Rural Health
Research Gateway

Medicare

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2024

  • A Comparison of 2017-2019 Uncompensated Care of Rural and Urban Hospitals and a First Look at Uncompensated Care in 2020 and 2021
    This project compared 2017-2019 uncompensated care as a percent of operating expense for rural and urban hospitals and investigated uncompensated care data for 2020 and 2021.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • Developing a Post-COVID Financial Distress Index
    This project updated and improved the North Carolina Rural Health Research Program's Financial Distress Index, which uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • Examining the Potential Impact of Multiple Payment Policies on Rural Versus Urban Home Health Agencies
    This study estimated the impact of three recent and upcoming Medicare home health payment policies (revised rural add-on payments, new prospective payment system, and value-based purchasing demonstration) on reimbursement for home health agencies based on rural-urban status, community factors, and home health agency characteristics.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Healthcare financing, Home health, Medicare, Post-acute care
  • 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
  • Low Volume Hospitals
    This analysis compared rural low-volume hospitals (LVHs) to non-LVH characteristics and estimate the financial impact of eliminating the LVH program and reverting to the original (2005) LVH classification and payment adjustment.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare
  • Medicare Advantage Plan Growth in Rural America: Opportunities for Beneficiaries?
    County Medicare Advantage enrollment data and plan characteristic data were used to create a model accounting for the availability of plans offering benefits addressing social determinants of health. Analyses compared rural and urban counties, and examined county characteristics to explore potential equitable opportunities for rural beneficiaries because of geography and other factors.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA), Medicare Part D, Social determinants of health, Telehealth, Transportation
  • Rural/Urban and Racial/Ethnic Inequities in Patient-Reported Health Care Access and Quality among Medicare Beneficiaries with Lung or Colorectal Cancer
    Incidence and mortality for colorectal and lung cancer are higher among rural versus urban residents, but many rural cancer patients lack accessible, high-quality care. This study 1) Identified rural/urban inequities in Medicare cancer patient-reported health care access and quality and 2) Determined if rural racial/ethnic minority patients have worse health care access and quality than rural White patients.
    Research center: Rural and Underserved Health Research Center
    Topics: Cancer, Health disparities and health equity, Healthcare access, Maternal health, Medicare, Minority health, Quality

2022

  • Estimation of the Fixed and Variable Costs of a Rural Emergency Hospital
    This project: 1) informed the design of CMS Rural Emergency Hospital (REH) payment methods, particularly the Medicare monthly additional facility payment; 2) estimated patient break-even volumes for the long-run financial sustainability of REHs; and; 3) provided a tool that rural hospitals can use to estimate the cost of operating a REH.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Legislation and regulation, Medicare
  • Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
    This project updated our 2014 brief: Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where? In addition to examining health conditions of patients discharged from rural Prospective Payment System hospitals and Critical Access Hospitals to swing beds and skilled nursing facilities, this project also looked to see what has changed over time and whether race and ethnicity, sex, or age explain differences.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Long-term care, Medicare
  • Healthcare Use and Expenditures Among Rural and Urban Medicare Beneficiaries Aged 85 and Over
    The proportion of U.S. residents ages 85+ is expected to grow substantially in the coming decades with the impact of this growth in rural areas likely to be pronounced. This project used data from the Medicare Current Beneficiary Survey to examine rural-urban differences in healthcare use and expenditures among Medicare enrollees ages 85+.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Healthcare access, Long-term care, Medicare
  • How Have the Sources of Revenue for Rural Hospitals Changed Since 2005?
    Rural hospitals have seen a steadily decreasing average acute daily census. If outpatient revenue is not expanding to fill that decrease, the decrease in patient revenue could further threaten hospital viability.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics, Medicare
  • Location and Characteristics of Nursing Homes in the Rural and Urban U.S.
    This project examined rural and urban nursing home availability; assessed the nursing home bed supply relative to the elderly population in rural and urban counties; summarized resident and nursing home characteristics; and analyzed the relationship between the rural location of nursing homes and resident and nursing home characteristics.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Health services, Healthcare access, Healthcare financing, Long-term care, Medicare
  • Medicare Beneficiary Access to Prescription Drugs Under Part D
    This study built on RUPRI Center work describing patterns of enrollment into Medicare Part D plans (including access to zero deductible plans) by using transaction files to analyze how medications are actually acquired and implications for access to local pharmacy services.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Part D
  • Rural Hospital Closure and Effect on Local Economies
    Several research projects have analyzed the health effects of rural hospital closures. However, highly cited evidence on the economic effects of rural hospital closures is more than a decade old. The purpose of this study was to quantify the economic impact rural hospital closures have on communities.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health disparities and health equity, Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  • Three Models of a Rural Emergency Hospital
    This project used secondary data about small rural emergency departments and expert opinion to develop three clinical and operational models of a Rural Emergency Hospital (REH). The REH models were based on case mix, service mix, patient volume, clinical staffing, and technology.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Legislation and regulation, Medicare

