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)

  • Rural Community Response to Hospital Closure
    The Rural Community Response to Hospital Closure project will study how rural communities adapt to local hospital closure. Within selected communities, the project will evaluate the impact of hospital closure on multiple community health-related services and characteristics.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Hospitals and clinics
  • 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
    Topic: 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. Accountable 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: Medicare, Quality

Completed Projects - (34)

  • 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 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 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: 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 services, Private health insurance
  • 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: Legislation and regulation, Medicare, Medicare Part D
  • 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
    Topic: Medicaid and S-CHIP
  • 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: 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
    Topics: Public health, Transportation
  • 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
    Topics: Care management, 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: 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 reform, Private health insurance
  • 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: Medicare, Uninsured and underinsured
  • 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: International Medical Graduates (IMGs), 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: Medicare Advantage (MA), Medicare Part D
  • Medicare Reform: Rural Considerations
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Prospective Payment System (PPS)
  • National Rural Hospital Flexibility Program Tracking Project Dissemination
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals, 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, 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
    Topics: Private health insurance, Uninsured and underinsured
  • 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 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 - (153)

  • 2012 Rural Medicare Advantage Quality Ratings and Bonus Payments
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2014
    This brief 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 about 1.95 million, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million in October 2014. Rural and urban enrollment increased despite reductions in payment and the conclusion of the MA bonus payment demonstration at 2014’s end.
  • 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
    This policy brief reports that Medicare Accountable Care Organizations 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
    This report 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 Health Panel: Rural Policy Analysis and Applications
    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
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2003
    This rural policy brief examines the viability of introducing private competition into the Medicare program. It discusses the availability of Medicare+Choice1, commercial HMO, and Federal Employees Health Benefits Program 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 records the actions taken by Congress and the Health Care Financing Administration 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.
  • Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results?
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2005
    This policy brief 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
    Under the Primary Care Incentive Payment Program (PCIP), if certain evaluation and management services represented 60% or more of Medicare allowable charges, the provider qualified for a 10% bonus calculated on the primary care portion of allowable charges. This brief assesses the impact of the rural provider service mix on the PCIP.
  • 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.
  • 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
    This report discusses the availability of Medicare + Choice (M+C), commercial HMO, and Federal Employee Health Benefit Program insurance plans and the potential impact of M+C service delivery area changes on healthcare 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
    This paper 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.
  • 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
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 06/2015
    This paper examines care coordination programs and processes that affect rural areas to discover what is happening in rural communities, how various programs and approaches are working, who benefits, and to 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
    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.
  • A Case Study of Developments in Rural Health in Difficult Economic Times: 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.
  • A Case Study of Developments in Rural Health in Difficult Economic Times: 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.
  • Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2013
    This policy brief identifies factors that contributed to the closing of six rural pharmacies in various states and describes how the affected communities adapted to losing locally based services.
  • 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
    This document is from a presentation on 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 accountable care organizations, focusing on characteristics important to their formation and operation.
  • Characteristics of Rural Communities with a Sole, Independently Owned Pharmacy
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015
    This brief describes the populations of rural communities with single independently owned pharmacies. About 2.7 million people, more than 25% of whom live below the poverty level, live in 663 rural communities with sole independently owned pharmacies. For about 70% of these rural communities, the next closest pharmacy is more than 10 miles away.
  • Chronic Disease Management Systems (Registries) in Rural Health Care
    Policy Brief
    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
    This rural policy brief informs policy and reports on the rural issue of contractor reform following the passage of the Medicare Regulatory and Contracting Reform Act of 2001. The 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
    This paper comments on and critiques the findings in MedPAC's Medicare in Rural America.
  • Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
    Policy Brief
    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
    This policy brief 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 Current and Future Role and Impact of Medicaid in Rural Health
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 09/2012
    This report outlines and describes the current Medicaid program and its importance to rural America. It 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. Preferred provider organization plans drove the increased enrollment in MA plans in rural areas in 2009, while private fee-for-service plans continued to dominate the market with over 50% of enrollment.
  • 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
    This study assesses how the definition of rural affects the potential impact of the 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.
  • 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
    This paper offers a rural perspective on the debate about the design/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 various proposals may meet rural needs.
  • Developmental Strategies and Challenges for Rural Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs.
  • Distance and Networks: A Regional Analysis of Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2018
    Using 2015-16 data on 15 Midwestern states, we examine the possibility that geographic distance to care plays a role in insurance issuer participation, premiums, and enrollment success through its effect on network adequacy and assess the moderating role that state-level policies on network adequacy standards and Rating Area design may have.
  • Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2017
    This policy brief provides information about the potential impact of scheduled changes in Medicaid Disproportionate Share Hospital (DSH) payment on hospitals in 47 states. We expect variation across states, because of differences in state policies allocating DSH payments, as well as geographic variation by census region.
