Medicare

Current Projects

• Availability, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities
  This project will examine differences in availability of hospice care in rural versus urban communities as well as provider-level quality and care practices by rural-urban status of hospices. Findings will highlight potential rural-urban disparities in hospice care that can be used to inform future Medicare policy.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Coronavirus Disease 2019 (COVID-19), Health services, Healthcare access, Hospice and palliative care, Medicare, Quality
  
• Changes in Rural Health Insurance Coverage, 2019-2024
  This project uses secondary data sources to characterize changes in health insurance coverage during 2019-2024 for rural and urban people. The analysis will focus on changes associated with demographic, economic (particularly employment), and geographic characteristics, and will describe how exogenous changes (e.g., the economy, pandemic) as well as changes in federal policies impacted coverage.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Healthcare access, Healthcare financing, Medicaid and CHIP, Medicare, Private health insurance, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured, Workforce
  
• Comparing Care-Seeking Patterns Among Rural Medicare Fee-for-Service and Medicare Advantage Beneficiaries
  This study uses national Medicare claims and encounter data to compare how often rural traditional Medicare and Medicare Advantage beneficiaries bypass their nearest hospital or primary care provider, how far they travel, and how these care-seeking patterns vary by plan type and region.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Aging, Critical Access Hospitals (CAHs), Health services, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare, Medicare Advantage (MA), Quality, Rural statistics and demographics
  
• Did Hospitals That Converted to Rural Emergency Hospital (REH) Avoid Closure?
  The goal of the Rural Emergency Hospital (REH) is to preserve access to essential services for rural residents, and to decrease the likelihood of hospital closures; some worry that the REH offers an option for otherwise financially strong hospitals to shed services. This study will investigate whether hospitals that converted to an REH in 2023 and 2024 would have likely closed in the absence of the REH designation.
  Research center: North Carolina Rural Health Research Center
  Topics: Healthcare access, Healthcare financing, Hospitals and clinics, Medicare, Rural Emergency Hospitals (REHs)
  
• Do Standby Costs and Low Patient Volume Affect the Financial Viability of Rural Hospitals?
  Rural hospitals face high fixed costs spread over low patient volumes, raising per-case costs and threatening financial sustainability. This study estimates the "low-volume premium" and examines whether standby costs and patient volume predict rural hospital closures nationally.
  Research center: North Carolina Rural Health Research Center
  Topics: Hospitals and clinics, Medicare
  
• Evaluating the Variation in Rural and Urban Hospital Wages and Wage Index Pre- and Post-COVID-19 Pandemic
  The primary purpose of the wage index is to address the differences in labor costs that hospitals experience based on their geographical location.
  Research center: North Carolina Rural Health Research Center
  Topics: Healthcare financing, Hospitals and clinics, Medicare, Workforce
  
• Examining Post-Acute Care Utilization and Outcomes for Rural Medicare FFS and Medicare Advantage Beneficiaries
  This study will describe differences in post-acute care utilization and post-discharge outcomes between rural Medicare Fee-for-Service beneficiaries and rural Medicare Advantage beneficiaries overall, by region of the country, and levels of rurality.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Care management, Critical Access Hospitals (CAHs), Healthcare access, Home health, Medicare, Medicare Advantage (MA), Post-acute care
  
• Exploring Rural and Urban Medicare Beneficiaries' Use of Home Health Services
  This study maps the geographic distribution of home health services provided to Medicare fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries and assesses how these patterns align with Medicare-approved home health agencies' service areas.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Aging, Chronic diseases and conditions, Home health, Medicare, Medicare Advantage (MA), Post-acute care
  
• Financial Consequences of Growth in the Number of Rural Referral Centers
  Since Centers for Medicare & Medicaid Services amended its regulations to allow hospitals in urban areas to reclassify as rural, over 400 hospitals have obtained status as a Rural Referral Center. This project will estimate the costs to hospital Medicare payment and profitability.
  Research center: North Carolina Rural Health Research Center
  Topics: Healthcare financing, Hospitals and clinics, Medicare
  