2021

  • Comparison of Rural Hospital Closures and the Communities Served, 1990-2020
    This project examined rural hospital closures during three decades to profile community characteristics, health status, health care services, and resources available in communities where rural hospitals have closed.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health disparities and health equity, Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  • Current and Longer Term Challenges of Rural Hospitals: A Survey of Rural Hospital Executives
    This project involved surveying rural hospital executives about how they will respond to current and long-term challenges related to financial and regulatory burdens.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Healthcare financing, Hospitals and clinics, Medicare
  • Estimating the Number of Hospitals that Might Convert to Rural Emergency Hospitals
    This project reviewed the literature to establish what is known about freestanding emergency centers (FECs) and implications for a rural community. The number and types of rural hospitals that would be eligible to convert to an FEC as an alternative to closure of acute inpatient care was estimated.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  • Geographic Access to Healthcare for Rural Medicare Beneficiaries: An Update and National Look
    This objective of this study was to compare, at a national and census division level, where rural and urban Medicare beneficiaries receive ambulatory care, which types of specialists they utilize and how far beneficiaries are traveling to obtain care.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Workforce
  • Hospital Readmission Following Care in a Swing Bed
    This study built on our portfolio of swing bed work by examining the rate of hospital readmission for patients who receive post-acute care in swing beds compared to skilled nursing facilities and informed the discussion on use, cost, and benefit of swing bed care.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS), Post-acute care, Quality
  • How Do Costs for Rural Medicare Beneficiaries Using Swing Beds Compare to Those Using Skilled Nursing Facilities?
    This study estimated and compared total Medicare expenditures for episodes of care that include post-acute stays in either swing beds or skilled nursing facilities (SNFs). Results informed federal and state agencies, rural providers and communities as to how post-acute care in swing bed versus a SNF affects the trajectory of costs and utilization for rural Medicare beneficiaries.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Long-term care, Medicare, Post-acute care
  • How Medicare Payment Standardization Affects the Perceived "Cost" of Post-Acute Care Provided in Critical Access Hospital Swing Beds
    Medicare-allowed charges are adjusted for geographic cost differences and payments that support larger Medicare program goals. This study aimed to identify the effects of the payment standardization method on the perceived "cost" of post-acute care provided in Critical Access Hospital swing beds.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Medicare, Post-acute care
  • Post-acute Care Trajectories for Rural Medicare Beneficiaries
    Utilization and costs of post-acute care for Medicare fee-for-service beneficiaries have grown rapidly during the last decade. This study examined post-acute care utilization for rural Medicare beneficiaries following acute hospitalization, describing use of home health and skilled nursing care and trajectories of care across settings.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Allied health professionals, Health services, Home health, Hospitals and clinics, Medicare, Nurses and nurse practitioners, Post-acute care
  • Rural Nursing Home Closures - Trends, Characteristics, and Impact on Access
    This project built a database of nursing home closures across rural and urban areas in the U.S. and evaluated the changes in access to post-acute and/or long-term care providers. It also described the differences in organizational, financial, and market characteristics between open vs. closed nursing homes in rural vs. urban areas.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Aging, Healthcare access, Long-term care, Medicare
  • The Availability of Optional Benefits in Medicare Advantage (MA) Plans in Rural and Urban Areas and the Implications for MA Payment Policy
    Enrollment and landscape files containing data regarding Medicare Advantage plan activities by county were used to describe the geographic differences in what is available to beneficiaries in benefit design and total out-of-pocket liability. Findings revealed potential for policy actions to address equity of benefits and cost to beneficiaries.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA), Medicare Prospective Payment System (PPS)
  • What Makes Successful Rural Accountable Care Organizations Successful?
    The U.S. Department of Health and Human Services plans to shift at least 50% of traditional Medicare spending into alternative payment models by 2018. Accountable Care Organizations (ACOs) represent a popular model in both the Medicare and Medicaid programs. This study used multiple methods to find what makes a successful ACO.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Quality

