Medicare

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2023

  • Medicare Advantage Enrollment Update 2022
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 01/2023
    The 2022 report continues the RUPRI Center's annual series of Medicare Advantage (MA) enrollment updates. In addition to tracking overall and nonmetropolitan/metropolitan enrollment, this brief also reports on changes in enrollment in types of MA plans and considers policy changes from previous years that may have impacted MA plan enrollment.

2022

  • Characteristics of Rural Hospitals Eligible for Conversion to Rural Emergency Hospitals and Three Rural Hospitals Considering Conversion
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 12/2022
    This brief presents 2021 data for Rural Emergency Hospital (REH)-eligible hospitals, compares financial and operational measures of three rural hospitals that have expressed interest in REH conversion to all REH-eligible hospitals, and discusses what factors may ultimately determine the number of rural hospitals that convert to REH.
  • The Evolution of Hospital Designations and Payment in the U.S.: Implications for Rural Hospitals
    Report
    RUPRI Center for Rural Health Policy Analysis, RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 12/2022
    Medicare hospital payment policies affecting rural hospitals play a significant role in the financial viability of rural hospitals. This report provides an overview of historic and current Medicare rural hospital payment policies and alternative payment models to understand their impact on rural hospitals and the communities they serve.
  • An Insurance Profile of Rural America: Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2022
    Over the past decade, health insurance coverage has changed in major ways in rural areas with shifts towards public and publicly subsidized coverage among the nonelderly – Medicaid, Marketplace plans – and a shift towards Medicare Advantage among those eligible for Medicare. This chartbook describes these trends in detail.
  • Patterns of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2022
    This study examines rural-urban differences in health care use among Medicare beneficiaries age 85+.
  • Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2022
    This study examines differences between patients discharged to swing beds versus skilled nursing facilities, stratifying by admitting hospital type (i.e., rural Critical Access Hospital versus rural Prospective Payment System hospital).
  • The impact of Medicare Shared Savings Program Participation on Hospital Financial Performance: An Event-Study Analysis
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2022
    This study evaluated the extent to which Medicare Shared Savings Program participation affected hospital financial outcomes, including patient revenue, operating margin, different revenue source shares, and allowance and discount rate.
  • Key Considerations for a Rural Hospital Assessing Conversion to Rural Emergency Hospital
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2022
    Based on findings from a literature review and consultation with practitioners, a conceptual framework and checklist were developed to organize and guide conversations about key considerations for conversion to a Rural Emergency Hospital.
  • Small Rural Hospitals with Low-Volume Emergency Departments that May Convert to a Rural Emergency Hospital (REH)
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2022
    This study profiles rural hospitals eligible to convert to Rural Emergency Hospitals. The objective is to characterize rural hospitals with very low emergency department volume to inform the clinical and operational decisions that will be required to implement this new provider model.
  • Nursing Homes in Rural America: A Chartbook
    Chartbook
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2022
    Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties.
  • Types of Rural and Urban Hospitals and Counties Where They Are Located
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 07/2022
    The purpose of this brief is to provide a snapshot of the types of rural and urban hospitals and the counties where they are located.
  • Medicare Accountable Care Organization Characteristics Associated with Participation in 2‐sided Risk
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2022
    This study examined the associations of accountable care organization (ACO) characteristics with the likelihood of participation in 2-sided risk tracks in the Medicare Shared Savings Program. Small and rural ACOs were found to be less prepared to transition into 2-sided risk tracks than their urban counterparts.
  • Trends in Revenue Sources Among Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2022
    Possible issues with existing rural hospital financing models suggest that outpatient-centric payment methods may be more effective in providing financial relief to rural hospitals. Given this, we explored the financial importance of outpatient care to rural hospitals by estimating changes in outpatient care as a source of revenue.
  • Predictors of Hospital Choice Among Rural Patients Seeking Elective Surgery: A Scoping Review
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2022
    The purpose of this scoping review was to identify literature describing determinants of hospital choice among rural patients seeking elective surgery.
  • The Economic Effects of Rural Hospital Closures
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2022
    This study updates previous research (Holmes, et al. 2006) on the economic effects of rural hospital closures by measuring the economic changes over time among U.S. rural counties that had a hospital closure from 2001-2018.
  • Rural Hospital Profitability During the Global COVID-19 Pandemic Requires Careful Interpretation
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 03/2022
    Many small rural hospitals struggle with profitability compared to their urban counterparts. The findings brief describes the pre-pandemic (2011-19) trend of rural hospital profitability and explains why possible increases in reported profitability during the pandemic (2020-21) may mask the long-term financial challenges of rural hospitals.
  • Contact by Collection Agencies for Medical Debt: Rural-Urban Differences Among Older and Younger Medicare Beneficiaries
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2022
    This study uses data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries) to understand the impact of medical debt for rural residents. The study analyzed rural-urban differences in rates of collection agency contact for unpaid medical bills.
  • Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2022
    This policy brief describes the quality of home health agencies (HHAs) by rural-serving status. While quality of patient care star ratings were not associated with rural-serving status, rural HHAs and urban HHAs that serve rural patients had higher patient experience star ratings than urban HHAs that do not serve rural patients.
  • Quality of Skilled Nursing Facilities Serving Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2022
    This policy brief describes the quality of skilled nursing facilities (SNFs) by rural-serving status. While overall star ratings and staffing star ratings were not associated with rural-serving status, rural SNFs and urban SNFs that serve rural patients had lower quality star ratings compared to urban SNFs that do not serve rural patients.
  • Rural Hospitals that Closed between 2017‐20: Profitability and Liquidity in the Year Before Closure
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 01/2022
    This brief examines the preclosure profitability and liquidity performance of rural hospitals that closed between 2017‐20 and compare it to the median performance of rural hospitals that remained open during the same year.

