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Rural Policy Brief

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https://www.readbyqxmd.com/read/27416650/medicare-accountable-care-organizations-beneficiary-assignment-update
#1
Thomas Vaughn, A Clinton MacKinney, Keith J Mueller, Fred Ullrich, Xi Zhu
This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services (CMS) Accountable Care Organization (ACO) regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Overall, the regulatory changes are intended to (1) encourage ACOs to participate in two-sided risk contracts, (2) increase the likelihood that beneficiaries are assigned to the physician (and ACO) from whom they receive most of their primary care services, and (3) make it easier for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to participate in ACOs...
June 2016: Rural Policy Brief
https://www.readbyqxmd.com/read/27416649/health-insurance-marketplaces-premium-trends-in-rural-areas
#2
Abigail R Barker, Leah M Kemper, Timothy D McBride, Keith J Meuller
Since 2014, when the Health Insurance Marketplaces (HIMs) authorized by the Patient Protection and Affordable Care Act (ACA) were implemented, considerable premium changes have been observed in the marketplaces across the 50 states and the District of Columbia. This policy brief assesses the changes in average HIM plan premiums from 2014 to 2016, before accounting for subsidies, with an emphasis on the widening variation across rural and urban places. Since this brief focuses on premiums without accounting for subsidies, this is not intended to be an analysis of the "affordability" of ACA premiums, as that would require assessment of premiums, cost-sharing adjustments, and other factors...
May 2016: Rural Policy Brief
https://www.readbyqxmd.com/read/26793822/rural-medicare-advantage-plan-payment-in-2015
#3
Leah Kemper, Abigail R Barker, Timothy D McBride, Keith Mueller
Payment to Medicare Advantage (MA) plans was fundamentally altered in the Patient Protection and Affordable Care Act of 2010 (ACA). MA plans now operate under a new formula for county-level payment area benchmarks, and in 2012 began receiving quality-based bonus payments. The Medicare Advantage Quality Bonus Payment Demonstration expanded the bonus payments to most MA plans through 2014; however, with the end of the demonstration bonus payments has been reduced for intermediate quality MA plans. This brief examines the impact that these changes in MA baseline payment are having on MA plans and beneficiaries in rural and urban areas...
December 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26793821/rural-enrollment-in-health-insurance-marketplaces-by-state
#4
Abigail R Barker, Timothy D McBride, Leah M Kemper, Keith J Mueller
Since passage of the Patient Protection and Affordable Care Act (ACA), much attention has been focused on the functioning of Health Insurance Marketplaces (HIMs). In this brief, cumulative county-level enrollment in HIMs through March 2015 is presented for state HIMs operated as Federally Facilitated Marketplaces (FFMs) and Federally Supported State-Based Marketplaces (FS-SBMs). We provide comparisons between enrollment in urban and rural areas of each state and corresponding percentages of "potential market" participants enrolled...
October 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26793819/rural-enrollment-in-health-insurance-marketplaces
#5
Abigail R Barker, Timothy D McBride, Leah M Kemper, Keith J Mueller
Our previous analysis of 2015 Health Insurance Marketplace (HIM) data on plan availability and premiums in comparison to 2014 showed only modest premium increases in many rural areas and increased firm participation in most areas. To determine whether HIM enrollment also shows a positive trend, we analyzed county-level HIM enrollment data for 2015 by geographic categories, population density, premium, and firm participation, comparing enrollment outcomes in rural places to those in urban places. Key Findings...
July 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26793818/2015-rural-medicare-advantage-enrollment-update
#6
Chance Finegan, Fred Ullrich, Keith Mueller
Key Findings. (1) Rural enrollment in Medicare Advantage (MA) and other prepaid plans increased by 6.8 percent between March 2014 and March 2015 to 2.1 million members, or 21.2 percent of all rural residents eligible for Medicare. This compares to a national enrollment in MA and other prepaid plans of 31.1 percent (16.7 million) of enrollees. (2) Rural enrollment in Health Maintenance Organization (HMO) plans (including point-of-service, or POS, plans), Preferred Provider Organization (PP0) plans, and other pre-paid plans (including Medicare Cost and Program of All-Inclusive Care for the Elderly Plans) all increased by 5-13 percent...