2020

  • Assessing Potential Unmet Need for Home Healthcare in Rural Areas
    This study estimated potential unmet need for home healthcare in rural areas for fee-for-service Medicare beneficiaries. We compared rates of home healthcare utilization in rural areas with urban areas, accounting for acute hospital discharges and utilization of inpatient rehabilitation facilities and skilled nursing facilities.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Home health, Hospitals and clinics, Medicare, Post-acute care
  • Healthcare Use and Access Among Rural & Urban Non-elderly Disabled Medicare Beneficiaries
    This project explored healthcare use and barriers to healthcare access among disabled Medicare beneficiaries under 65 in rural and urban areas. The study was based on quantitative analyses of the 2009-2013 Medicare Current Beneficiary Survey.
    Research center: Maine Rural Health Research Center
    Topics: Disabilities, Health disparities and health equity, Medicare
  • Medicare Beneficiaries' Access to Preventive Services: Diabetes Self-Management Training, Medical Nutrition Therapy, and Health and Behavior Assessment and Intervention
    Medicare offers preventive services focused on self-management through several programs: Diabetes Self-Management Training, Medical Nutrition Therapy, and Health and Behavior Assessment and Intervention.
    Research center: Rural and Underserved Health Research Center
    Topics: Diabetes, Health promotion and disease prevention, Medicare, Obesity
  • Patterns of Inpatient Care-Seeking by Rural Residents
    This study seeks to gain an understanding of inpatient care-seeking behavior by rural residents to provide insight into drivers of bypass rates, the extent to which a community uses a hospital other than its local rural hospital.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health services, Hospitals and clinics, Medicare
  • Rural-Urban Variation in CMS Hierarchical Condition Categories (HCC) Risk Scores
    CMS uses hierarchical condition categories (HCC) to risk-adjust Medicare beneficiaries for multiple conditions. This adjustment is used for multiple programs, but it's unknown whether the adjustment works similarly in rural and urban areas. This project investigated the distribution of beneficiaries' and providers' HCC risk scores across rurality.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Medicare
  • Understanding Trends in Telehealth Use: An All-Payer Analysis in Maine
    This project's primary purpose was to use Maine's All-Payer Claims Database and key informant interviews to develop a descriptive overview of telehealth use in Maine, examining how telehealth use had changed over time (2008-2017) among rural and urban patients and providers.
    Research center: Rural Telehealth Research Center
    Topics: Medicare, Private health insurance, Telehealth
  • 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
  • Who Provides Mental Health Services to Rural Medicare Beneficiaries?
    Most rural counties do not have a psychiatrist to care for the common conditions of depression or anxiety. This study describes the provider workforce that cares for rural elderly patients with depression/anxiety, including regional and rural-urban variations in mental healthcare provision.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Medicare, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce

2019

  • Access to Care for Rural Medicare Beneficiaries
    This project examined multiple dimensions of access to care, with a focus on rural Medicare beneficiaries, including rural-urban differences in access to care, and within-rural differences in access to care by region, coverage type (traditional fee-for-service vs. supplemental Medigap coverage), and socio-demographic characteristics.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Healthcare access, Medicare, Medicare Advantage (MA)
  • Ambulatory Care Provided to Rural Medicare Beneficiaries by Rural and Urban FQHCs, RHCs, and Acute Hospitals
    This project characterized the volume, cost, and case mix of ambulatory care provided to rural Medicare beneficiaries by rural and urban federally qualified health centers (FQHCs), rural health clinics (RHCs), and acute hospitals. The study included urban-rural and geographic comparisons of volume, cost, and case mix by provider type.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health services, Hospitals and clinics, Medicare
  • Diverging Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute vs. Community-entry Home Health in Rural Areas
    This study examined differences between rural, fee-for-service Medicare beneficiaries who were admitted to home health from the community (community-entry) and those who were admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Home health, Medicare, Post-acute care
  • Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
    This study assessed the financial impact of changing Critical Access Hospital (CAH) swing bed reimbursement from the cost-based system to the skilled nursing facility (SNF) prospective payment system (PPS).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Long-term care, Medicare, Post-acute care
  • Impact of Capping Medicare Disproportionate Share Hospital Payments on Rural Hospitals
    Rural hospitals receiving Medicare prospective payment system payment and receiving disproportionate share hospital payments are subject to a 12% cap on those payments. This project provided information on the number and location of rural hospitals subject to this cap and the fiscal impact.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Medicare, Medicare Prospective Payment System (PPS)
  • Rural Health Clinic Financial Performance and Productivity
    This study used Medicare cost reports for independent and provider-based clinics to provide a detailed national picture of the financial and operational performance of RHCs and describe variations in performance related to revenue, costs, staffing, payer mix, productivity levels, and hours of operation across independent and provider-based clinics. The project also developed measures that can be used to benchmark RHC performance over time.
    Research center: Maine Rural Health Research Center
    Topics: Medicare, Rural Health Clinics (RHCs)
  • The Rural MACRA Experience
    The Rural MACRA Experience project studied rural effects of the new Medicare Quality Payment Program (QPP) implementation and operation. Rural QPP effects included provider eligibility, program preparation and data collection challenges, data analysis bias, and differential fiscal impact.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Medicare, Physicians
  • Utilization of Hospital Care for Rural Medicare Beneficiaries
    This project examines where rural and frontier Medicare beneficiaries access hospital care. Specifically, it explores the different types of inpatient care sought in local rural communities and at tertiary providers. Beneficiary patterns of care by condition, location type and other factors will be examined. The study will also focus on the bypassing behavior of rural residents when being hospitalized. Analysis sensitivity analyses are being performed regarding small travel time differences per alternative hospitals.
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Frontier health, Hospitals and clinics, Medicare

2018

2017

  • Provision of Skilled Nursing in Rural America: Skilled Nursing Facilities and Swing Beds
    This project will allow researchers and policy makers to understand the nature of swing bed and skilled nursing facility care provision in rural areas of the U.S. Our national comparison will include indicators such as service mix, length of stay, discharges, volume and census, and certifications and provider characteristics.
    Research center: Southwest Rural Health Research Center
    Topics: Aging, Hospitals and clinics, Long-term care, Medicare
  • Rural-Urban Differences in Medicare Service Use and Expenditures in the Last Six Months of Life
    Patterns of end-of-life care are known to vary by rurality and by minority status, and the availability of facilities such as hospice also vary with rurality. This study will examine the relationship between level of service use during the last six months of life and facility availability in county of residence (hospital, SNF, IRF, home health, hospice), as well as minority status of the beneficiary and whether the beneficiary is also eligible for Medicaid ("dual eligible").
    Research center: Rural and Minority Health Research Center
    Topics: Aging, Medicaid and CHIP, Medicare, Minority health
  • The Financial and Community Experience of Sole Community Hospitals in Comparison to Other Rural Hospitals
    This research will investigate the financial and community experience of Sole Community Hospitals (SCHs) in comparison with other rural hospitals. The availability of alternative facilities, and the socioeconomic and demographic characteristics of SCH service areas will be compared to other rural hospital service areas.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS), Rural statistics and demographics
  • Transitions of Care Among Rural Medicare Beneficiaries: The Care Continuum
    Because they are often hospitalized outside their home community, rural Medicare beneficiaries may experience a different sequence of services after discharge than do urban beneficiaries. This study will follow beneficiaries across the continuum of post-hospital care to determine if rural beneficiaries, particularly minority beneficiaries, are more likely to experience care disruption and adverse outcomes, such as re-hospitalization.
    Research center: Rural and Minority Health Research Center
    Topics: Medicare, Minority health

2016

  • Analyzing the Variation in the Performance of Accountable Care Organizations Serving Rural Medicare Beneficiaries
    The goals of this project are to characterize ACOs that operate in rural areas, describe the models being used to organize those ACOs, and to test relationships of those characteristics to performance measures related to financial success and quality. The study will identify potential changes in legislative and regulatory policies that could strengthen the utility of the ACO model to achieve high performing rural healthcare delivery organizations.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Legislation and regulation, Medicare, Quality
  • Colorectal Cancer Screening Bypass Behavior and Outcomes
    Studies have shown that increased distance to the closest endoscopy provider is associated with lower screening utilization among Medicare enrollees. The purpose of this study is to expand beyond the Medicare population to examine the travel behaviors of the entire population, comparing urban vs. rural residents in obtaining endoscopies for colorectal cancer screening.
    Research center: Rural and Minority Health Research Center
    Topics: Cancer, Health promotion and disease prevention, Medicare
  • How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals? (Year 2)
    The second year of this two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); and (4) financial performance.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Healthcare financing, Medicaid and CHIP, Medicare, Private health insurance, Uninsured and underinsured
  • Relationship Between Service Utilization and Costs for High Cost Rural Medicare Patients
    This project will 1) assess the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum, and 2) examine the relationships between rural beneficiaries' service utilization and market structure.
    Research center: University of Minnesota Rural Health Research Center
    Topic: Medicare
  • Rural Health Clinics: Medicare & Medicaid Profile (Year 2)
    Year 2 of a project developing a longitudinal data collection/tracking mechanism of key RHC Medicare claims data and cost report elements. RHC Medicaid data for a sample of states also will be requested and analyzed to determine utilization patterns and identification of potential quality metrics.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Medicaid and CHIP, Medicare, Rural Health Clinics (RHCs)
  • Trends in Medicare Advantage Quality and Enrollment: The Effects of Quality Based Payment Incentives on Rural People and Places
    This research will analyze the quality of Medicare Advantage (MA) plans offered to rural MA beneficiaries currently, in relation to urban beneficiaries, and how it has evolved over the past four years. In addition, the effect of quality-based payment incentives will be measured by: 1) changes that have been made to improve the quality of existing plans in rural areas or to encourage the entry of high quality plans into rural areas, and 2) the movement of plans' entry and exit into the MA market by plan type and rural/urban location.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Use of Home Health Services Among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Hospital Readmission
    This study will examine the 60-day post-acute care outcomes of rural Medicare patients who were discharged from hospitals and admitted to home healthcare services. Key predictors include home health services provided, type of Medicare home health reimbursement, and available community healthcare resources.
    Research center: WWAMI Rural Health Research Center
    Topics: Home health, Hospitals and clinics, Medicare, Post-acute care
  • What Would be the Financial Consequence of Eliminating Low Volume Hospital Payments?
    Analysis will include comparison of the long-term profitability of low-volume hospitals to other rural hospitals and estimation of the potential profitability consequences of eliminating the payment classification altogether.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)

2015

  • Are Part D Plans Meeting the Needs of Rural Medicare Beneficiaries?
    The purpose of this project is to assess whether the Medicare Part D prescription drug plans available in rural counties are sufficient to meet the needs of rural Medicare beneficiaries.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  • Out-of-Pocket Costs Among Rural Medicare Beneficiaries
    The purpose of this project is to examine out-of-pocket spending among Medicare beneficiaries, to identify whether there are rural-urban differences in out-of-pocket costs, and to explore what factors account for these differences. Should Medicare redesign occur, this study will provide important information against which to assess the possible impact of different design options on rural Medicare beneficiaries.
    Research center: Maine Rural Health Research Center
    Topics: Disabilities, Medicare
  • Post-Acute Stroke Care Delivery for Rural Medicare Beneficiaries
    Post-stroke rehabilitation has been shown to improve outcomes among patients, but the limited available evidence suggests that rural residents and African Americans are less likely to receive this care. Our analysis will determine whether residence or race-based disparities exist in post-stroke care, after taking into consideration differences in patient status.
    Research center: Rural and Minority Health Research Center
    Topics: Medicare, Minority health, Post-acute care
  • Post-Hospital Transitions in Care Among Dually-Eligible Medicare Beneficiaries
    This project will examine the hospitalization rates, post-discharge physician follow-up, and subsequent readmission rates among Medicare beneficiaries who are also enrolled in Medicaid. We will examine these dual-eligible beneficiaries by level of rurality to determine if residence is a significant factor in these rates. We will also control for co-morbidities, county characteristics, and other factors related to readmission rates.
    Research center: Rural and Minority Health Research Center
    Topics: Diabetes, Hospitals and clinics, Medicare
  • Rural Health Clinics: Medicare & Medicaid Profile
    This study builds on our work with the 2009 RHC Medicare claims. This project will result in the development of a longitudinal data collection/tracking mechanism of key RHC Medicare claims data and cost report elements (provider-based cost reports only at this point in time). RHC Medicaid data for a sample of states will be requested and analyzed to determine utilization patterns and identification of potential quality metrics.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare access, Medicare, Rural Health Clinics (RHCs)
  • What Does it Cost to Operate a Rural Free-Standing Emergency Department (RFED)?
    In recent months, there have been numerous media reports of rural hospital closures and the adverse effect on communities. In the face of hospital closure, one alternative for maintaining access to healthcare is a rural free-standing emergency department (RFED).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Medicare

