Publications

Policy Briefs

2025

• The Impact of High Hospital Fixed-Cost Ratios on Rural Populations Brief No. 2025-3
• Evaluating Medicare Advantage Benchmark Setting Methodology on Rural Counties Brief No. 2025-2
• March 2024: Medicare Advantage Enrollment Update Brief No. 2025-1

2024

• Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program Brief No. 2024-5
• Changes in Rural Pharmacy Presence 2023 Brief No. 2024-4
• Medicare Advantage Plan Growth in Rural America: Availability of Supplemental Benefits Brief No. 2024-3
• Nonmetropolitan Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces in 2022 Brief No. 2024-1

2023

• Medicare Advantage Enrollment Update 2023 Brief No. 2023-9
• Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties Brief No. 2023-8
• COVID-19 Vaccination Rates Brief No. 2023-5
• Financial Risk Acceptance among Rural Health Care Providers Participating in the Quality Payment Program Brief No. 2023-4
• Medicare Advantage Enrollment Update 2022 Brief No. 2023-3
• Changes in Service Offerings Post-System Affiliation in Rural Hospitals Brief No. 2023-2

2022

• Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22 Brief No. 2022-4
• Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021 Brief No. 2022-3
• Medicare Beneficiary Access to Prescription Drugs in Rural Areas Brief No. 2022-2
• Rural and Urban Pharmacy Presence – Pharmacy Deserts Brief No. 2022-1

2021

• Medicare Advantage Enrollment Update 2021 Brief No. 2021-7
• COVID-19 Cases and Vaccination Rates Brief No. 2021-8
• Medicare Advantage Enrollment Update 2020 Brief No. 2021-6
• Sources of Insurance Coverage in Nonmetropolitan Areas: The Role of Public and Private Insurance Since 2009 Brief No. 2021-5
• Geographic Expansion of Medicaid Managed Care Organizations: Assessing Access to Primary Care in Nonmetropolitan Counties Brief No. 2021-4
• Availability of Supplemental Benefits in Medicare Advantage Plans in Rural and Urban Areas Brief No. 2021-3
• High-Functioning Rural Medicare ACOs - A Qualitative Review Brief No. 2021-2
• Trends in Nursing Home Closures in Nonmetropolitan and Metropolitan Counties in the United States: 2008-2018 Brief No. 2021-1

     All RUPRI COVID-19 Publications

2020

• Pharmacy Vaccination Service Availability in Nonmetropolitan Counties Brief No. 2020-10
• COVID-19 Cases and Deaths, Metropolitan and Nonmetropolitan Counties Over Time Brief No. 2020-9
• Medicare Advantage Enrollment Update 2019 Brief No. 2020-8
• Telepharmacy Rules and Statutes: A 3-Year Update for all 50 States Brief No. 2020-7
• Access to Medicare Part D Plans: A Comparison of Metropolitan and Nonmetropolitan Areas Brief No. 2020-5
• County-Level 14-Day COVID-19 Case Trajectories Brief No. 2020-6
• Metropolitan/Nonmetropolitan COVID-19 Confirmed Cases and General and ICU Beds Brief No. 2020-4
• Health Care Professional Workforce Composition before and after Rural Hospital Closure Brief No. 2020-3
• Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties Brief No. 2020-2
      - Previous versions
• Rural Hospital Participation in Medicare Accountable Care Organizations Brief No. 2020-1

2019

• Impact of the Medicare Disproportionate Share Hospital Payment Cap on Rural and Urban Hospitals Brief No. 2019-6
• Effects of the Patient Protection and Affordable Care Act on Coverage and Access to Care in Metropolitan vs. Non-Metropolitan Areas through 2016 Brief No. 2019-5
• Insurer Participation in Rural Health Insurance Marketplaces: Are Some Markets Intrinsically More Competitive Than Others? Brief No. 2019-4
• Primary Care Clinician Participation in the CMS Quality Payment Program Brief No. 2019-3
• Medicare Advantage Enrollment Update 2018 Brief No. 2019-2
• Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics Brief No. 2019-1

2018

• Changes to the Merit-based Incentive Payment System Pertinent to Small and Rural Practices, 2018 Brief No. 2018-6
• Trends in Hospital System Affiliation, 2007-2016 Brief No. 2018-5
• Spread of Medicare Accountable Care Organizations in Rural America Brief No. 2018-4
• Health Insurance Marketplaces: Issuer Participation and Premium Trends in Rural Places, 2018 Brief No. 2018-3
• Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018 Brief No. 2018-2
• Medicare Accountable Care Organization Growth in Rural America, 2014–2016 Brief No. 2018-1
      - Supplemental Tables and Maps

2017

• Rural-Urban Enrollment in Part D Prescription Drug Plans: June 2017 Update Brief No. 2017-7
• Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals Brief No. 2017-6
• Medicare Advantage Enrollment Update - March 2017 Brief No. 2017-5
      National and State Enrollment Tables and Maps
• Telepharmacy Rules and Statutes: A 50-State Survey Brief No. 2017-4
      - Supplemental Table
• Issues Confronting Rural Pharmacies after a Decade of Medicare Part D Brief No. 2017-3
• Changing Rural and Urban Enrollment in State Medicaid Programs Brief No. 2017-2
• Rural Enrollment in Health Insurance Marketplaces, by State Brief No. 2017-1