2021

  • 2021 CMS Hospital Quality Star Ratings of Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 10/2021
    The purpose of this study is to 1) compare the 2021 CMS Hospital Quality Star Rating results for rural and urban hospitals, 2) to compare the 2021 and 2016 CMS Hospital Quality Star Rating results for rural hospitals, and 3) to identify implications for the usefulness of the CMS Hospital Quality Star Ratings for rural hospitals.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries: A National Study
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2021
    Using national data from 2014, this policy brief describes geographic variation in the mix of providers caring for rural versus urban Medicare beneficiaries, the quantity of visits received by beneficiaries across Census Divisions and types of rural areas, and the distance traveled for care for several serious conditions.
  • Medicare Advantage Enrollment Update 2021
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2021
    The RUPRI Center's annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. However, between 2020 and 2021 the rate of growth in nonmetropolitan counties was more than twice as large as that in metropolitan counties.
  • Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2021
    The purpose of this brief is to describe differences in Medicare Outpatient Prospective Payment System (OPPS) payments between rural and urban hospitals by Medicare payment classification and by number of acute beds.
  • How Many Hospitals Might Convert to a Rural Emergency Hospital?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2021
    In this study, three measures were used to predict the number of rural hospitals with 50 beds or less that are likely to consider conversion to a Rural Emergency Hospital: 1) three years negative total margin; 2) average daily census (acute + swing) less than three; and 3) net patient revenue less than $20 million.
  • Medicare Advantage Enrollment Update 2020
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 05/2021
    This annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. The percent of nonmetropolitan MA enrollees in Health Maintenance Organization (HMO) plans has increased every year since 2017. Metropolitan HMO enrollment has decreased every year since 2016.
  • Medicare-Paid Naloxone: Trends in Nonmetropolitan and Metropolitan Areas
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 05/2021
    Naloxone is an opioid overdose reversal medication. Medicare beneficiaries benefit from access to naloxone because they have high rates of high-dose prescription opioids. This brief examines trends in Medicare-paid naloxone dispensing rates in nonmetropolitan versus metropolitan areas from 2014 to 2018.
  • Geographic Access to Health Care for Rural Beneficiaries in Five States: An Update
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2021
    Using data from five states, this study describes the mix of providers caring for rural Medicare beneficiaries, the quantity of care received, and how far rural beneficiaries traveled for care for several selected conditions in 2014. Results are also compared with a similar study of the same states that used data from 1998.
  • Spatial Analysis of Healthcare Utilization Among Medicare Beneficiaries with Coal Workers' Pneumoconiosis and Other Related Pneumoconiosis
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 04/2021
    Miners risk developing coal workers' pneumoconiosis (black lung disease) and other pneumoconiosis. This study determines, maps, and analyzes the spatial patterns of healthcare utilization among Medicare beneficiaries with black lung disease and other related pneumoconiosis using the Medicare beneficiaries Limited Data Set from 2011-2014.
  • The Effect of Medicare Payment Standardization Methods on the Perceived Cost of Post-Acute Swing Bed Care in Critical Access Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2021
    The purpose of this study is to describe the effects of current Medicare payment standardization methods on the perceived cost of Critical Access Hospital swing bed care as it relates to the Medicare Spending per Beneficiary measure.
  • Post-acute Care Trajectories for Rural Medicare Beneficiaries: Planned versus Actual Hospital Discharges to Skilled Nursing Facilities and Home Health Agencies
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2021
    This policy brief describes trajectories for rural Medicare beneficiaries following hospital discharge, including differences between planned and actual discharge to skilled nursing facilities and home health agencies. More than 40% of beneficiaries for whom home health care was indicated did not receive care from a home health agency.
  • Alternatives to Hospital Closure: Findings from a National Survey of CAH Executives
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2021
    Despite the many challenges of operating a Critical Access Hospital (CAH), little research examines the perspectives of CAH executives on potential community healthcare options if the CAH closed. This brief provides policymakers with a better understanding of what CAH executives think about the viability of various alternatives to closure.
  • Health System Challenges for Critical Access Hospitals: Findings from a National Survey of CAH Executives
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2021
    Despite the numerous challenges of operating a Critical Access Hospital (CAH), there is little research examining the perspectives of CAH executives on potential community healthcare options if the CAH closed. This brief presents a subset of results from a national survey of CAH executive perspectives on pressing challenges.
  • High-Functioning Rural Medicare ACOs – A Qualitative Review
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2021
    This brief identifies common success factors among four high-performing rural Medicare Accountable Care Organizations.
  • Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 01/2021
    This paper advances policy discussion of population health in rural places, focusing on the role of rural healthcare organizations. Lessons from ongoing programs provide policy considerations. Medicare and Medicaid programs should prioritize staff and infrastructure development, flexibility in covered benefits, and further expansion of telehealth.
  • Barriers to Health Care Access for Rural Medicare Beneficiaries: Recommendations from Rural Health Clinics
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 01/2021
    This brief presents findings from an online survey of Rural Health Clinics describing barriers for Medicare patients in accessing healthcare services and recommendations for how to improve access to care for Medicare beneficiaries in rural areas.
  • Characteristics and Challenges of Rural Ambulance Agencies – A Brief Review and Policy Considerations
    Report
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 01/2021
    There are 23,272 ambulance agencies in the U.S., and 73% of those agencies report serving rural areas. This paper examines current rural ambulance agency characteristics and challenges and identifies public policy considerations designed to stabilize rural ambulance agencies.