2014

  • Analysis of Medicare Advantage Quality in Rural Areas: Historically and Moving Forward
    This project examines the role that geography and demographics play in the success and quality of different types of MA plans in particular regions of the country.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Characteristics and Utilization Patterns of Rural Dual-eligible Medicare Beneficiaries
    Persons who are eligible for both Medicare and Medicaid insurance coverage (dual eligible) represent 21% of total Medicare enrollment, but account for more than 36% of Medicare expenditures. The purpose of this study is to ascertain whether dual-eligible beneficiaries living in rural areas differ from their urban counterparts in demographic characteristics and Medicare expenditures.
    Research center: Rural and Minority Health Research Center
    Topics: Cancer, Diabetes, Medicaid and CHIP, Medicare
  • Comprehensive Study of Swing Bed Use in Rural Hospitals
    This project will comprehensively address questions about how swing beds are used by rural hospitals. Questions to be answered include whether decision about use are driven by patient need, community resources, hospital operational concerns or some combination of these factors; the cost implications of swing bed use in critical access hospitals to the Medicare program; and whether patients served in swing beds differ in meaningful ways from those in skilled nursing facilities.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
  • Effects of Changing Medicare Advantage Landscape on Rural Enrollees
    The goal of this project is to assess the impact of changes in Medicare payment policy on the availability of choices for rural Medicare beneficiaries. The objectives are quantify the impact of payment policy on the number of competing plans in strata of rural counties and the effects of using quality star ratings on choices in rural counties.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services
    This study will assess whether Medicare beneficiaries in rural areas receive a lower intensity of home health (HH) services compared to their urban counterparts. Specifically, the study will examine (1) the distribution of levels of HH services for four conditions: joint (hip and knee) replacement, stroke, end-stage renal disease (ESRD), and diabetes; (2) the distribution of type of provider for each condition across the levels of rurality; and (3) the median charge and payment per beneficiary for these services across the levels of rurality.
    Research center: Rural and Minority Health Research Center
    Topics: Chronic diseases and conditions, Diabetes, Home health, Medicare
  • Observation Care Services in Rural Hospitals: Reimbursement and Quality Implications
    This project will describe the nature and scope of observation care services provided by rural hospitals and discuss policy relevant issues for Medicare beneficiaries and providers. Study findings will provide the first assessment of rural observation care services and identify policy options to minimize the potential for unintended consequences of Medicare policies related to observation care services.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Hospitals and clinics, Medicare, Quality
  • Rural and Urban Differences in Case-Mix Among Recipients of Home Health Care
    We will examine current patient case-mix for the Medicare population receiving skilled health care from a home health agency to determine if there are rural or race/ethnicity-based disparities with regards to receipt of services and clinical acuity indicators.
    Research center: Rural and Minority Health Research Center
    Topics: Health disparities and health equity, Home health, Medicare
  • Rural Hospital Mergers and Acquisitions - Who is Being Acquired and What Happens Afterwards?
    This study compares the financial and market characteristics of recently acquired rural hospitals to other rural hospitals and investigates the post-acquisition change in services and financial performance of these hospitals. This study will inform rural advocates, federal and state agencies, and regulators as to how mergers and acquisitions (M&As) of small rural hospitals affect access to care for Medicare beneficiaries, and the potential financial consequences of M&As to small rural hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics, Medicare

