RUPRI Center for Rural Health Policy Analysis

Current Projects

• Causal Effect of Nursing Home Closure on Resident Outcomes in Rural Areas
  We will evaluate the causal impact of nursing home closure on two key outcomes: distance to the transitioned nursing home, and resident physical and mental health outcomes. We will compare the effect of closures on outcomes for rural and urban areas using resident-level data from 2010-2019 and advanced difference-in-differences regression methods.
  Topics: Aging, Health services, Healthcare access, Long-term care, Post-acute care, Quality
  
• Changes in Rural Health Insurance Coverage, 2020-2023
  This project uses secondary data sources to characterize changes in health insurance coverage during the public health emergency (2020-2023) for rural and urban people according to demographic, employment, and geographic characteristics, and to describe how changes in federal policies impacted coverage. Researchers also assess the potential impact of maintaining more robust marketplace subsidies on rural and urban coverage rates once the "unwinding" of continuous Medicaid enrollment is complete.
  Topics: Health reform, Healthcare financing, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Private health insurance, Rural statistics and demographics, Uninsured and underinsured
  
• Concordance Between Social Needs Screening Provision, Programming, and Partnerships in Rural PPS Hospitals
  This study will examine how rural Prospective Payment System (PPS) hospitals differ from urban hospitals concerning social needs screening practices and alignment between social needs screening performance and corresponding programs/strategies and/or community partnerships to address social needs.
  Topics: Health services, Hospitals and clinics, Medicare Prospective Payment System (PPS), Networking and collaboration, Social determinants of health
  
• Differences in Rural and Urban Hospital Cost Structures: Evidence and Implications
  The project will compare fixed-to-variable cost ratios in U.S. rural and urban hospitals. We hypothesize that rural hospitals will realize proportionally greater fixed costs than urban hospitals, suggesting important hospital payment system implications.
  Topics: Health reform, Healthcare financing, Medicare
  
• Non-Metropolitan/Metropolitan Differences in Barriers to Care and Utilization of Preventive Care and Wellness Visits Among Traditional Medicare and Medicare Advantage
  This project proposes to use the Medicare Current Beneficiaries Survey to examine differences across geography and plan type (Medicare Advantage vs. traditional) with regards to barriers to care (e.g., costs) and use of preventive services (e.g., flu shot).
  Topics: Health services, Healthcare access, Medicare Advantage (MA)
  
• Retention and Expansion of Hospital Services Offered by Rural Hospitals After Enrollment in 340B
  The 340B Federal program is designed to provide hospitals with financial stability through provision of drug discounts which may, in turn, allow hospitals to maintain or expand their service line offerings. Using a series of event study analyses over an 11-year period, this study will examine the impact of enrollment in the 340B program on discontinuing services, maintaining services, and adding new services in eligible rural hospitals.
  Topics: Critical Access Hospitals (CAHs), Health services, Hospitals and clinics, Pharmacy and prescription drugs
  
• RHCs and CAHs Participating in SSP: Characteristics of the Providers and Communities
  This project describes characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the Medicare Shared Savings Program (SSP), and the communities they serve. Comparisons will be made to RHCs and CAHs not participating in the SSP.
  Topics: Critical Access Hospitals (CAHs), Healthcare financing, Medicare, Rural Health Clinics (RHCs)
  
• Rural Implications of Increased Medicare Beneficiary Enrollment in ACOs and MA Plans
  This project will leverage Centers for Medicare & Medicaid Services data showing the number of Medicare beneficiaries assigned to Accountable Care Organizations, in combination with enrollment in Medicare Advantage in rural counties, to describe implications for rural health care organizations.
  Topics: Health reform, Healthcare financing, Medicare, Medicare Advantage (MA)
  
• Rural Nursing Home Staffing, and Resident Health, Closure, and Financial Performance
  There are concerns about availability and quality of care provided in nursing homes in rural areas. This project aims to evaluate staffing levels and shortages, the health status of residents, closures, and financial performance of rural nursing homes both before and during the COVID-19 pandemic.
  Topics: Aging, Long-term care, Post-acute care
  
• Rural-based Accountable Care Organizations Accepting Downside Risk
  The RUPRI Center will update its studies of rural provider participation in accountable care organizations, including differences between those who exit the program, those who remain, and those who enter. In particular, this project will address participation decisions made after a rule change in July 2019 that requires conversion to two-sided risk.
  Topics: Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), Health reform, Hospitals and clinics, Legislation and regulation, Medicare
  
• Rural-Urban Differences in Medicare Advantage Plan Quality Scores
  This project updates previous RUPRI Center publications focused on rural-urban differences in access to, and enrollment in, Medicare Advantage plans with four- and five-star quality ratings.
  Topics: Health services, Healthcare financing, Medicare, Medicare Advantage (MA)