characteristics emerged as influential in the formation of these ACOs. First is previous organizational integration experience, which includes physician-hospital organizations, independent practice associations and mergers. Second is experience in risk-sharing arrangements, which includes participation in the Medicare Advantage program and insurance plan ownership. Third are information technologies, especially shared electronic health records, which enable several ACO capabilities. And fourth is developing partnerships with health and human services organizations in local and regional communities. These findings can help rural providers interested in forming or participating in an ACO assess the status and potential gaps of their core structures and capabilities.

  • February 2010: A Dramatic Shift Away from Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2010
    In a reversal of recent trends, private fee-for-service (PFFS) enrollment fell dramatically in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas (excluding other prepaid plans) fell slightly in early 2010 for the first time in years. Nationwide, enrollment in preferred provider organization and health maintenance organization plans grew, offsetting the decline in PFFS enrollment and contributing to a slight growth in total MA enrollment in 2010.
  • The Federal Employees' Health Benefits Program: A Model for Competition in Rural America?
    RUPRI Center for Rural Health Policy Analysis
    Date: 2005
    Tests the hypothesis that the Federal Employees' Health Benefits Program (FEHBP) has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas.
  • 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.
  • From Health Care Volume to Health Care Value - Success Strategies for Rural Health Care Providers
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014
    Examines strategies that rural healthcare providers can use to improve healthcare quality for patients.
  • 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
    Describes how the Frontier Extended Stay Clinic model may be appropriate in rural communities other than the five original demonstration sites.
  • Geographic Variation in Premiums in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2014

    This Policy Brief analyzes the 2014 premiums of health insurance plans available in the new marketplaces created by the Affordable Care Act. Using methodology developed in an earlier Policy Brief, we find that initially, a state-based marketplace design and an “MSAs+1” rating area design are associated with lower average premiums. Rating areas with more than 1000 people per square mile also tend to have the lower premiums. We find that the rating areas with the highest average premiums are characterized by smaller populations, greater land areas, and far fewer health providers per square mile.

  • A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2014

    Provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces (HIMs) across geography. Comparisons of premiums must include adjustments for several factors: plan type (metal level), enrollee age and family status, overall cost of living in the area, and the design of marketplace rating areas (state policy choices). What might appear to be differences showing plans in rural places to be more or less expensive than in urban places could shrink or even reverse after appropriate adjustments.

  • Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015

    Analysis of nationwide county-level Health Insurance Marketplace plan and premium data for 2014 and 2015 provides evidence that many low-density rating areas are gaining firms and that average premium growth is low in many rural areas. However, premium growth is somewhat higher in low-density rating areas, and a small minority of rural states have experienced large average premium increases. Thus there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes.

  • Health Insurance Marketplaces: Premium Trends in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    Total Health Insurance Marketplace premiums have grown disproportionately in rural places in 2016. Urban counties have an average of 4.2 firms, while rural counties average 3.2 firms offering coverage through the HIMs. This causes concern since, at the county level, we find that as the number of firms increases, premiums increase at a slower rate.
  • Health Services at Risk in "Vulnerable" Rural Places
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    Discusses implications of a method to identify places in rural America that are at risk of being without healthcare services because they may lack a sufficient number of people to support a practice/provider, who are able to pay the full cost of care, or the population size and composition do not warrant the level of services currently available.
  • The High Performance Rural Health Care System of the Future
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    Describes a future rural system that would be built on foundations of affordability, accessibility, community focus, high quality, and patient centeredness.
  • Hospital Views of Factors Affecting Telemedicine Use
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2015

    This Policy Brief expands previous research examining hospital-based use of telemedicine by 1) determining the type of use by hospitals, whether it be providing services as a hub or receiving services as a spoke; and 2) then identifying factors from the hospitals’ perspective that affect use. Key informants at 36 hospitals were interviewed. The hospitals were evenly split between urban/rural and hub/spoke in 22 states, representing all four U.S. Census Regions. Respondents reported factors that initiated telemedicine use at their hospitals, such as a variety of start-up funding from federal, state, and foundation sources. They reported benefits, such as meeting hospital missions and improving patient access, as well as challenges, such as reimbursement procedures and clinician buy-in. They also discussed barriers to expansion, such as licensing and credentialing policies. While challenges and barriers are significant, both hub and spoke hospital respondents state considerable benefits for continued telemedicine use.