2020

  • Association of CMS‐HCC Risk Scores with Health Care Utilization Among Rural and Urban Medicare Beneficiaries
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2020
    The study examines the relationship between Centers for Medicare & Medicaid Services Hierarchical Condition Categories risk scores and future healthcare utilization among rural and urban Medicare beneficiaries.
  • CMS Hierarchical Condition Category 2014 Risk Scores Are Lower for Rural Medicare Beneficiaries than for Urban Beneficiaries
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2020
    The study investigates potential differences in rural and urban Centers for Medicare & Medicaid Services Hierarchical Condition Category risk scores by rurality, census region, and beneficiary race or ethnicity.
  • Decline in Inpatient Volume at Rural Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2020
    This study examined inpatient volume in rural hospitals between 2011 and 2017. Patient population and the organizational and geographic characteristics of hospitals that were significant predictors of inpatient volume included census region, Medicare payment type, ownership type, total margin, and percent of the population in poverty.
  • Rural Hospitalizations for COVID-19: Snapshot on December 10, 2020
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 12/2020
    U.S. Department of Health and Human Services data were analyzed to compare rural and urban hospitals on two metrics: 1) the percentage of hospitalized patients with COVID-19, and 2) the percentage of hospital beds occupied by patients that have COVID-19.
  • Rural Hospitals Have Higher Percentages of Patients with COVID-19
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 12/2020
    U.S. Department of Health and Human Services data were analyzed to compare the percentage of hospitalized patients with COVID-19 in rural versus urban hospitals.
  • Medicare Advantage Enrollment Update 2019
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 10/2020
    The annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. However, the rate of growth has been higher in nonmetropolitan counties for the past two years. Local Preferred Provider Organization plans account for nearly half of nonmetropolitan MA enrollment.
  • A Comparison of Rural and Urban Specialty Hospitals
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 09/2020
    This brief describes key differences between specialty hospitals located in rural versus urban areas.
  • Urban Hospitals with a High Percentage of Inpatient Days for Rural Patients
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2020
    The purpose of this brief is to describe characteristics of urban hospitals with a high percentage of inpatient days for rural patients and to compare how they differ from urban hospitals with lower percentages of rural inpatient days.
  • Comparing the Health Workforce Provider Mix and the Distance Travelled for Mental Health Services by Rural and Urban Medicare Beneficiaries
    Journal Article
    WWAMI Rural Health Research Center
    Date: 08/2020
    This study used 2014 administrative Medicare claims data to describe the mix of health professionals who care for rural and urban patients with mood and/or anxiety disorders. It further describes where these beneficiaries received care and the one-way distance (miles) and time (minutes) they travelled to receive it.
  • Changes in Care-Seeking after Rural Hospitals Merge
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2020
    Rural hospital mergers have increased significantly since 2010. Enhanced financial performance and improved quality are often cited as benefits, but hospital mergers can also lead to changes in the services provided by acquired hospitals. This brief estimates the use of inpatient services delivered by acquired rural hospitals following a merger.
  • Rural/Urban Disparities in the Utilization of Health and Behavioral Assessments/Interventions in the Fee-for-Service Medicare Population
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 06/2020
    Identifying behaviors that contribute to disease and modifying them can be an important step in treatment. This study investigated geographic disparities and the availability of Health and Behavioral Assessments and Interventions services in rural and urban areas by examining fee-for-service Medicare beneficiaries in 2012-2016.
  • Rural/Urban Disparities in Utilization of Diabetes Self-Management Training to the Fee-for-Service Medicare Population
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 06/2020
    Diabetes self-management training (DSMT) is recommended for all newly diagnosed patients with diabetes. However, the utilization rate of DSMT is low, and geographic disparities in availability exist. This study sought to identify the extent of the rural/urban disparity in the provision of DSMT to fee-for-service Medicare beneficiaries in 2012-2016.
