Xi Zhu, PhD

RUPRI Center for Rural Health Policy Analysis

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

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

Completed Projects - (3)
Publications - (20)

Completed Projects - (3)

Financial Risk Assumption Among Rural Healthcare Providers
This project assessed rural/urban providers' participation in different payment models and assumption of financial risk in the Medicare Quality Payment Program. We conducted qualitative interviews to examine rural providers' motivations and preparedness for participating in different risk-bearing payment models.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health reform, Healthcare financing, Rural Health Clinics (RHCs)
How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
This project examined the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project provided policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Care management, Health reform, Health services, Hospitals and clinics, Medicare
What Factors Influence Rural Hospitals' Participation in Accountable Care Organizations?
This project examined rural hospitals' participation in Accountable Care Organizations (ACOs), identified factors that influenced ACO participation, compared whether different factors influenced rural/urban hospital participation in ACOs, and analyzed factors influencing Critical Access Hospitals' participation in the Medicare Shared Savings Program.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health reform, Healthcare financing, Medicare

Publications - (20)

2024

Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 09/2024
This brief presents financial performance trends of hospitals who participated in Medicare's Shared Savings Program (SSP) from 2011 to 2018. Trends in six financial outcomes are compared between SSP and non-SSP hospitals over time and between rural and urban hospitals.

2023

Financial Risk Acceptance Among Rural Health Care Providers Participating in the Quality Payment Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2023
This policy brief summarizes non-metropolitan and metropolitan providers' participation in different Centers for Medicare & Medicaid Services Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance.

2022

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.
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.

2021

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

2020

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

2018

Organizational Attributes Associated With Medicare ACO Quality Performance
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 07/2018
Peer-reviewed paper evaluating associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance.
Organizational Attributes With Medicare ACO Quality Performance
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2018
Cross-sectional and longitudinal analyses of Medicare Shared Savings Program Accountable Care Organizations' (ACOs') quality performance found rural ACOs' score was comparable to those in other categories. ACOs with hospital-system sponsorship, larger beneﬁciary panels, and higher post-hospitalization follow-up rates had better performance.

2016

Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2016
Provides an analysis of the differences in Accountable Care Organization (ACO) performance on the quality measures among the Medicare Shared Saving Program ACOs with varying levels of rural presence. Findings suggest that ACOs with significant rural presence have performed as well as, if not better than, urban ACOs in delivering quality care.
Financial Performance of Rural Medicare ACOs
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 08/2016
Assesses the financial performances of rural accountable care organizations (ACOs) based on different levels of rural presence.
Medicare Accountable Care Organizations: Beneficiary Assignment Update
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2016
This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services Accountable Care Organization regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Understanding ACO beneficiary assignment policies is dire in managing ACO providers and beneficiaries.

2015

Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs With Rural Presence
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 05/2015
In this policy brief, we present the findings of a survey of 27 rural accountable care organizations, focusing on characteristics important to their formation and operation.
A Rural Taxonomy of Population and Health-Resource Characteristics
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2015
This brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics and discusses how this classification tool can be utilized by policymakers and rural communities.
Developmental Strategies and Challenges for Rural Accountable Care Organizations
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2015
This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs.

2014

Facilitating the Formation of Accountable Care Organizations in Rural Areas
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 07/2014
This brief shows characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions. The findings can help rural providers interested in forming/participating in an ACO assess the status and potential gaps of their core structures and capabilities.
From Health Care Volume to Health Care Value - Success Strategies for Rural Health Care Providers
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 04/2014
Examines strategies that rural healthcare providers can use to improve healthcare quality for patients.
Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 04/2014
This brief discusses Medicare Shared Savings Program eligibility, participation requirements, and quality measures relative to accountable care organization formation.
Trends in Hospital Network Participation and System Affiliation, 2007-2012
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 2014
Network participation and system affiliation are two ways for hospitals to build and/or access necessary capacities to engage in the transformation to an integrated, patient-centered, pay-for-value care delivery model. This brief tracks trends in network participation and system affiliation among U.S. general community hospitals from 2007 to 2012.

2013

Accountable Care Organizations in Rural America
RUPRI Center for Rural Health Policy Analysis
Date: 07/2013
This policy brief reports that Medicare Accountable Care Organizations currently operate in 16.7% of all U.S. non-metropolitan counties.