  • The Immediate and Future Role of the J-1 Visa Waiver Program for Physicians: The Consequences of Change for Rural Health Care Service Delivery
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2002
    Examines the consequences for the delivery of healthcare services in rural underserved areas if current policies governing the granting of J-1 visa waivers are changed and increases or decreases the numbers of physicians affected.
  • Impact of National Policy on Access to Health Care: The Rural Perspective
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2002
    Current state of financial and geographic access to healthcare in the U.S. and federal policy
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Independently Owned Pharmacy Closures in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2008

    The purpose of this policy brief is to provide policy makers, researchers, and stakeholders with information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 to 2008. This period coincides with the implementation of two major policies related to payment for prescription medications: Medicare prescription drug discount cards were introduced on January 1, 2004, and the Medicare prescription drug benefit began on January 1, 2006. In this brief, we focus on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research

  • Independently Owned Pharmacy Closures in Rural America, 2003-2010
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2011
    Provides information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 through 2010.
  • Inequitable Access: Medicare+ Choice Program Fails to Serve Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2002
    This brief discusses the Medicare+ Choice plan and how it has failed to meet the health issues of Americans.
  • Information Technology and Rural Health Networks: An Overview of Network Practices
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2004
    Focuses on the use of information technology (IT) in rural health networks, based on detailed interviews with representatives for 15 rural health networks that received funding from the federal Rural Health Network Development Grant program. In general, IT was found to be most beneficial to the network when it was integrated into the initial plans for network development, scaled to the needs of the specific project, and expanded to new applications only as the network itself matured to take on new tasks.
  • 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.
  • July 2009: Rural Enrollment in Medicare Advantage Continues to Grow
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2009
    Rural enrollment in Medicare Advantage continues to grow, with growth in the last 18 months led by the growth of preferred provider organization (PPO) plans. Despite the growth in PPO plans, private fee-for-service plans continue to dominate enrollment in rural areas and have accounted for much of the program's growth since 2005.
  • June 2011: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    Shows increases in enrollment into Medicare Advantage plans in rural America. The enrollment is concentrated in plans offered by three firms, especially in the types of plans with high rural enrollment which are preferred provider organizations and private fee-for-service plans.
  • June 2012: Rural MA Enrollment and Premium Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2013
    Medicare Advantage (MA) enrollment continued to grow and premiums continued to decline in 2012 despite reductions in payment to the plans as mandated by the Affordable Care Act. Rural MA enrollees face higher premiums than their urban counterparts, and the average premium for rural MA beneficiaries fell to $48 per month in 2012 as compared to $52 per month in 2011.

    Analysis of the zero premiums by plan in relationship to the plans charging a premium gives additional insights into the MA marketplace as faced by rural enrollees. Zero premium plans are less available in rural areas and are selected less often when they are available, which is a potential source of inequity between rural and urban areas.

  • 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. Local rural pharmacies continue to serve many of the nation's communities as the sole provider of pharmacy services. However, between May 2006 and December 2008, the number of retail pharmacies in 213 rural places dropped from one to zero, and the number of retail pharmacies in 118 rural places dropped from more than one to only one. The brief includes a table showing the data by state.
  • March 2011: Growth in PPOs Dominates the Rural MA Market in 2011
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2011
    From March 2010 to March 2011, rural Medicare Advantage (MA) enrollment in preferred provider organization plans grew from 28% (396,006 enrollees) to 46% (702,315 enrollees) of total enrollment, while rural MA enrollment in private-fee-for-service plans fell from 38% (530,678 enrollees) to 16% (249,499 enrollees).
  • March 2012: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2012
    Presents key findings on Rural Medicare Advantage (MA) enrollment and on Rural Preferred Provider Organization (PPO) enrollment.
  • May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    A changing landscape is emerging for rural Medicare Advantage (MA) enrollment in 2009 as rapid growth in preferred provider organization (PPO) plan enrollment is coupled with a decline in the growth rate of enrollment in private fee-for-service (PFFS) plans. Enrollment in MA plans has continued to climb in 2009, but it has been impacted by the slowed rate of growth in PFFS plans, which cover over half of MA enrollees in rural areas. The growth in PPO enrollment in recent months is likely tied to changes in policy that have encouraged the growth of new PPO plans, enrollment in existing PPO plans, and expansions of the service areas of existing plans.
  • 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: Program Eligibility, Beneficiary Assignment, and Quality Measures
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014

