RUPRI Health Panel Releases Comments on Rural Emergency Hospital RFI

The Panel is pleased to comment in response to the proposed rule for Medicare hospital outpatient prospective payment system (OPPS) program and the Request for Information (RFI) on Rural Emergency Hospitals (REH). Our comments will focus only on the latter, Section XVII of the proposed rule, Federal Register pages 42285 – 42289. We also limit […]

RUPRI Releases Comments on Office Of Management & Budget Proposal to Revise Metropolitan and Micropolitan Area Standards. March 2021

RUPRI, led by the Rural Health Panel and the Population and Place Analytics Panel, has released comments on Recommendations from the Metropolitan and Micropolitan Statistical Area Standards Review Committee to Changes in Metropolitan and Micropolitan Area Standards. Read Comments Here In our comments, we recommend that OMB not implement a change in the metropolitan statistical […]

Characteristics & Challenges of Rural Ambulance Agencies. RUPRI Health Panel. January 2021.

The RUPRI Health Panel has released a new brief, Characteristics and Challenges of Rural Ambulance Agencies. Every year, nearly 10 million rural Americans receive EMS care. There are 23,272 ambulance agencies in the U.S. and 73 percent of those agencies report serving rural areas. Thus, rural Americans rely on EMS professionals to deliver life-saving emergency […]

Advancing Population Health in Rural Places: New from RUPRI Health Panel. January 2021.

The RUPRI Health Panel has released a new paper, Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities. This paper advances policy discussion of population health in rural places, focusing on the role of rural health care organizations. Lessons from ongoing programs provide policy considerations. Medicare and Medicaid programs should prioritize staff and […]

The Evolving Landscape of National Telehealth Policies during a Public Health Emergency: Responsiveness to Rural Needs

The coronavirus pandemic precipitated significant but temporary changes in telehealth policy and the use of telehealth services to ensure access to needed health services during a public health emergency (PHE). Extending the temporary policy changes will require statutory and regulatory action. This paper takes stock of current telehealth policies and assesses options for expanding the […]

Considerations for Defining Rural Places in Health Policies and Programs

The RUPRI Health Panel has released a new brief that identifies key questions to ask when creating, modifying, or using a definition. Rural definitions in statute and policy are used to direct resources to underserved peoples. But changes in population behavior and Census processes have led to concern about historic methods of defining rural. This […]

Behavioral Health in Rural America: Challenges and Opportunities

The prevalence of mental health and substance use diagnoses and unmet treatment needs are not equally distributed, with rural residence being one factor associated with these differences. Moreover, the rural context has proven challenging for ensuring the availability of and access to prevention, diagnosis, treatment, and recovery services in rural areas. This paper reviews the […]

Health Panel Comment Letter – Anti-Kickback Statute – December 2019

The Panel is pleased to provide comment on the proposed rule Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements. The Panel is encouraged by OIG’s recognition that there are certain circumstances that warranttreating rural providers differently than those in urban geographies. The Panel offers comments ontwo specific […]

Health Panel Comment Letter – Stark Law – December 2019

The Panel is pleased to provide comments on the proposed rule Modernizing and Clarifying the Physician Self-Referral Regulations.The Panel is encouraged by CMS’s recognition throughout the proposed rule of the unique ruralhealth care environment. The Panel agrees that circumstances exist in which it is appropriate to treatrural providers differently than other kinds of providers. View […]

Health Panel Comment Letter – PFS Proposed Rule 2020 Revisions – September 2019

The Panel is pleased to offer comments in response to the proposed updates to the CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) The Panel applauds CMS’s attention to rural issues throughout the proposed rule. CMS hasdemonstrated its commitment to rural areas in considering innovative telehealth care delivery foropioid use disorder […]

Policy Opportunities for Advancing Rural Health

This presentation describes the transformation in the finance and delivery of health systems as well as exploring social determinants of health. High-performance rural health systems are influenced by policy actions. Presented by Keith Mueller (PhD), Andrew Coburn (PhD), Jennifer Lundblad (PhD), Timothy McBride (PhD) at the Annual Conference of the National Rural Health Association in […]

Toward a High Performing Rural Health Care System: Key Issues and Recommendations from Rural Health Care System Innovators. Roundtable with Rural Health Innovators. RUPRI Rural Health Panel. December 2018.

Toward a High Performing Rural Health Care System: Key Issues and Recommendations from Rural Health Care System Innovators View Report On December 6-7, 2018, the Rural Health Policy Research Institute’s (RUPRI) Health Panel convened a meeting in Washington, DC, of rural health leaders from around the country to discuss strategies and models for rural health […]

Health Panel Comment Letter – NQF Draft Report – February 2019

The Panel welcomes the opportunity to submit comments on Addressing the Low Case-Volume Challenge in Healthcare Performance Measurement of Rural Providers: Recommendations from the MAP Rural Health Technical Expert Panel. The RUPRI Health Panel strongly supports the NQF Measure Applications Partnership Rural Health Workgroup. Valid and reliable quality performance measures are critically important to rural […]

Health Panel Comment Letter – Medicare, Medicaid & CHIP – January 2019

RE: 42 CFR Parts 438 and 457 – Medicaid Program; Medicaid and Children’s Health Insurance Plan (CHIP)Managed Care The Panel welcomes the opportunity to submit comments on the Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-for-Service, and Medicaid Managed Care Programs for years 2020 and 2021 proposed […]

Health Panel Comment Letter – Medicare, Part D & Medicaid – December 2018

RE: 42 CFR Parts 422, 423, 438, and 498: Medicare and Medicaid Programs; Policy and Technical Changes tothe Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-Inclusive Care for the Elderly(PACE), Medicaid Fee-for-Service, and Medicaid Managed Care Programs for Years 2020 and 2021 The Panel welcomes the opportunity to submit comments on the Medicare Advantage, […]

Assessing the Unintended Consequences of Health Policy on Rural Populations and Places

The RUPRI Rural Health Panel, through the support of the Federal Office of Rural Health Policy (FORHP) in the Department of Health and Human Services, has released a new Policy Brief, Assessing the Unintended Consequences of Health Policy on Rural Populations and Places. The purpose of this paper is to illuminate the unintended consequences of health […]

Health Panel Comment Letter – ACO Proposed Rule – October 2018

RE: 42 CFR Part 414 and 425: Medicare Program; Medicare Shared Savings Program; Accountable CareOrganizations – Pathways to Success The Panel is pleased to offer comments in response to this particular proposed rule. Our comments are limited to rural-specific issues and are structured to parallel questions posed, or issues stated, by CMS (not technical comments […]

RUPRI’s Rural Health Research Findings included in new GAO Report on Rural Hospital Closures

The United States Government Accountability Office was asked by Members of Congress to examine Rural Hospital Closures and the Number and Characteristics of Affected Hospitals and Contributing Factors. Research and policy considerations from the RUPRI Health Panel, the RUPRI Center for Rural Health Policy Analysis and Rural Health Value, in partnership with Stratis Health, were included in the report. GAO’s analysis […]

Health Panel Comment Letter – Outpatient Payment & Interoperability – Septembe 2018

RE: 42 CFR Part 416 and 419: Medicare Program; Proposed Changes to Hospital Outpatient ProspectivePayment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Requests forInformation on Promoting Interoperability and Electronic Health Care Information, Price Transparency, andLeveraging Authority for the Competitive Acquisition Program for Part B Drugs and Biologicals for a PotentialCMS Innovation Center […]

Webinar – Insuring Rural America: Health Insurance Challenges and Opportunities

September 17, 2018 @ 12:00 pm – 1:00 pm Current U.S. policy utilizes various market-based models within Medicare, Medicaid, and Health Insurance Marketplaces to ensure access to health insurance coverage, but access is increasingly uneven and unaffordable, especially in some rural areas. After giving an overview of some of the relevant economic theory, this webinar will take […]

Insuring Rural America: Health Insurance Challenges and Opportunities

This presentation discusses the economic theory and the potential of regulated markets as well as rural-specific issues such as network information and adequacy. Policy opportunities and recommendations are also touched upon. Presented by Timothy D. McBride (PhD) and Abigail R. Barker (PhD) from the Rural Policy Research Institute on September 17, 2018. View Presentation

Health Panel Comment Letter – Revisions to Physician Payments – September 2018

RE: 42 CFR Part 405, 410, 411, 414, 415, and 495: Medicare Program; Revisions to Payment Policies Under thePhysician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings ProgramRequirements; Quality Payment Program; and Medicaid Promoting Interoperability Program The Panel is pleased to offer comments in response to the proposed rules […]

Primary Care: The Foundation for a High-Performance Rural Health Care System

This paper will review elements of a robust rural primary care system, including development and maintenance of a high performance rural primary care system and workforce as well as policy considerations and opportunities that address the sustainability of rural primary care. Written by Keith J. Mueller (PhD), Charlie Alfero (MA), Andrew F. Coburn (PhD), Jennifer […]

Insuring Rural America: Health Insurance Challenges and Opportunities

This paper discusses the realities and challenges of designing a market structure that will result in affordable health insurance being offered in rural markets, and reviews the rural implications of policies affecting rural health insurance markets and health systems. Written by Keith J. Mueller (PhD), Charlie Alfero (MA), Andrew F. Coburn (PhD), Jennifer P. Lundblad […]

Oral Testimony for the U.S. Senate Committee on Finance

This testimony focuses on three areas of particular relevance, rural experience with Medicare’s accountable care organization and use of Telehealth. It will conclude with general observations about future directions in rural health policy. Spoken by Keith J. Mueller (PhD) (Interim Dean, College of Public Health; Director, RUPRI Center for Rural Health Policy Analysis; Chair, RUPRI […]

Written Statement for the U.S. Senate Finance Committee

This statement focuses on three areas of particular relevance, rural experience with Medicare’s accountable care organization and use of Telehealth. It will conclude with general observations about future directions in rural health policy. Written by Keith J. Mueller (PhD) (Interim Dean, College of Public Health; Director, RUPRI Center for Rural Health Policy Analysis; Chair, RUPRI […]

Taking Stock: Policy Opportunities for Advancing Rural Health

This paper examines the progress of health system transformation and the gaps that remain as they affect rural people, places, and providers. The health system transformation activities examined here are not limited to the Patient Protection and Affordable Care Act of 2010 (PPACA), but also touch upon activities undertaken by states, insurance plans, and public […]

Health Panel Comment Letter – FCC Promoting Telehealth in Rural America – January 2018

Promoting Telehealth in Rural America 47 CFR Part 54 The Panel is pleased to offer comments in response to the proposed rule for Promoting Telehealth in Rural America, specifically the Federal Communications Commission (FCC) Rural Healthcare (RHC) Program. View Comment Letter

Dr Keith Mueller, RUPRI Health Panel Chair presents at Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States

January 17, 2018 Wednesday, January 17, 2018 9:30 a.m. to 11:00 a.m. ETBipartisan Policy Center, 1225 Eye St NW, Suite 1000, Washington, DC, 20005 To better understand the challenges and opportunities rural communities face with health care delivery and infrastructure, the Bipartisan Policy Center led an effort over the past 6 months to learn from […]

Primer on Rural Long-Term Services and Support

 Rural Long-Term Services and Supports: A Primer provides policymakers and other interested stakeholders a primer on rural long-term services and supports (LTSS): (1) the fundamentals of the rural LTSS system, (2) rural access to and use of LTSS, and (3) discussion of the opportunities within and limitations of current Federal and State LTSS policy for advancing […]

Accessing Behavioral Health Services in Rural Communities

This presentation explains the concepts of affordability and availability as well as broadening network of participating local organizations to include social services. It also discusses the future of health homes and behavioral health services. Presented by Keith J. Mueller, PhD (College of Public Health, University of Iowa) at the National Academies on November 14, 2017. […]

Rural Health and the Law: Emerging Issues and Trends

This presentation discusses the transformation underway as a result of payer policies designed to improve the value and outcomes of health care while attempting to slow cost growth. It also touches on gaps affecting rural people, places, and providers. Presented by Jennifer P. Lundblad, PhD (President and CEO, Stratis Health; Member RUPRI Health Panel) on […]

After Hospital Closure: Pursuing High Performance Rural Health System without Inpatient Care

The RUPRI Health Panel describes opportunities for rural communities to develop a high-performance rural health system after hospital closure, including three case studies that describe real-world transitions from a hospital-based locus of care to new models of care delivery in rural places. After Hospital Closure: Pursuing High Performance Rural Health System without Inpatient Care This paper describes […]