  • Rural/Urban Disparities in Utilization of Medical Nutrition Therapy to the Fee-for-Service Medicare Population
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 06/2020
    Medical Nutrition Therapy (MNT) is important in the treatment of many chronic conditions, but the availability of MNT in rural versus urban communities has not been examined. This study sought to identify the availability of MNT in rural and urban communities by examining Medicare fee-for-service beneficiaries in 2012-2016.
  • Differences by Rurality in Satisfaction with Care Among Medicare Beneficiaries
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2020
    There are stark differences between rural and urban areas in demographic characteristics, health status, and healthcare. Yet less is known about rural‐urban differences in Medicare beneficiaries' satisfaction with care. We seek to understand rural‐urban differences in satisfaction with care for Medicare beneficiaries.
  • Estimated Reduction in CAH Profitability from Loss of Cost‐Based Reimbursement for Swing Beds
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2020
    The purpose of this study was to estimate the impact of potential loss of cost-based reimbursement for swing beds on Critical Access Hospital (CAH) profitability and to examine the characteristics of CAHs that would be most affected by such a change in reimbursement.
  • Most Rural Hospitals Have Little Cash Going into COVID
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2020
    This infographic uses Medicare Cost Report data to illustrate the type of rural hospitals most likely to struggle financially during the pandemic as measured by lower median days cash on hand.
  • 2016-18 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2020
    This study compares the 2016-18 profitability of urban Prospective Payment System (PPS) hospitals to that of rural hospitals. Rural hospitals are further divided by size of rural PPS hospitals and by the rural Medicare payment classifications.
  • Patterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2020
    Hospital bypass, the tendency of local rural residents to not seek care at their closest hospital, is thought to be a contributing factor for rural hospital closure. The purpose of this brief is to update the knowledge base of determinants of bypass behavior by analyzing state inpatient data from 2014-2016.
  • 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.
  • Rural Hospitals with Long-Term Unprofitability
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2020
    The purpose of this study is to examine the characteristics of rural hospitals that had negative total margins in 2016, 2017, and 2018. We examined net patient revenue, Medicare payment classification, region, and state for 311 rural hospitals.
  • Understanding the Broader Context of Rural Hospitals and Profitability
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2020
    The intent of this infographic is to quantify rural hospital profitability in the broader context of all hospitals. This infographic compares the number of rural and urban hospitals and rural and urban operating revenue and operating income.
  • Occupancy Rates in Rural and Urban Hospitals: Value and Limitations in Use as a Measure of Surge Capacity
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2020
    The purpose of this brief is to provide healthcare leaders and policymakers with information about historic occupancy rates (the percent of available beds that are occupied) as an input for state and system-level planning to manage population health during a pandemic.
  • Variation in Use of Home Health Care Among Fee-for-Service Medicare Beneficiaries by Rural-Urban Status and Geographic Region: Assessing the Potential for Unmet Need
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2020
    This study describes use of home healthcare by rural-urban status and geographic region. Findings suggest geographic region drives variation more than rural-urban status. Unmet need may be highest in the most remote rural counties and rural counties within the West North Central, East North Central, Mountain, and Pacific Census Divisions.
  • Health Care Use and Access Among Rural and Urban Nonelderly Adult Medicare Beneficiaries
    Policy Brief
    Maine Rural Health Research Center
    Date: 01/2020
    Little is known about the characteristics and healthcare use of rural residents with disabilities. This study compares access to and use of health services among rural and urban nonelderly Medicare beneficiaries with a disability and the factors associated with rural access issues.