    Discusses the Medicare Shared Savings Program (MSSP) eligibility, participation requirements, and quality measures relative to Accountable Care Organization (ACO) formation.

    Recommendations: Organizations considering participating in the MSSP (Medicare ACO program) should carefully review program eligibility requirements and the beneficiary assignment process. Due to beneficiary assignment based on the greater of allowed Medicare charges, new Medicare ACOs may discover fewer assigned beneficiaries than anticipated. Potential shared savings will be reduced by suboptimal quality Therefore, new Medicare ACOs must provide excellent care in 33 outpatient clinical quality and patient satisfaction measures to a void shared savings reduction.

  • 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.
  • Medicare Beneficiary Access to Primary Care Physicians -- Better in Rural, but Still Worrisome
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2011

    Primary care is the foundation of the rural U.S. health care system. Thus, the willingness of rural primary care physicians to accept new Medicare patients is critically important to the Medicare program and to rural America's elderly. In this policy brief, results from a large national physician survey are used to assess U.S. primary care physician and general surgeon willingness to accept Medicare patients and physician-reported reasons for not accepting Medicare patients.

  • Medicare Issues
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2003
    Overview of rural policy issues related to Medicare. Presentation made 8/26/03 in Casper, WY.
  • Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2006
    Provides a first snapshot of enrollment in Medicare Part D in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under this program.
  • Medicare Payment for Services in Rural Communities: Testimony before The Subcommittee on Health, Committee on Ways & Means, U.S. House of Representatives
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2001
    Reasons to change Medicare payment policies and a new framework for making appropriate changes. Report available by contacting the Center.
  • Medicare Physician Payment
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2003
    Examines how the Resource-Based Relative Value Scale (RBRVS) has replaced the 25 year-old Medicare CPR charge system.
  • Medicare Physician Payment Policy and the Rural Perspective (Final Report)
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2008
    During the past six years, the RUPRI Center has examined the effects of Medicare payment changes on rural physician practice revenue. Despite the apparently tenuous association between Medicare physician payment policy and physician practice decision making, we infer that changes to practice revenue potentially affect physician decisions regarding rural practice. This report presents the results of the RUPRI Center's work and provides a framework for understanding this continuing policy question.
  • Medicare Physician Payment: Impacts of Changes on Rural Physicians
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2006
    Overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Discusses the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
  • Medicare Physician Payment: Practice Expense
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2003
    Examines the physician practice expense component of Medicare payment, which proportionately results in greater geographic physician payment variation than does the physician work payment. The practice expense adjustment methodology warrants careful validation to demonstrate that the index measures actual geographic practice cost differences. A complete understanding of the reasons for different payments will inform both physicians who want to know why the same procedure results in less reimbursement in one place than it does in another and policymakers who want to address that concern.
  • Medicare Prescription Drug, Improvement, And Modernization Act Of 2003, (P.L. 108-173): A Summary Of Provisions Important To Rural Health Care Delivery
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2004
    Provides a wide audience of rural health policymakers, advocates, and researchers a consolidated summary of legislative provisions contained in Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) that have particular meaning to the delivery of services in rural areas. Includes information on how this Act will impact beneficiaries, healthcare access, and payments to rural healthcare providers.
  • Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2015

