Xi Zhu, PhD

RUPRI Center for Rural Health Policy Analysis

Phone: 319.384.3829
Email: xi-zhu@uiowa.edu

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


Current Projects - (2)

  • Financial Risk Assumption Among Rural Healthcare Providers
    This project will assess rural/urban providers' participation in different payment models and assumption of financial risk in the Medicare Quality Payment Program. We will conduct qualitative interviews to examine rural providers' motivations and preparedness for participating in different risk-bearing payment models.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health reform, Healthcare financing, Rural Health Clinics (RHCs)
  • How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
    This project will examine the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project will provide policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Care management, Health reform, Health services, Hospitals and clinics, Medicare

Completed Projects - (1)

  • What Factors Influence Rural Hospitals' Participation in Accountable Care Organizations?
    This project examined rural hospitals' participation in Accountable Care Organizations (ACOs), identified factors that influenced ACO participation, compared whether different factors influenced rural/urban hospital participation in ACOs, and analyzed factors influencing Critical Access Hospitals' participation in the Medicare Shared Savings Program.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health reform, Healthcare financing, Medicare

Publications - (17)

2022

2021

  • Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment
    Journal Article
    Rural Telehealth Research Center
    Date: 11/2021
    This study explores facilitators and barriers to implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. Researchers conducted semi-structured interviews with 50 key personnel involved in the School-Based Telehealth Network Grant Program.

2020

  • Averted Transfers in Rural Emergency Departments Using Telemedicine: Rates and Costs Across Six Networks
    Journal Article
    Rural Telehealth Research Center
    Date: 08/2020
    In a cohort of 4,324 tele-ED cases across 26 months in 65 hospitals in 6 tele-ED networks, 20% were averted transfers, and 43% of those were then routinely discharged rather than being transferred. Averted transfers saved on average $2,673 in avoidable transport costs per patient, with 63.6% of these cost savings accruing to public insurance.
  • Rural Hospital Participation in Medicare Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2020
    This policy brief summarizes national and regional rates of rural hospital participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs) and identifies factors associated with ACO participation.

2018

  • Organizational Attributes Associated with Medicare ACO Quality Performance
    Journal Article
    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.
  • Organizational Attributes with Medicare ACO Quality Performance
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2018
    Cross-sectional and longitudinal analyses of Medicare Shared Savings Program Accountable Care Organizations' (ACOs') quality performance found rural ACOs' score was comparable to those in other categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher post-hospitalization follow-up rates had better performance.

2016

  • Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2016
    Provides an analysis of the differences in Accountable Care Organization (ACO) performance on the quality measures among the Medicare Shared Saving Program ACOs with varying levels of rural presence. Findings suggest that ACOs with significant rural presence have performed as well as, if not better than, urban ACOs in delivering quality care.
  • Financial Performance of Rural Medicare ACOs
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2016
    Assesses the financial performances of rural accountable care organizations (ACOs) based on different levels of rural presence.
  • 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.

2015

2014

2013

  • 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.