  • The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014
    This policy brief describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices portion of the Medicare Physician Fee Schedule on rural primary care providers’ practice revenue from Medicare.
  • Elements of Successful Rural Diabetes Management Programs
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2006
    This report shares 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 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
    Medicare Part D low-income supplement (LIS) is designed to help low-income persons access prescription drugs with reduced premiums and lower out-of-pocket costs. Despite efforts to enroll as many eligible persons as possible, many Medicare beneficiaries are estimated to be eligible for but not enrolled in the LIS program.
  • Enrollment in FEHBP Plans In Rural America: What Are The Implications For Medicare Reform?
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2003
    This brief presents information showing how the Federal Employees Health Benefits Program is functioning in rural areas. Enrollment patterns into the various options available in the FEHBP, descriptions of 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
    This study of health plan enrollment decisions made by rural retirees and federal workers examines how a Federal Employees Health Benefit Program plan may work when applied to Medicare.
  • Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2007
    This policy brief provides updated findings about Medicare beneficiary enrollment in prescription drug plans 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
    This analysis details 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.
  • 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
    This case study describes firsthand reports from 12 rural independent pharmacists in seven states about their experiences with Medicare Part D plans in the first seven months of 2006.
  • Extent of Telehealth Use in Rural and Urban Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014
    This brief provides discussion with statistics on the use of telehealth in rural hospitals and the opportunities telehealth can bring to supporting healthcare in rural communities.
  • Facilitating the Formation of Accountable Care Organizations in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014
    This brief shows characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions. The findings can help rural providers interested in forming/participating in an ACO assess the status and potential gaps of their core structures and capabilities.
  • 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
    Private fee-for-service (PFFS) enrollment fell in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas fell. Nationwide, enrollment in preferred provider organization and health maintenance organization plans grew, offsetting the decline in PFFS enrollment and contributing to growth in total MA enrollment.
  • 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
    This policy brief describes how the Frontier Extended Stay Clinic model may be appropriate in rural communities beyond 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.
  • 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
    This brief provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces across geography.
  • 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 national county-level Health Insurance Marketplace (HIM) plan data for 2014 and 2015 shows 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
    This brief discusses implications of a method to identify places in rural America at risk of being without healthcare services because they may lack a sufficient number of people to support a practice/provider, they are able to pay the full cost of care, or the population size/composition doesn't warrant the level of services currently available.
  • The High Performance Rural Health Care System of the Future
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 09/2011
    This project 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 brief expands upon previous research by examining hospital-based use of telemedicine by determining the type of use by hospitals, whether it be providing services as a hub or receiving services as a spoke, and then identifying factors from the hospitals’ perspectives that affect 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
    This paper 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
    This document discusses the current state of financial and geographic access to healthcare in the United States 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 and the Rural Health Panel of the Rural Policy Research Institute to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program.
  • Independently Owned Pharmacy Closures in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2008
    This brief focuses on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community.
  • Independently Owned Pharmacy Closures in Rural America, 2003-2010
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2011
    This policy brief 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
    This paper focuses on the use of information technology 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.
  • Insuring Rural America: Health Insurance Challenges and Opportunities
    Policy Brief
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 07/2018
    This brief discusses a series of policy considerations in three main categories: policies related to rural insurance risk, policies related to provider networks, and policies related to rural payment rates and structures.
  • 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 increase, 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
    This brief 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
    Though 2012 Medicare Advantage enrollment grew and premiums declined, rural enrollees faced higher premiums than urban enrollees. Analysis of the zero premiums by plan in relationship to plans charging premiums gives insights into the MA marketplace.
  • Loss of Community Pharmacies Since 2006: State Experiences
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2009
    This brief presents the latest data from a continuous monitoring of the status of rural pharmacies by the RUPRI Center. The brief includes a table showing the data by state.
  • March 2011: Growth in PPOs Dominates the Rural MA Market in 2011
    Policy Brief
    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
    This policy brief presents key findings on rural Medicare Advantage enrollment and on rural Preferred Provider Organization enrollment.
  • May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    Rural Medicare Advantage (MA) enrollment had rapid growth in preferred provider organization plans and a decline in the growth rate of private fee-for-service (PFFS) plans. MA enrollment has continued to climb, but it has been impacted by the slowed rate of growth in PFFS plans, which cover more than half of MA enrollees in rural areas.
  • Medicare Accountable Care Organization Growth in Rural America, 2014-2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2018
    This RUPRI Center data report describes Medicare accountable care organization (ACO) growth in non-metropolitan U.S. counties from 2014 to 2016. ACOs are the most widespread of the Centers for Medicare & Medicaid Services (CMS) value-based payment programs and demonstrations.