July 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26793816/characteristics-of-rural-accountable-care-organizations-acos-%C3%A2-a-survey-of-medicare-acos-with-rural-presence
#7
Abiodun Salako, Xi Zhu, A Clinton MacKinney, Fred Ullrich, Keith Mueller
Accountable Care Organizations (ACOs) are groups of health care providers, principally physicians and hospitals, who develop a new entity that contracts to provide coordinated care to assigned patients with the goal of improving quality of care while controlling costs. Section 3022 of the Patient Protection and Affordable Care Act of 2010 created the Medicare Shared Savings Program (SSP). The Centers for Medicare & Medicaid Services (CMS) implements this program and has approved SSP contracts in five cycles since 2011, including some that participated in a special demonstration project that provided advance payment (as a forgivable loan)...
May 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26793814/health-insurance-marketplaces-early-findings-on-changes-in-plan-availability-and-premiums-in-rural-places-2014-2015
#8
Abigail Barker, Timothy D McBride, Leah M Kemper, Keith Mueller
The Patient Protection and Affordable Care Act established Health Insurance Marketplaces (HIMs) in all 50 states and the District of Columbia. This policy brief assesses the changes in HIMs from 2014 to 2015 in terms of choices offered and premiums charged, with emphasis on how these measures vary across rural and urban places. Key Findings. (1) In 74 percent of HIM rating areas, the number of firms operating increased by at least one, while the number of firms decreased in only about 6 percent of rating areas...
May 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26793812/characteristics-of-rural-communities-with-a-sole-independently-owned-pharmacy
#9
Matthew Nattinger, Fred Ullrich, Keith J Mueller
Prior RUPRI Center policy briefs have described the role of rural pharmacies in providing many essential clinical services (in addition to prescription and nonprescription medications), such as blood pressure monitoring, immunizations, and diabetes counseling, and the adverse effects of Medicare Part D negotiated networks on the financial viability of rural pharmacies.1 Because rural pharmacies play such a broad role in health care delivery, pharmacy closures can sharply reduce access to essential health care services in rural and underserved communities...
April 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26793811/hospital-views-of-factors-affecting-telemedicine-use
#10
Kimberly A S Merchant, Marcia M Ward, Keith J Mueller
Telemedicine (also known as telehealth) is a means to increase access to care, one of the foundations of the Triple Aim. However, the expansion of telemedicine services in the United States has been relatively slow. We previously examined the extent of uptake of hospital based telemedicine using the 2013 HIMSS (Healthcare Information and Management Systems Society) Analytics national database of 4,727 non-specialty hospitals. Our analysis indicated that the largest percentage of operational telemedicine implementations (15...
April 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26364327/a-rural-taxonomy-of-population-and-health-resource-characteristics
#11
Xi Zhu, Keith J Mueller, Thomas Vaughn, Fred Ullrich
This policy 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 policy makers and rural communities. Key Findings. (1) We classified 10 distinct types of rural places based on characteristics related to both demand (population) and supply (health resources) sides of the health services market. (2) In descending order, the most significant dimensions in our classification were facility resources, provider resources, economic resources, and age distribution...
March 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26364326/developmental-strategies-and-challenges-of-rural-accountable-care-organizations
#12
Jure Baloh, A Clinton MacKinney, Keith J Mueller, Tom Vaughn, Xi Zhu, Fred Ullrich
This policy brief shares insights gained from site visits in 2013 to four Accountable Care Organizations (ACOs) serving rural Medicare beneficiaries. Initial strategic decisions made and challenges faced as the ACOs were being developed can inform development of other rural ACOs. Key Findings. (1) The rural ACOs we studied were formed as a step toward a value-driven rural delivery system, recognizing that ACO participation may or may not have a short term return on investment. (2) Common rural ACO strategies to increase health care value include care management, post-acute care redesign, medication management, and end-of-life care planning...
February 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26415235/surgical-services-in-critical-access-hospitals-2011
#13
Paula Weigel, Fred Ullrich, Marcia M Ward, Keith J Mueller
In this policy brief we describe the types and volume of major surgical services provided in the inpatient and outpatient settings of Critical Access Hospitals (CAHs) in 2011. Major surgical services are those procedures that require use of an operating room (OR), regardless of whether the procedure was inpatient or outpatient. Key Findings (1) CAH discharges of patients having a major surgical procedure that required use of an OR were analyzed from four regionally representative states: Colorado, North Carolina, Vermont, and Wisconsin...
2015: Rural Policy Brief
https://www.readbyqxmd.com/read/26364324/2014-rural-medicare-advantage-enrollment-update
#14
Leah Kemper, Abigail Barker, Timothy McBride, Keith Mueller
Key Data Findings. (1) Reclassification of rural and urban county designations (due to the switch from 2000 census data to 2010 census data) resulted in a 10 percent decline in the number of Medicare eligible Americans living in rural counties in 2014 (from roughly 10.7 million to 9.6 million). These changes also resulted in a decline in the number of MA enrollees considered to be living in a rural area, from 2.19 million to 1.95 million. However, the percentage of Medicare beneficiaries enrolled in MA and prepaid plans in rural areas declined only slightly from 20...