    In January, 2015, Department of Health and Human Services (HHS) Secretary Burwell announced new goals and timelines for moving Medicare reimbursement from fee-for-service to value-based payment. These payment changes are driving delivery system reforms (DSR) by making health care organizations more accountable for patients’ health as well as population and community health. Payment and delivery system reform, however, is concentrated in urban centers, and Medicare rural payment policies that were designed to strengthen rural health providers and systems are now complicating payment and delivery system reform in rural areas. The inclusion of rural providers in Medicare payment reform is critical for the program and for the 23 percent of Medicare beneficiaries who reside in rural areas. Rural Medicare beneficiaries should have the same opportunity as their urban counterparts to benefit from payment reform’s positive effects including strengthened primary care, embedded care coordination, and improved clinical quality. In this paper, we describe five recommendations to facilitate rural inclusion in value-based payment and delivery system reform:

    1. Organize rural health systems to create integrated care.
    2. Build rural system capacity to support integrated care.
    3. Facilitate rural participation in value-based payments.
    4. Align Medicare payment and performance assessment policies with Medicaid and commercial payers.
    5. Develop rural appropriate payment systems
  • One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 09/2007
    Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A findings brief is also available. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
  • One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 10/2007
    Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A final report is also available. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
  • Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
    Rural Policy Analysis and Applications
    Date: 09/2010
    Summarizes six issue areas of the Affordable Care Act (ACA) and discusses implications for access to services and improving the health status of rural residents. These issue areas are: health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
  • The Patient Protection and Affordable Care Act: A Summary of Provisions Important to Rural Health Care Delivery
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2010
    This paper provides a consolidated summary of legislative provisions contained in the Patient Protection and Affordability Act of 2010 (PPACA) that have particular meaning to rural residents and to the delivery of services in rural areas. Changes from the Health Care and Education Reconciliation Act of 2010 are incorporated. This paper serves as a rural roadmap of the PPACA for use by advocates, analysts, practitioners, and policy makers focused on rural health as they continue the important task of improving the system as it affects rural interests. Included in the paper are rural-relevant highlights of the legislation and detailed tables for each section.
  • 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
    Discusses survey responses from 29 rural physician practices from around the country. When asked about their use of specific policies and procedures that are 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.
  • Place-based Policies and Public Health: The Road to Healthy Rural People and Places
    Rural Policy Analysis and Applications
    Date: 03/2011
    Identifies how the Patient Protection and Affordable Care Act of 2010 (ACA) can influence the determinants of health and contribute to the prosperity, equity, sustainability, and livability of rural places.
  • Preparing for Medicare Part D: An Opportunity for State Offices of Rural Health and State Rural Health Associations
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2005
    Keeping with their organizational missions to improve and promote the health of rural Americans, state offices of rural health and state rural health associations have an inherent interest in helping beneficiaries access necessary healthcare services, including prescription medications.
  • Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2008
  • Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2001
    Provides a framework to help shape proposals to redesign Medicare to the benefit of rural beneficiaries and providers. Chapters focus on equity, quality, choice, access, and cost. Each chapter outlines the current situation, analyzes the implications of various approaches to changing the program, and makes recommendations for developing a Medicare program of greatest benefit to rural residents. Report produced by the RUPRI Rural Health Panel.
  • Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    With this paper, the RUPRI Rural Health Panel is presenting a well-defined framework for what should be included in any discussion of Medicare policies.
  • Regional Variation in Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2007
    Estimates and documents the regional magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals.
  • The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits among Medicare Beneficiaries
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2017
    Uses nationally representative 2007 to 2010 Medicare data to examine the relationship between Rural Health Clinic (RHC) use and potentially preventable hospitalizations and ED visits. RHC use was associated with an increase in both preventable hospitalizations and ED visits among all Medicare enrollees, regardless of their reason for eligibility.
  • Reliance on Independently Owned Pharmacies in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2007
    Provides locations of independently owned pharmacies in rural America that are the sole sources of access to local pharmaceutical services. In over 2,000 rural communities, the only local pharmacy is independently owned, and in 1,044 of those communities, there is no other pharmacy within 10 miles.
  • Report on Enrollment: Rural Medicare Beneficiaries in Medicare+Choice Plans
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This policy brief describes the experience to date with the Medicare+Choice program, focusing on changes in enrollment and plan formation through Fall 1999. Report produced by the RUPRI Rural Health Panel.
  • Rural Assessment of Leading Proposals to Redesign the Medicare Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2000
    This Policy Paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" (S. 1895, introduced by Senator Breaux and others) and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed, specifically how they affect rural Medicare beneficiaries and rural providers of health care services. Report produced by the RUPRI Rural Health Panel.
  • Rural Diabetes Care Management Programs: An Inventory of Sample Programs in Six States
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2005
    Developed to share key contact and program information with organizations that are interested in starting a chronic disease management (DM) program in their facility. Report available by contacting the Center.
  • Rural Enrollment in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2015