2013

  • Impact of Payment Policy on Access to Physician Care in Rural America
    Profiles of physician practices will be constructed that specify the percent of payments derived from specific current procedural terminology (CPT) codes, dichotomized into evaluation and management (often considered to define primary care) or procedural. Differences across rural practices and between rural and urban practices will be analyzed, with implications for payment policies intended to reward rural primary care.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Medicare, Physicians
  • System Integration and Rural Provider Participation in Accountable Care Organizations (ACOs)
    This project will develop a national descriptive database of both rural providers and larger (often urban) health systems participating in Medicare ACOs and health system networks. Case studies of four ACOs will generate an awareness of decisions being made that affect configuration of services in rural places and provide suggestions for further research with representative samples of ACOs.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Medicare
  • Use of Rural Health Clinics by Medicare Beneficiaries
    Determination of Medicare beneficiaries utilization of available RHCs and development of a descriptive profile of Medicare beneficiaries who utilize RHCs including both geographic and diagnostic elements and a comparison to Medicare beneficiaries who utilize FQHCs.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Medicare, Rural Health Clinics (RHCs)

2012

  • Analysis of the Effects of Federal Debt Reduction and Long Term Budget Adjustment on Rural Health Care Delivery
    The RUPRI Center for Rural Health Policy Analysis will examine suggested changes in Medicare and Medicaid as stated in proposals to reduce spending as part of achieving deficit reduction.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Medicaid and CHIP, Medicare
  • Assessing the Community Impact of the MMA
    This project will measure the community-level impacts of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and will provide feedback to policymakers regarding the impact of the MMA on its policy targets (providers and beneficiaries), in the context of rural places.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Legislation and regulation, Medicare, Medicare Part D
  • Community and Financial Experience of Medicare Dependent Hospitals in Comparison to Other Rural Hospitals
    This research will investigate the community and financial experience of Medicare Dependent Hospitals (MDHs) in comparison with other rural hospitals. Analysis of the financial experience will include comparison of the long-term profitability of MDHs to other rural hospitals, estimation of the potential profitability consequences of eliminating the payment classification, and estimation of the potential consequences of maintaining the payment classification but failing to update the base year from which costs are trended forward.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
  • Dialysis Availability in Rural America
    Working from Medicare Dialysis Compare files and the Standard Analysis File of the US Renal Data System, we will evaluate the current availability of dialysis services across rural America. We will examine general availability of services, service to population ratios, and patient outcome measures across levels of rurality.
    Research center: Rural and Minority Health Research Center
    Topics: Chronic diseases and conditions, Diabetes, Medicare
  • Effect of Type and Timeliness of Post-Acute Care on Preventable Hospital Readmissions for Rural Medicare Beneficiaries
    The purpose of this project is to: 1) determine how location of hospitals used for initial admissions by rural patients affects readmission rates; 2) assess how the use of swing beds affects rural patients' readmissions; and 3) examine the impact of the type and timeliness of post-acute care, including home health care, skilled nursing, and physician visits, on readmissions for rural patients.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Hospitals and clinics, Medicare, Post-acute care
  • Impact of Changing Medicare Advantage Landscape on Rural Enrollees
    This project will explore three important questions related to Medicare Advantage (MA) plans. What is the impact of recent changes in the MA market on rural Medicare beneficiaries, providers and communities? In particular, how have recent changes in markets and payment policy led to changes in the choices of plans facing beneficiaries, and the quality of those plans (as defined by the coverage offered by the plans)? Finally, what is the likely impact of changes made in Medicare Advantage payment rates passed in the Patient Protection Affordable Care Act of 2010 (PPACA) on rural enrollment in MA plans in 2011 and beyond?
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Medicare Advantage and Medicare Prescription Drug Plans in Rural Areas
    The rapid growth in Medicare Advantage (MA) plans, as well as evidence that MA plans are being paid significantly more than traditional fee-for-service Medicare, has created the impetus for reform of the MA program, especially reductions in payment to MA plans. This project will continue the RUPRI Center's work in tracking and analyzing the trends in MA plan enrollment in rural areas, including changes in types of plans.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)

2011

  • Implementation of Health Reform Legislation in Rural America
    The RUPRI Center has developed particular expertise, including the use of simulations, in how changes in public policy that are now part of the Patient Protection and Affordable Care Act (PPACA) affect the rural health care providers and communities. We have published policy briefs and papers related to Medicare Advantage and Part D plans, effects of insurance reform on the percentage of uninsured in rural areas, and effects of changes in physician payment on projected total income of rural primary care physicians. The purpose of this project is to take advantage of RUPRI's capacity for further simulation analysis and empirically based analyses of changes occurring as a result of the PPACA.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Uninsured and underinsured
  • Transitions in Care for Rural Medicare Beneficiaries with Diabetes
    Hospital readmission rates among persons with diabetes, as well as absolute admission rates, may be used to study health disparities among rural and minority populations. This project will use data from the Medicare Chronic Conditions Data Warehouse to explore residence- and race-based disparities in diabetes admission rates, effective transitions to outpatient care, and re-admission rates, to help guide rural policy-makers and healthcare providers.
    Research center: Rural and Minority Health Research Center
    Topics: Chronic diseases and conditions, Diabetes, Health disparities and health equity, Medicare, Minority health