January 2015: Rural Policy Brief
https://www.readbyqxmd.com/read/25399475/geographic-variation-in-premiums-in-health-insurance-marketplaces
#15
Abigail R Barker, Timothy D McBride, Leah M Kemper, Keith Mueller
This policy brief analyzes the 2014 premiums associated with qualified health plans (QHPs) made available through new health insurance marketplaces (HIMs), an implementation of the Patient Protection and Affordable Care Act (ACA) of 2010. We report differences in premiums by insurance rating areas while controlling for other important factors such as the actuarial value of the plan (metal level), cost-of-living differences, and state-level decisions over type of rating area. While market equilibrium, based on experience and understanding of the characteristics of the new market, should not be expected this soon, preliminary results give policymakers key issues to monitor...
August 2014: Rural Policy Brief
https://www.readbyqxmd.com/read/25399474/facilitating-the-formation-of-accountable-care-organizations-in-rural-areas
#16
Jure Baloh, Xi Zhu, Tom Vaughn, A Clinton MacKinney, Keith J Mueller, Fred Ullrich, Matthew Nattinger
This Policy Brief presents characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries. Doing so provides considerations for provider organizations contemplating creating rural-based ACOs. Key Findings. (1) Previous organizational integration and risk-sharing experience facilitated ACO formation. (2) Use of an electronic health record system fostered core ACO capabilities, including care coordination and population health management. (3) Partnerships across the care continuum supported utilization of local health care resources...
July 2014: Rural Policy Brief
https://www.readbyqxmd.com/read/25399473/the-effect-of-medicare-payment-policy-changes-on-rural-primary-care-practice-revenue
#17
Paula Weigel, A Clinton MacKinney, Fred Ullrich, Keith J Mueller
In this policy brief we analyze the effect of Medicare payment adjustments on Medicare-derived revenues to rural primary care providers. Building on prior work in this area, we look at the effect of changes in the Geographic Practice Cost Indices (GPCIs) from 2013 to 2014 as implemented in the Pathway for SGR Reform Act of 2013 and the Protecting Access to Medicare Act. Key Findings. (1) Changes to the GPCIs made between January 1, 2013, and March 31, 2014, resulted in an average 0.12% (median 0.18%) Medicare-derived revenue increase in rural primary care practices...
July 2014: Rural Policy Brief
https://www.readbyqxmd.com/read/25399472/update-independently-owned-pharmacy-closures-in-rural-america-2003-2013
#18
Fred Ullrich, Keith J Mueller
Key Findings. (1) From March 2003 to December 2013, there was a loss of 924 (12.1%) independently owned rural pharmacies in the United States. The most drastic loss occurred between 2007 and 2009. From 2010-2013, the trend has been for more closures, although the decline is not as pronounced or clear as in earlier years. (2) Four hundred ninety rural communities that had one or more retail pharmacy (including independent, chain, or franchise pharmacy) in March 2003 had no retail pharmacy in December 2013.
June 2014: Rural Policy Brief
https://www.readbyqxmd.com/read/25399470/a-guide-to-understanding-the-variation-in-premiums-in-rural-health-insurance-marketplaces
#19
Abigail R Barker, Timothy D McBride, Leah M Kemper, Keith Mueller
Key Findings. (1) State-level decisions in implementing the Patient Protection and Affordable Care Act of 2010 (ACA) have led to significant state variation in the design of Health Insurance Marketplace (HIM) rating areas. In some designs, rural counties are grouped together, while in others, rural and urban counties have been deliberately mixed. (2) Urban counties have, on average, approximately one more firm participating in the marketplaces, representing about 11 more plan offerings, than rural counties have...
May 2014: Rural Policy Brief
https://www.readbyqxmd.com/read/25399468/medicare-accountable-care-organizations-program-eligibility-beneficiary-assignment-and-quality-measures
#20
A Clinton MacKinney, Keith J Mueller, Xi Zhu, Thomas Vaughn
Accountable Care Organizations (ACOs) are groups of providers (generally physicians and/or hospitals) that may receive financial rewards by maintaining or improving care quality for a group of patients while reducing the cost of care for those patients. The Patient Protection and Affordable Care Act of 2010 (ACA) established a Medicare Shared Savings Program (MSSP) and accompanying Medicare ACOs to “facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service (FFS) beneficiaries and reduce unnecessary costs...
April 2014: Rural Policy Brief
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