2019

  • Access and Capacity to Care for Medicare Beneficiaries in Rural Health Clinics
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to timely, high-quality healthcare is essential for health, but rural areas face particular barriers to access, including for primary care. We present findings from an online survey of RHCs describing clinic characteristics related to healthcare access for rural Medicare beneficiaries.
  • Access to Specialty Care for Medicare Beneficiaries in Rural Communities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to care is a challenge in many rural communities for both primary care services and specialty care services. We present findings from an online survey of Rural Health Clinics describing access issues for rural Medicare beneficiaries in seeking care from specialty care providers.
  • Impact of the Medicare Disproportionate Share Hospital Payment Cap on Urban and Rural Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2019
    The Medicare Disproportionate Share Hospital payment adjustment is intended to compensate hospitals serving a disproportionate number of low-income patients. This policy brief describes the number and location of urban and rural hospitals affected by a 12% payment cap established by the Medicare Modernization Act of 2003.
  • Rural-Urban Differences in Access to and Attitudes Toward Care for Medicare Beneficiaries
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to healthcare is important to health outcomes and well-being. Even among Medicare beneficiaries, access to care may differ by rural-urban location due to differences in the healthcare and socio-demographic landscape. We describe rural-urban differences in access to care for Medicare beneficiaries.
  • 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.
  • Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
    Journal Article
    Maine Rural Health Research Center
    Date: 01/2019
    Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply.

2018

2017

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.
  • 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.
  • Ambulatory Care-Sensitive Condition Hospitalizations Among Medicare Beneficiaries
    Journal Article
    Rural and Minority Health Research Center
    Date: 06/2016
    Examines the relationship between the distribution of primary care physicians and Medicare beneficiaries' ambulatory care-sensitive condition hospitalizations using statistical and spatial analyses.
  • 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 Rural Health Clinics (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.
  • Rural Medicare Beneficiaries Have Fewer Follow-up Visits and Greater Emergency Department Use Post-discharge
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2015
    Compares rates of post hospital discharge care among Medicare beneficiaries in rural and urban settings. Discusses the effect on policies for follow-up care and readmission penalties.
  • Thirty-Day Readmission Rates Among Dual-Eligible Beneficiaries
    Journal Article
    Rural and Minority Health Research Center
    Date: 08/2015
    Examines readmission rates and factors affecting readmission of patients eligible for both Medicare and Medicaid (dual-eligibility).
  • Minimum Distance Requirements Could Harm High-Performing CAHs and Rural Communities
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2015
    Compares the effect of location on critical access hospitals' size, quality of care, and financial strength. Discusses implications of minimum distance requirements on critical access hospitals.
  • Poorer Quality Outcomes of Medicare-Certified Home Health Care in Areas with High Levels of Native American/Alaska Native Residents
    Journal Article
    Rural and Minority Health Research Center
    Date: 04/2015
    Examines CMS quality indicators in home healthcare to determine disparities in rural areas with high population of Native American or Alaska Natives.
  • 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

1999

  • Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 1999
    Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas.