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 - (4)

  • 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
  • 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: Health policy, 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
    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 - (148)