Medicare

Research Products

Listed by publication date. You can also view these publications alphabetically.

2019

  • Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 06/2019
    The purpose of this study is to investigate cost barriers to accessing care at Federally Qualified Health Centers and Rural Health Clinics for the rural Medicare population.
  • Unmet Need for Personal Care Assistance among Rural and Urban Older Adults
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2019
    This brief presents data on rural-urban differences in unmet need for personal care among older adults with functional limitations.
  • 2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 05/2019
    This brief characterizes rural/urban disparities in the 2019 Centers for Medicare & Medicaid Services hospital wage index by describing and comparing the wage indices of rural and urban hospitals by the number of beds, the amount of net patient revenue, and Medicare payment classification.
  • Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 05/2019
    This brief describes the geographic variation of the 2019 Centers for Medicare & Medicaid Services hospital wage index by rural/urban definition, census region, Frontier and Remote Area codes and state.
  • Differences in Care Processes Between Community-Entry Versus Post-acute Home Health for Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2019
    This study describes home healthcare processes for rural Medicare beneficiaries who are admitted from the community (community-entry) versus those who are admitted following an inpatient stay (post-acute). Care processes include timely initiation of care, length of stay, and services provided (e.g., physical therapy, medical social work).
  • Medicare Advantage Enrollment Update 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2019
    This annual report on Medicare Advantage (MA) enrollment shows growth in the program in nonmetropolitan and metropolitan areas. The rate of metro enrollment is higher than in nonmetro areas, but the growth rate in the nonmetropolitan population is higher. There are also significant differences in metro/nonmetro MA enrollment by plan type.
  • Facility-Based Ambulatory Care Provided to Rural Medicare Beneficiaries in 2014
    Chartbook
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2019
    This chartbook uses available Medicare claims data to describe facility-based (i.e., excludes private practitioners) ambulatory care provided to rural Medicare beneficiaries and includes claims, costs, and common diagnoses.
  • Do Hospital Closures Affect Patient Time in an Ambulance?
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2019
    Our study explores how a local hospital closure changes patient time in an ambulance for 9-1-1 calls. Access to emergency department services in communities, especially rural communities, persists as a priority for the Medicare program. We found when hospitals close, rural patients requiring ambulance services are disproportionately affected.

2018

2017

  • Differences in Community Characteristics of Sole Community Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2017
    The purpose of this brief is to: 1) present a snapshot of SCHs4 and the communities served by them in 2015 (cross-sectional analysis) and 2) identify some trends in selected SCH and community characteristics between 2006 and 2015 (longitudinal analysis).
  • Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 10/2017
    Ambulance services are at risk of scaling back or dissolving in some places. We analyzed Medicare beneficiaries’ use of ambulance services across the U.S. Improved understanding of how beneficiaries, most of whom are elderly, use these services provides vital information for policymakers who set rules and regulations about access to the services.
  • Rural-Urban Variations in Medicare Live Discharge Patterns from Hospice, 2012-2013
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 09/2017
    This brief 1) provides an overview of the geographic distribution of “freestanding” (i.e., rather than those co-located in a hospital, home health agency, or skilled nursing facility) rural and urban hospices and, 2) explores live discharge rates for hospices operating in rural versus urban areas.
  • Differences in Medicare Service Use in the Last Six Months of Life among Rural and Urban Dual – Eligible Beneficiaries
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    In this brief, we compare rural and urban dual-eligible beneficiaries to Medicare-only beneficiaries in their service utilization in the last six months of life. Within rural beneficiaries, we further explore differences associated with race/ethnicity.
  • 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.
  • Rural-Urban Differences in Medicare Service Use in the Last Six Months of Life
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    This brief focuses on the current status of healthcare use during the last six months of life among Medicare beneficiaries. We used data from a sample of Medicare beneficiary claims to assess whether service utilization differed between rural and urban decedents and across decedents of different race/ethnicity categories.
  • Transitions in Care Among Rural Residents with Congestive Heart Failure, Acute Myocardial Infarction, and Pneumonia
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    Rural and urban hospitals vary with regard to the levels of care they are able to provide, requiring that a subset of patients be transferred from the first point of encounter to a second facility. The degree to which inter-hospital transfers occur, and the outcomes for transfer patients, have not been studied across rural and urban institutions.
  • The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2017
    This brief describes Medicare post-acute and hospice care provided by hospitals in rural areas by characterizing the variation in the number of rural hospitals that provide PAC and hospice care, the average amount of Medicare revenue rural hospitals receive for these services, and the financial importance of PAC and hospice care to rural hospitals.
  • CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars is the Problem
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 06/2017
    The purpose of this brief is to look more closely at the characteristics of rural hospitals with and without CMS Hospital Quality Star Ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.