• Health Care Spending in Rural vs. Urban U.S. by Health Condition
  Health care spending patterns vary substantially between rural and urban areas in the U.S. This project will examine detailed health care spending patterns using insurance claim data in U.S. counties by specific health conditions across the rural-urban continuum.
  Research center: WWAMI Rural Health Research Center
  Topics: Chronic diseases and conditions, Health services, Healthcare access, Healthcare financing, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Pharmacy and prescription drugs, Private health insurance, Quality
  
• Identifying Characteristics Associated With Rural and Urban Medicare Beneficiaries Bypassing Local Skilled Nursing Facilities for Post-Acute Care
  This project will compare how often rural versus urban beneficiaries receive post-acute care from skilled nursing facilities (SNFs) outside of their local communities, and which patient, provider, and community characteristics are associated with bypass of local SNFs, informing policies to support SNFs in rural communities.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Healthcare access, Long-term care, Medicare, Post-acute care
  
• Marriage and Family Therapist and Mental Health Counselor Training Programs
  This study will examine the national geographic distribution of marriage and family therapists and mental health counselors training programs, characterize variation in state training requirements, and assess the extent to which programs incorporate rural-specific curricula or clinical rotations.
  Research center: WWAMI Rural Health Research Center
  Topics: Healthcare access, Medicare, Mental and behavioral health, Workforce
  
• Medicare Disproportionate Share Hospital and Uncompensated Care Payments Since the ACA
  This project will compare Disproportionate Share Hospital payments and uncompensated care payments to rural and urban hospitals for the years 2013-2022.
  Research center: North Carolina Rural Health Research Center
  Topics: Medicare, Medicare Prospective Payment System (PPS)
  
• MOUD Treatment Utilization by Medicaid Beneficiaries Across Rurality and in RCORP vs. Non-RCORP Counties
  Rural Communities Opioid Response Program (RCORP) has invested substantially in expanding access to medications for opioid use disorder (MOUD) in rural communities. This study will assess MOUD utilization among Medicaid beneficiaries with opioid use disorder across the rural-urban spectrum and compare access, treatment rates, and travel burden in RCORP-funded versus non-RCORP counties.
  Research center: WWAMI Rural Health Research Center
  Topics: Healthcare access, Medicaid and CHIP, Medicare, Transportation
  
• Payer Mix of Rural Health Clinics and Federally Qualified Health Centers
  This project will assess the payer mix of the more than 5,000 Rural Health Clinics and 1,400 Federally Qualified Health Center grantees throughout the country. The analysis will include assessing trends over time and across types and ownership for RHCs and across regions for FQHCs.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Federally Qualified Health Centers (FQHCs), Medicaid and CHIP, Medicare, Private health insurance, Rural Health Clinics (RHCs), Uninsured and underinsured
  
• Rural Access to Infusion Services: A Geographic Analysis of Service Availability
  Infusion services are increasingly used to treat cancer and other chronic conditions, yet rural access remains poorly understood. This project will examine where rural and urban Medicare beneficiaries receive infusion services and quantify rural travel burden, including distance and travel time, across infusion types and settings.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Cancer, Health services, Healthcare access, Medicare, Transportation
  
• Rural and Urban Sepsis Outcomes as a Measure of Health Care Quality: A Nationwide Comparative Analysis Using HCUP Data
  This study examines differences in sepsis prevalence, outcomes, costs, and treatment between rural and urban hospitals using the HCUP Nationwide Readmissions Database. It aims to inform policies related to access to timely, high-quality sepsis care and identify strategies to enhance healthcare outcomes across diverse hospital settings.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Care management, Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Healthcare access, Hospitals and clinics, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Private health insurance, Quality, Social determinants of health
  
• Rural Dementia Spending and Workforce Supply
  This project will estimate the rural and urban supply of dementia care specialists in the U.S. and examine differences health care spending patterns for dementia across the rural-urban continuum using claims and facility records data.
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Health services, Healthcare access, Medicaid and CHIP, Medicare, Nurses and nurse practitioners, Physicians, Workforce
  
• Rural-Urban Differences in Health and Health Care Use Among Medicare Beneficiaries Under 65
  Information is urgently needed about the health and health care access characteristics of Medicare beneficiaries under 65, in order to best allocate resources to meet their needs. This project will examine characteristics and health care use among rural and urban Medicare beneficiaries under 65, and explore challenges and opportunities regarding rural residents younger than 65 applying for and accessing Medicare.
  Research center: University of Minnesota Rural Health Research Center
  Topics: Chronic diseases and conditions, Healthcare access, Medicare, Rural statistics and demographics, Social determinants of health
  
• Rural-Urban Differences in Medicare Supplemental Insurance Coverage
  This study analyzes rural-urban differences in Medicare supplemental coverage using 2015-2024 Medicare Current Beneficiary Survey data. It examines current patterns and trends in Medicare Advantage and Fee-for-Service supplemental enrollment, exploring demographic and health factors influencing coverage differences.
  Research center: Northeast Rural Health Research Center
  Topics: Aging, Health services, Healthcare access, Healthcare financing, Medicare, Medicare Advantage (MA), Rural statistics and demographics, Social determinants of health, Uninsured and underinsured
  
• Rural/Urban Differences in Forgoing Health Care During the COVID-19 Pandemic
  Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped healthcare services during the initial months of the COVID-19 pandemic. This study examines changes in healthcare utilization for primary and preventative care among rural and urban Medicare fee-for-service enrollees since the COVID-19 pandemic.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Aging, Care management, Chronic diseases and conditions, Coronavirus Disease 2019 (COVID-19), Diabetes, Health promotion and disease prevention, Health services, Medicare, Mental and behavioral health, Telehealth
  
• Screening, Brief Intervention and Referral to Treatment (SBIRT) Penetration in Rural vs. Urban Healthcare Settings in the U.S.
  This study will include an analysis of 2018/2019 Medicare, Medicaid and Commercial claims to compare the penetration of Screening, Brief Intervention and Referral to Treatment (SBIRT) and its different components in rural compared to urban healthcare settings. Within the overarching analysis, the study team will examine the type of interventions conducted within the SBIRT framework stratified by provider type, healthcare setting, and rural and urban provider ZIP codes. Findings will be analyzed within the context of county-level substance use rates, historical enactment of state SBIRT billing codes, overdoses, and alcohol poisoning-based hospital admissions contrasting trends in SBIRT administration with a proxy for community need.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Chronic diseases and conditions, Health promotion and disease prevention, Medicaid and CHIP, Medicare, Mental and behavioral health, Private health insurance, Public health, Substance use and treatment
  
• The Changing Landscape of Medicare Advantage in Rural America
  The recent rapid growth in Medicare Advantage (MA) enrollment, particularly in counties with very little previous activity, has made MA a "hot issue" in rural health policy. This project will provide deeper knowledge of the MA marketplace including the firms offering MA plans and the beneficiaries who are enrolling.
  Research center: RUPRI Center for Rural Health Policy Analysis
  Topics: Healthcare financing, Medicare, Medicare Advantage (MA)
  
• Usual Source of Primary Care for Rural Medicare Beneficiaries Before and During COVID-19
  The global pandemic was highly disruptive to existing health care use patterns, potentially affecting rural America more than urban communities. This study will describe the usual sources of primary care (USC) for rural Medicare beneficiaries before and during COVID-19 to provide insight into how COVID-19 affected USC of Medicare beneficiaries.
  Research center: North Carolina Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Healthcare access, Hospitals and clinics, Medicare, Rural Health Clinics (RHCs)
  
• Utilization of Medicare Care Management Codes
  This study assesses the adoption of Medicare care management billing codes among rural and urban providers and the extent to which rural Medicare beneficiaries access these services. Using 2024 Medicare fee-for-service claims and provider data, this study will analyze trends in provider participation and utilization by service type, region, and rurality.
  Research center: ETSU/NORC Rural Health Research Center
  Topics: Care management, Federally Qualified Health Centers (FQHCs), Health services, Medicare, Rural Health Clinics (RHCs), Social determinants of health