    This brief provides analysis of Health Insurance Marketplace enrollment outcomes for 2015 at the rating area and county levels. Enrollment rates are reported by number of firms participating and for multiple geographic categories: population density, Census region, and metropolitan status of the county. Rural rates are similar to urban rates in many places, but areas of concern exist and may benefit from additional outreach in the future.

  • Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2015

    In this brief, we provide comparisons between cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas of each state and corresponding percentages of “potential market” participants enrolled, controlling for Medicaid expansion status. We show that in several states, non-metropolitan enrollment rates exceed metropolitan enrollment rates, a finding that is obscured in an aggregate comparison. This analysis provides some indication of how well outreach and enrollment efforts targeting rural populations are proceeding in the states.

  • Rural Enrollment in Medicare Advantage Continues to Grow Rapidly in 2008, Led by Private Fee-for-Service Plans
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2008
    Enrollment of rural beneficiaries into Medicare Advantage (MA) plans has more than quadrupled since the inception of the MA program at the beginning of 2006 and increased 35% in the last year. However, as a percent of all beneficiaries, the enrollment rate in rural areas remains well below the national enrollment rate. The tremendous growth in rural MA plans over the past two and a half years is mostly attributed to the spread of private fee-for-service plans across the country, which now account for 58% of rural Medicare eligibles. This policy brief provides findings about enrollment in the MA program in rural areas and across the United States and updates findings from analysis of the MA program presented in previous RUPRI Center policy briefs. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research. Report available by contacting the Center.
  • Rural Enrollment in Medicare Advantage Growing Rapidly in 2007, Especially in Private Fee-for-Service Plans
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2007
    Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas, with state and national data.
  • Rural Enrollment in Medicare Advantage Is Concentrated in Private Fee-for-Service Plans
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2007
    Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas. Includes rural and urban data on enrollment in Medicare Advantage and other pre-paid plans by type of plan. Also provides state-level information on MA enrollment.
  • Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions in the United States, by Insurance Type, 2000 to 2004
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2011
    In this policy brief, we report findings from a study that used nationwide hospital inpatient discharge data to examine the trends and regional variations of rural hospital charges due to ambulatory care sensitive conditions (ACSCs) in the United States, by insurance type, from 2000 to 2004. Hospital charges due to ACSCs are reported by region and payment source. Changes in the percentage of hospital charges generated by ACSCs may indicate opportunities for cost savings through use of care management. The data presented in this policy brief indicate potential benefit from targeting resources designed to support ambulatory primary care.
  • Rural Hospital HIPAA Readiness and Resource Needs
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    Presents a survey of rural hospitals regarding the extent of their preparation for HIPAA requirements and their need for resources to implement HIPAA requirements. Results shown by hospital size. Also includes information on financial and staff commitment levels.
  • Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2014

    Presents different states’ approaches to the health insurance marketplaces including service areas and rating areas, network adequacy requirements, rural consumer outreach, rural representation on the Marketplace governing board, certification and oversight of Qualified Health Plans, and design of the Small Business Health Options Program.

  • Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2001
    Covers rural health policy, SCHIP Benefit Improvement Plan, and legislation.
  • Rural Implications of the Primary Care Incentive Payment Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    Reports on eligibility among rural primary care providers for the Primary Care Incentive Payments established in the Patient Protection and Affordable Care Act.
  • Rural Medicare Advantage 2011: Enrollment Trends and Plan Characteristics
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2011
    This paper report findings from analysis of the Centers for Medicare and Medicaid Services data to examine the trends and geographic variations in Medicare Advantage (MA) plan enrollment, premiums and market concentration by firm. MA enrollment in rural areas remains strong and continues to grow in 2011, despite the recent shift in enrollment from private fee-for-service plans to preferred provider organization plans. The data presented in this policy brief provide an overview of the Medicare Advantage program in rural America and highlight key rural/urban differences within the program.
  • Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2016
    There is significant variation in the quality ratings of MA plans that are available to rural beneficiaries. This brief suggests that policy interventions may be necessary to improve the quality of MA plans in rural areas.
  • Rural Medicare Advantage Plan Payment in 2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2016
    Payment to Medicare Advantage (MA) plans was fundamentally altered by the Patient Protection and Affordable Care Act of 2010 (ACA). This brief finds that while plans operating in both rural and urban areas have experienced a reduction in MA payment, the reduction in rural payment overall has been less significant.
  • Rural Medicare Advantage: Modest Enrollment Growth in 2010
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2010
    Despite a slight drop in enrollment and a dramatic shift in the landscape of the rural Medicare Advantage (MA) market in early 2010, MA plans have experienced modest growth in enrollment in rural areas over the last two quarters of 2010. The majority of the growth is concentrated in preferred provider organization plans, counteracting a decline in private fee-for-service plan enrollment.
  • Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
    NORC Walsh Center for Rural Health Analysis, RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    Provides in chart form sections of the MMA which were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policymakers. The particular sections are cited and implications for rural health services are indicated. Most of the sections identified are concerned with access to prescription drug coverage and the impact of the proposed legislation on rural pharmacies. The primary focus is on rules that will affect providers of drug coverage; this policy paper does not focus on rural dimensions of coverage from the insurance providers' perspective.
  • Rural Pharmacy Closures: Implications for Rural Communities
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2013
    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, describing characteristics about the communities and retail pharmacies in question.
  • Rural Physicians' Acceptance Of New Medicare Patients
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    Findings from analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians indicate that: 1) The trend among all physicians is to not accept new Medicare patients, 2) The percentage of physicians in both urban and rural areas who are accepting new Medicare patients is declining, 3) Physicians practicing in rural areas not adjacent to urban areas are the most likely to accept new Medicare patients, and 4) Findings also indicate that the negative implications of not taking the necessary steps to reverse the small but important decline in physician willingness to take new Medicare patients may be most serious in rural communities.
  • Rural Primary Care Physician Payment 2006-2009: What a Difference Three Years Doesn't Make
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2009
    The analysis in this brief shows the impact of Medicare's Evaluation and Management (E&M) service valuation adjustment (implemented January 1, 2007) on two prototypical primary care practices--one providing only E&M services and the other providing a mix of procedures and E&M services.
  • A Rural Taxonomy of Population and Health-Resource Characteristics
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2015

    This policy 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 policy makers and rural communities. Using the most current data from multiple sources, we applied the cluster analysis to classify 10 distinct types of rural places based on characteristics related to both demand (population) and supply (health resources) sides of the health services market. In descending order, the most significant dimension in our classification was facility resources, followed by provider resources, economic resources, and age distribution. Each type of rural places was distinct from other types of places based on one or two defining dimensions.

  • Rural/Urban Analysis on Individual Insurance Market Topics
    Fact Sheet
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Some special challenges face the development and sustainability of marketplace plans in rural areas. This data release provides some additional detail on some important topics, with particular importance to rural people, places, and providers.
  • Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
    Rural Policy Analysis and Applications
    Date: 12/2010
    The ACA calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
  • September 2010: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2010
    Rural enrollment in Medicare Advantage (MA) plans grew to nearly 1.5 million enrollees in September 2010 (15% of eligible Medicare beneficiaries), while national MA enrollment grew to over 11.5 million (25%). Rural Medicare beneficiaries will find fewer options for MA health insurance coverage in 2011- an average of 16 MA plans to choose from, compared with 24 plans on average in 2010.
  • September 2012: Medicare Advantage Enrollment Update
    Rapid Response to Requests for Rural Data Analysis
    Date: 04/2013
    Policy brief discussing current rural Medicare Advantage enrollment data.
  • 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
    Reports 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. Provides further detail of enrollment, including urban and rural enrollment by type of plan and by state.
  • State Health Insurance Exchanges: Assessing Rural Implications of Statutes
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2013

    This report analyzes how five characteristics of health insurance exchanges might address particular rural concerns.

    Key Findings:

    • Standards requiring that exchanges contract with Qualified Health Plans (QHPs) to provide an “optimal combination of choice, value, quality, and service” (see examples within California and Rhode Island statutes) could result in improved insurance markets in rural areas.
    • Two states (Oregon and Hawaii) require geographic diversity among members of the exchange governing boards.
    • Four states (Massachusetts, Oregon, Vermont, and Utah) require community-based activities to facilitate consumer enrollment into QHPs through the exchange; Massachusetts specifically requires outreach activities that target persons “who may require individualized support due to geography.”
    • All statutes and executive orders that we analyzed incorporate the network adequacy standards as stated in the ACA and subsequent regulations issued by CMS, which could require contracting with rural providers.
  • 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 (CAHs) across four regionally representatives states in 2011. Of the surgery volume performed in CAHs, on average 77% was performed on an outpatient basis and 23% inpatient. Operations on the musculoskeletal system, the eye, and the digestive system accounted for 67% of all surgical procedures performed in CAHs. Most reports of surgery volume in CAHs focus on inpatient procedures, thus missing a significant portion of the surgery volume that CAHs perform. CAHs offering outpatient procedures that complement inpatient surgical capacity are providing the communities they serve significant and valuable services through access to both convenient and emergent surgical care services that lessen many of the healthcare burdens associated with travel for surgery and follow-up care.

  • 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 represent two viable ways for hospitals to build and/or access necessary capacities to engage in the transformation to an integrated, patient-centered, pay-for-value model of care delivery. This policy brief tracks trends in network participation and system affiliation among U.S. general community hospitals from 2007 to 2012. Network participation increased in larger hospitals, non-government not-for-profit hospitals, and metropolitan hospitals. System affiliation generally increased in hospitals of all sizes and types. However, there are notably higher percentages of system affiliation among midsized and large hospitals, investor-owned hospitals, and metropolitan hospitals compared to their counterparts.

  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
    Date: 2005
    The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in 2004 to identify a set of researchable questions concerning rural healthcare.
  • The Uninsured: An Analysis by Age, Income, and Geography
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2014

    Using the 2010 Small Area Health Insurance Estimates (SAHIE), we analyze the rural and urban uninsured populations by age, showing that in both places, uninsured rates decline dramatically with age. We find that, within each age group, rural uninsured rates are somewhat lower than urban uninsured rates at income levels below 400% of the Federal Poverty Level. However, since a greater proportion of the rural population falls into the age and income categories with high uninsured rates, rural people as a group stand to benefit slightly more from subsidized coverage through the Health Insurance Marketplaces (HIM) or Medicaid expansion (if enacted). Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive HIM premiums upward, an effect which may be mitigated or compounded by various other factors.

  • The Uninsured: An Analysis by Income and Geography
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    Reports that a larger proportion of the rural population than the urban population is uninsured and low income. A larger proportion of the rural population than the urban population will be eligible for subsidized Health Insurance Marketplace coverage due to income levels and current lack of insurance.
  • Update on Medicare+ Choice: Rural Medicare Beneficiaries Enrolled in Medicare+ Choice Plans through September 2001
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2002
    Medicare+ Choice Plans, counties enrolled, and data available.
  • Update on Rural Enrollment in Medicare Advantage: Growth Continues
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2007
    Provides findings about rural enrollment in the Medicare Advantage (MA) program and other pre-paid plans, with state and national data.
  • Update: Independently Owned Pharmacy Closures in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2014

    Examines the closure of independently owned rural pharmacies in America from 2003-2013 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
    By creating a medical home program within Medicare, the Patient Protection and Affordable Care Act of 2010 gave momentum to growing interest in the concept of a patient-centered medical home (PCMH). Are physician practices, especially non-metropolitan primary care practices, ready to become PCMHs? We use a nationwide survey of physician practices to partially answer this question, focusing on the use of health information technology.
  • 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.