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.
  • Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2016
    Outcomes of care vary by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions such as heart failure. Those in the East South Central and West South Central Census Divisions had lower rates of community discharge and higher rates of hospital readmission and emergency department use.
  • Spread of Accountable Care Organizations in Rural America
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2016
    This brief updates a RUPRI Center analysis of the presence of Medicare Accountable Care Organizations (ACOs) in rural areas of the US 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.
  • 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.
  • Characteristics of Medicaid Beneficiaries Who Use Rural Health Clinics
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2016
    The RHC role varies by state. While we don’t have an understanding of what this looks like for each state, we can see that RHCs are an important provider for Medicaid beneficiaries. One of the most important differences is by age groups. All states tend to cater RHC services toward children, with a minimum of 39% of the RHC population < 18.
  • Identifying Rural Health Clinics in Medicaid Data
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2016
    Identifying RHCs in Medicaid claims across states is challenging, but this brief recommends methods for identifying the majority of these claims in four states.
  • Medicare Costs and Utilization Among Beneficiaries in Rural Areas
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 03/2016
    This study assesses the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum. It also examines the relationships between rural beneficiaries’ service utilization and healthcare delivery market structure and evaluates strategies and policies to address high costs in rural areas.
  • Access to Rural Home Health Services: Views from the Field
    Report
    WWAMI Rural Health Research Center
    Date: 02/2016
    Access to home health care can be challenging for rural Medicare clients. Key informants for this study detailed obstacles, including financial, regulatory, workforce, and geographic issues. Rural communities will likely benefit from payment reforms that reward quality services while providing incentives to use best practices in home health care.
  • 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.

2015

  • Estimated Costs of Rural Freestanding Emergency Departments
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2015
    A rural freestanding emergency department (RFED) is one potential model for providing emergency services in areas where hospitals have closed. The North Carolina Rural Health Research Program’s Findings Brief, Estimated Costs of Rural Freestanding Emergency Departments explains the RFED concept and estimates RFED costs in three scenarios.
  • 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.
  • Rural Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    Most beneficiaries seek added coverage to close the gap between the care they need and the costs covered by Medicare. This study evaluated rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service.
  • Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    The Hospital Readmissions Reduction Program reduces Medicare payments for hospitals with excess rates of patient readmissions for certain conditions. It assesses rural/urban differences in the proportion of hospitals penalized under the program over time and whether condition-specific hospital readmission rates differ for rural/urban hospitals.
  • Post-discharge Rehabilitation Care Delivery for Rural Medicare Beneficiaries with Stroke
    Policy Brief
    Rural and Minority Health Research Center
    Date: 09/2015
    Provision/type of post-discharge rehab care (PDRC) received by stroke survivors by rurality and race/ethnicity are examined as are the distances between their homes and the discharge hospitals related to the type of PDRC recommended. The brief also looks at whether factors such as initial hospital admission relate to the PDRC provision/type.
  • Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2015
    To inform policy discussions on how complex current payment models may affect rural hospitals, the North Carolina Rural Health Research Program studied differences in financial condition among rural hospitals and important determinants of differences in rural hospital costs.
  • 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.

2014

2013

  • Rural/Urban Differences in Inpatient Related Costs and Use among Medicare Beneficiaries
    Rapid Response to Requests for Rural Data Analysis
    Date: 12/2013
    Medicare beneficiaries who are admitted to rural hospitals tend to have lower outpatient costs than their counterparts at urban hospitals. The differences are due to multiple factors. The analysis suggests that consideration of the total cost of an acute episode of care might be considered, not just the cost of the acute inpatient stay.
  • Geographic Variation in the Profitability of Critical Access Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2013
    This study describes geographic variation in the profitability of Critical Access Hospitals (CAHs) in 2012 to understand some of the regional differences in the potential effects of implementing policy proposals impacting CAHs.
  • March 2013: Medicare Advantage Update
    Rapid Response to Requests for Rural Data Analysis
    Date: 09/2013
    This policy brief discusses current rural Medicare Advantage enrollment data.
  • Profitability of Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2013
    This study compares the profitability between 2010 and 2012 of urban and rural hospitals paid under the Medicare Prospective Payment System (U-PPS and R-PPS, respectively) to rural hospitals with special Medicare payment provisions.
  • 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.
  • 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.
  • Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2013
    This brief presents a summary of the geographic distribution and clinic-level characteristics of rural health clinics, as well as an overview of the Medicare beneficiaries they served.
  • 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.

2012

2011

2010

2009

  • 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.
  • 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.
  • 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 (PPO) 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.
  • Rural Issues Related to Bundled Payments for Acute Care Episodes
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009
    Bundling Medicare payments has been proposed as a way of encouraging providers to find innovative, cost-reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address the challenges.
  • 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.
  • Medicare Beneficiaries' Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2009
    This report describes the contracting patterns of sole rural community pharmacies to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.

2008

2006

  • 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.
  • A Primer on the Occupational Mix Adjustment to the Medicare Hospital Wage Index
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2006
    This paper focuses on the occupational mix adjustment (OMA) to the labor-related share in the hospital inpatient prospective payment system. The primer explains what the OMA is, why it is needed, and how it has been calculated. In addition, reasons why the effect of the OMA has been less than some rural advocates anticipated are discussed.
  • Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes
    NORC Walsh Center for Rural Health Analysis
    Date: 05/2006
    This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes and to ascertain whether there are agency characteristics that are associated with better or worse outcomes.

2005

2004

2003

2002

2001

2000