RUPRI Health Panel Member, Jennifer Lundblad, Discusses Antibiotic Stewardship for Rural Hospitals

In a recent Rural Monitor article for the Rural Health Information Hub, Jennifer Lundblad, CEO of Stratis Health and a member of the RUPRI Health Panel, discusses the economic impact of antibiotic stewardship (AS) programs for rural hospitals.  She also referenced a RUPRI Health Panel public comment letter on a proposed rule from the Centers on Medicare and Medicaid that would require […]

RUPRI Health Panel member, Jennifer Lundblad, discusses rural hospital innovation

In Health & Hospitals Networks latest publication, Jennifer Lundblad, RUPRI Health Panel Member and president and CEO of Stratis Health, discusses how rural hospitals and rural communities are well-positioned to create innovative population health and wellness programs. “A rural environment lends itself to population health and wellness,” she says. “Providers probably know the patient and their family, they […]

Medicaid Payment and Delivery System Reform: Challenges and Opportunities for Rural Health Systems

Medicaid has grown significantly in its importance to rural health systems and communities; a higher proportion (22 percent) of rural residents was enrolled in Medicaid than Medicare (20 percent) in 2014. At the same time, the use of payment and delivery innovations has grown significantly, but varies across the U.S. As a result of expansions […]

Policy Brief: Medicare Value-Based Payment Reform

Medicare Value-Based Payment Reform: Priorities for Transforming Rural Health Systems View Policy Brief | Related: View Full Report In January 2015, Department of Health and Human Services (HHS) Secretary Burwell announced new goals and timelines for moving Medicare reimbursement from fee-for-service to value-based payment. These payment changes are driving delivery system reforms by making healthcare […]

Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems

View Report | Related: View Policy Brief In recognition of unsustainable healthcare cost growth and sub-optimal delivery system performance, the Patient Protection and Affordable Care Act of 2010 (ACA) contains provisions that redesign healthcare payment and delivery. ACA payment change provisions are driving delivery system reform by making healthcare organizations more accountable for patients’ health […]

Accountable Care Communities in Rural: Laying the Groundwork in Humboldt County, CA – 2015

This joint paper was authored by members of both the Health and Human Services Panel in June 2015. The paper presents a case for the viability of Accountable Care Community (ACC) models in rural communities, including in rural Humboldt County, California. Accountable Care Communities reflect a unified approach to improving the health and reducing the […]

Transitioning to a High Performance Rural Health System

This presentation discusses how hospitals should respond and why response should be other than incremental adjustment. It will touch base on change and how it creates opportunities as well as threats. Presented by Keith J. Mueller, PhD (Director, RUPRI Center for Rural Health Policy Analysis) and Charles W. Fluharty, M. Div. (President, Rural Policy Research […]

Advancing the Transition to a High-Performance Rural Health System. RUPRI Health Panel. November 2014.

In Advancing the Transition to a High-Performance Rural Health System, the RUPRI Health Panel discusses strategies and options for creating a pathway to a transformed, high-performing rural health system. This paper builds on the RUPRI Health Panel’s earlier paper that conceptually defined the core elements of a high-performance rural health system. We have also incorporated […]

Access to Rural Health Care – Literature Review and New Synthesis

This report reviews important access definitions and frameworks from the literature. The review serves as a concept map to create a unique synthesis of perspectives that may be used by researches and policy makers to design or clarify access to health care providers. Prepared in August 2014 by the RUPRI Health Panel: A. Clinton MacKinney, […]

The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: 2010 First and 2014 Second Look

These two policy documents from 2010 and 2014 take a first and second look at the implementation of the Patient Protection and Affordable Care Act of 2010 and how it contributes to reshaping the health care delivery landscape, particularly in rural areas. Prepared in September 2010 and April 2014 by the RUPRI Health Panel: Andrew […]

Transitioning to a Value-Based Health Care Future

This presentation discusses the climate of change in health care, payment policies and price reduction threats. It will also touch base on the Affordable Care Act. Presented by A. Clinton MacKinney (Deputy Director and Assistant Professor, RUPRI Center for Rural Health Policy Analysis) at the Improving Health in a Climate of Change NACo in San […]