2010

2008

  • Impact of Medicare Advantage Plan Concentration on Choices and Competition in Rural Areas
    This project focuses on the analysis of Medicare Advantage (MA) plan choices for rural beneficiaries and what the concentration of plan choices in rural areas may mean in the context of how rural beneficiaries are making their choices. Using measures of concentration from the economics literature, this project will explore the relationship between market concentration in MA plans and the generosity of MA plans, and how it varies by the location of residence of Medicare beneficiaries.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Medicare Advantage (MA)
  • Rural Dimensions of Medicare Payment Policies
    This project examines major Medicare fee-for-service payment policies from the rural perspective.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Medicare, Post-acute care

2007

2006

  • Rapid and Flexible Analysis of Data from Centers for Medicare and Medicaid Services
    Project staff will provide rapid and flexible analysis of Centers for Medicare and Medicaid Services (CMS) data in response to requests from Office of Rural Health Policy (ORHP) staff. Work will be ongoing throughout the contract year, with the design of individual products determined in response to ORHP staff needs.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Medicare, Rural statistics and demographics
  • Rural-Urban Physician Payment Differences Across the Nation: Methodological Changes
    This project will simulate the effects of changes to the methodologies used to calculate the three geographic practice cost indices currently used to adjust physician payment across the 89 Medicare payment areas in the U.S. and territories. Changes to the payment formula will be analyzed to determine potential impact on payment across areas and revenues for rural physician practices.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians, Workforce
  • Urban and Rural Differences in Access to Care and Treatment for Medicare Beneficiaries with Cancer
    Little is known about the differences in the diagnosis, treatment and outcomes of care for cancer patients across urban and rural regions of the country. This study will extend our understanding of the challenge of providing high-quality cancer care to Medicare beneficiaries and how provider availability influences access to needed care in urban and rural areas.
    Research center: FORHP-funded Individual Grantees
    Topics: Cancer, Chronic diseases and conditions, Health services, Medicare, Quality

2005

  • Access to Physician Care for the Rural Medicare Elderly
    This study described where Medicare beneficiaries in five states obtain their health care, how far they travel for that care, and the mix of physician specialties from which they obtain ambulatory care. Special attention was paid to beneficiaries who have dual Medicare-Medicaid status, who reside in poorer income areas, and who live in designated Health Professional Shortage Areas.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Chronic diseases and conditions, Health services, Medicare, Physicians, Poverty
  • Is Medicare Beneficiary Access to Primary Care Physicians At Risk?
    This project examined the impact of changes in Medicare payment to physicians on access to care for rural beneficiaries.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
  • National Study of Home Health Access in Rural America
    This project will develop home health care service areas that will allow for the measurement of access to home health care for rural Medicare beneficiaries who die of cancer, and recommend options for increasing access to home health care in underserved rural areas.
    Research center: FORHP-funded Individual Grantees
    Topics: Cancer, Health services, Home health, Hospice and palliative care, Medicare
  • Post-Acute Care: A Rural and Urban Comparison
    This multi-phase analysis examines whether discharge patterns for and use of post-acute care services by rural and urban hospitalized Medicare beneficiaries differ and, if they do, what are the sources of these different patterns.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Home health, Long-term care, Medicare, Post-acute care

2004

2003

2002

2001

1999

Unknown

  • Access to Cancer Services for Rural Colorectal Cancer Medicare Patients: A Multi-State Study
    This study examined a comprehensive database to quantify the distance and access to four types of cancer services in a sample of rural, Medicare-insured, CRC patients of different racial and ethnic groups, and will inform future work designed to understand discrepancies in cancer service use by the rural elderly in different racial and ethnic groups.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Cancer, Chronic diseases and conditions, Health services, Medicare, Minority health