  • 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
    This brief discusses Medicare Shared Savings Program eligibility, participation requirements, and quality measures relative to accountable care organization formation.
  • 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
    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
    This document provides an overview of rural policy issues related to Medicare. The presentation was made August 26, 2003 in Casper, Wyoming.
  • Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2006
    This policy brief 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 are detailed.
  • Medicare Physician Payment
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2003
    This rural policy brief examines how the Resource-Based Relative Value Scale 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
    The RUPRI Center has examined the effects of Medicare payment changes on rural physician practice revenue. We infer that changes to practice revenue potentially affect physician decisions regarding rural practice. This report presents the results of the center's work and provides a framework for understanding this continuing policy question.
  • Medicare Physician Payment: Impacts of Changes on Rural Physicians
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2006
    This policy brief provides an overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on physician payment rates in rural areas. The brief discusses the effects of the Medicare incentive payment 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
    This rural policy brief 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 warrants careful validation to demonstrate that the index measures actual geographic cost differences.
  • 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
    This paper provides a wide audience of rural health policy makers, 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.
  • Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2015
    As Medicare moves to value-based payment, healthcare groups are made more accountable for patient health. But the changes have been concentrated in urban areas. Policies meant to strengthen rural health systems are complicating payment and delivery system reform in rural areas. This study examines ways to include rural areas in the changes.
  • 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
    This report describes the experiences of 51 rural, independently owned pharmacies that are the sole providers of pharmacy services in their communities one year after implementation of the Medicare Part D prescription drug benefit.
  • 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
    This brief describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their communities one year after implementation of the Medicare Part D prescription drug benefit.
  • Organizational Attributes Associated with Medicare ACO Quality Performance
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2018
    Peer-reviewed paper evaluating associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs’ quality performance.
  • Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 09/2010
    This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The 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 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.
  • Patient-Centered Medical Home Services in 29 Rural Primary Care Practices: A Work in Progress
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    This brief discusses responses from 29 rural physician practices. When asked about the use of specific policies/procedures included as criteria to certify patient-centered medical homes, fewer of them would qualify in each of five domains, including access to care, population-based, quality, care management, and clinical information management.
  • Place-based Policies and Public Health: The Road to Healthy Rural People and Places
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 03/2011
    This paper identifies how the Patient Protection and Affordable Care Act of 2010 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
    Policy Brief
    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
    This issue brief presents the findings of a national survey whose purpose was to describe the prevalence of evidence-based, safe medication practices, including the use of voluntary medication error reporting, in the nation’s smallest hospitals.
  • Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2001
    This book 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.
  • 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
    This policy brief 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
    This policy brief provides locations of independently owned pharmacies in rural America that are the sole sources of access to local pharmaceutical services. In more than 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
    Policy Brief
    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.
  • Rural Assessment of Leading Proposals to Redesign the Medicare Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2000
    This paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed.
  • Rural Diabetes Care Management Programs: An Inventory of Sample Programs in Six States
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2005
    This report was developed to share key contact and program information with organizations that are interested in starting a chronic disease management program in their facility.
  • Rural Enrollment in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2015
    This brief analyzes Health Insurance Marketplace enrollment outcomes for 2015 at rating area/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/urban rates are often similar, but areas of concern exist.
  • Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2015
    This brief compares cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas by state and the percentages of potential market participants enrolled. Non-metropolitan enrollment rates were higher in several states. The analysis shows how well outreach/enrollment efforts targeting rural areas work.
  • Rural Enrollment in Medicare Advantage Continues to Grow Rapidly in 2008, Led by Private Fee-for-Service Plans
    Policy Brief
    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 in 2006 and increased 35% in the last year. However, the enrollment rate in rural areas remains well below the national enrollment rate. This policy brief shows enrollment in the MA program in rural areas.
  • 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
    This policy brief provides findings about enrollment in the newly designed Medicare Advantage 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
    This policy brief provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas. It includes rural and urban data on enrollment in MA and other pre-paid plans by type of plan and provides state-level information on MA enrollment.
  • Rural Enrollment in Medicare Advantage: Growth Slows in 2008
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2009
    The rate of growth of enrollment in the Medicare Advantage program decreased significantly in 2008, compared to previous years. The growth rate in preferred provider organization plans in rural areas now exceeds that in private fee-for-service plans. This updates earlier findings from analysis of the MA program reported by the RUPRI Center.
  • 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 in the United States, by insurance type, from 2000 to 2004.
  • Rural Hospital HIPAA Readiness and Resource Needs
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    This rural policy brief presents a survey of rural hospitals regarding the extent of their preparation for HIPAA requirements and their need for resources to implement them.
  • Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2014
    This report presents various states’ approaches to the Health Insurance Marketplace, including service 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
    This report 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
    This policy brief reports on eligibility among rural primary care providers for the Primary Care Incentive Payments established in the Patient Protection and Affordable Care Act.
  • Rural Long-Term Services and Supports: A Primer
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2017
    This paper provides policymakers and other interested stakeholders a primer on the fundamentals of the rural LTSS system, rural access to and use of LTSS, and the opportunities and limitations of current federal and state LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system.
  • Rural Medicare Advantage 2011: Enrollment Trends and Plan Characteristics
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2011
    This paper reports findings from Centers for Medicare and Medicaid Services data analysis to examine the trends/geographic variations in Medicare Advantage (MA) plan enrollment, premiums, and market concentration by firm. The data provide an overview of the MA 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 during the last two quarters of 2010. The majority of the growth is concentrated in preferred provider organization plans.
  • 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
    This policy paper provides, in chart form, sections of the MMA that were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policy makers.
  • Rural Pharmacy Closures: Implications for Rural Communities
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2013
    This study documents the closure of local retail pharmacies in which the pharmacist was the only clinical provider available in the community at the time the pharmacy closed. This brief describes the characteristics of the communities and retail pharmacies in question.
  • Rural Physicians' Acceptance Of New Medicare Patients
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    Findings are presented regarding rural physicians’ acceptance of new Medicare patients from an analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians.
  • 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 brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics and discusses how this classification tool can be utilized by policymakers and rural communities.
  • Rural-Urban Enrollment in Part D Prescription Drug Plans: June 2017 Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2017
    As of June 2017, the percentage of rural enrollment in Part D plans, which include stand-alone prescription drug plans (PDPs) and Medicare Advantage with Prescription Drug (MA-PD) plans, lags urban enrollment despite significant growth overall in the number of Medicare beneficiaries with prescription drug coverage through Medicare Part D plans.
  • 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
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 12/2010
    The Affordable Care Act 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 more than 11.5 million (25%). Rural Medicare beneficiaries will find fewer options for MA health insurance coverage in 2011.
  • September 2012: Medicare Advantage Enrollment Update
    Rapid Response to Requests for Rural Data Analysis
    Date: 04/2013
    This policy brief discusses 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
    This report shows that as of May 2011, 59.1% of rural Medicare beneficiaries were enrolled in Medicare Part D through insurance plans that provide coverage for prescription medications. It also provides further detail, including urban and rural enrollment by type of plan and by state.
  • 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.
  • Surgical Services in Critical Access Hospitals, 2011
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
  • Telepharmacy Rules and Statutes: A 50-State Survey
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2017
    This is summary analysis reviews administrative rules and legislative statutes governing the practice of telepharmacy in all 50 states. Telepharmacy is specifically authorized in 23 states and 16 states have no rules or legislation authorizing telepharmacy. Other states have pilot programs or waivers that would enable telepharmacy.
  • Telepharmacy Rules and Statutes: A 50-State Survey (Journal Article)
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2018
    Peer-reviewed paper identifying state-enacted regulations and legislation authorizing use of community telepharmacy initiatives and describing implications for patients in underserved rural communities. Also provides a table listing states that permit telepharmacy, and pilot programs and waivers that enable telepharmacy initiatives.
  • Trends in Hospital Network Participation and System Affiliation, 2007-2012
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 2014
    Network participation and system affiliation are two ways for hospitals to build and/or access necessary capacities to engage in the transformation to an integrated, patient-centered, pay-for-value care delivery model. This brief tracks trends in network participation and system affiliation among U.S. general community hospitals from 2007 to 2012.
  • 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
    This brief analyzes the rural/urban uninsured populations by age. Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive Health Insurance Marketplace 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
    This brief reports that a larger proportion of the rural versus urban population is uninsured and low income and 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
    This rural policy brief provides an update on 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
    This policy brief provides findings about rural enrollment in the Medicare Advantage 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
    This brief examines the closure of independently owned rural pharmacies in the United States from 2003 to 2013 and its effects on rural Americans’ access to medications and other pharmacy services. This report is an update to past publications from RUPRI.
  • Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2018
    Rural pharmacies play an important role in health service delivery to rural populations. This RUPRI Center brief updates previous findings on the continued decline in the number of independently owned rural pharmacies since the implementation of Medicare Part D. This brief provides follow-up data on rural pharmacy closures through March 2018.
  • Use of Health Information Technology in Support of Patient-Centered Medical Homes Is Low Among Non-metropolitan Family Medicine Practices
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2011
    Are physician practices, especially non-metropolitan primary care practices, ready to become patient-centered medical homes? We use a nationwide survey of physician practices to partially answer this question, focusing on the use of health information technology.
  • 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.