2016

• Medicare Accountable Care Organizations: Quality Performance by Geographic Categories Brief No. 2016-6
• Spread of Accountable Care Organizations in Rural America Brief No. 2016-5
• Medicare Advantage Enrollment Update 2016 Brief No. 2016-4
• Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications Brief No. 2016-3
• Health Insurance Marketplaces: Premium Trends in Rural Areas Brief No. 2016-1
• Medicare Accountable Care Organizations: Beneficiary Assignment Update Brief No. 2016-2

2015

• Rural Medicare Advantage Plan Payment in 2015 Brief No. 2015-12
• Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems A RUPRI Panel Brief
• Rural Enrollment in Health Insurance Marketplaces, by State Brief No. 2015-11
• Rural Enrollment in Health Insurance Marketplaces Brief No. 2015-10
• 2015: Rural Medicare Advantage Enrollment Update Brief No. 2015-9
• Characteristics of Rural Accountable Care Organizations (ACOs) – A Survey of Medicare ACOs with Rural Presence Brief No. 2015-8
• Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015 Brief No. 2015-7
• Characteristics of Rural Communities with a Sole, Independently Owned Pharmacy Brief No. 2015-6
• Hospital Views of Factors Affecting Telemedicine Use Brief No. 2015-5
• A Rural Taxonomy of Population and Health-Resource Characteristics Brief No. 2015-4
     - Technical Report
     - Maps and Tables
• Developmental Strategies and Challenges of Rural Accountable Care Organizations Brief No. 2015-3
• Surgical Services in Critical Access Hospitals, 2011 Brief No. 2015-2
• Medicare Advantage Enrollment Update: March 2014 Brief No. 2015-1

2014

• Advancing the Transition to a High Performance Rural Health System
      RUPRI Health Panel Paper
      RUPRI Health Panel Brief
• Geographic Variation in Premiums in Health Insurance Marketplaces Brief No. 2014-10
• Facilitating the Formation of Accountable Care Organizations in Rural Areas Brief No. 2014-9
• The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue Brief No. 2014-8
      - Supplemental table
• Update: Independently Owned Pharmacy Closures in Rural America, 2003-2013 Brief No. 2014-7
• Trends in Hospital Network Participation and System Affiliation, 2007-2012 Brief No. 2014-6
• A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces Brief No. 2014-5
• Extent of Telehealth Use in Rural and Urban Hospitals Brief No. 2014-4
• Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures Brief No. 2014-3
• The Uninsured: An Analysis by Age, Income, and Geography Brief No. 2014-2
• 2012 Rural Medicare Advantage Quality Ratings and Bonus Payments Brief No. 2014-1

2013

• Assessing the Impact of Rural Provider Service Mix on the Primary Care Incentive Payment Program Brief No. 2013-16
• Demographic and Economic Characteristics Associated with Sole County Pharmacy Closures, 2006-2010 Brief No. 2013-15
• Medicare Advantage Enrollment Update: March 2013 Brief No. 2013-14
• Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study Brief No. 2013-11
• The Frontier Extended Stay Clinic Model: A Potential Health Care Delivery Alternative for Small Rural Communities Brief No. 2013-9
       Appendix
• Accountable Care Organizations in Rural America Brief No. 2013-7
       National and regional maps
• The Uninsured: An Analysis by Income and Geography Brief No. 2013-6
• Rural Implications of the Primary Care Incentive Payment Program Brief No. 2013-5
• September 2012: Medicare Advantage Enrollment Update Brief No. 2013-3
• Rural MA Enrollment and Premium Update: June 2012 Brief No. 2013-2
• Rural Pharmacy Closures: Implications for Rural Communities: February 2013 Brief No. 2012-5

2012

• Update: Independently Owned Pharmacy Closures in Rural America: July 2012 Brief No. 2012-4
• Rural Medicare Advantage Enrollment Update Brief No. 2012-3

2011

• Rural Medicare Advantage Enrollment Update Brief No. 2011-8
• Patient-Centered Medical Home Services in 29 Rural Primary Care Practices: A Work in Progress Brief No. 2011-6
• Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions in the United States, by Insurance Type, 2000-2004 Brief No. 2011-4
• Independently Owned Pharmacy Closures in Rural America, 2003-2010 Brief No. 2011-5
• Rural Medicare Advantage: Growth in PPOs Dominates the Rural MA Market in 2011 Brief No. 2011-3
• Use of Health Information Technology in Support of Patient-Centered Medical Homes is Low Among Non-Metropolitan Family Medicine Practices Brief No. 2011-2
• Medicare Beneficiary Access to Primary Care Physicians — Better in Rural, but Still Worrisome Brief No. 2011-1

2010

• Rural Medicare Advantage Enrollment Update Brief No. 2010-6
• Increases in Primary Care Physician Income due to the Patient Protection and Affordable Care Act of 2010 - Continued Tweaking of Physician Payment Brief No. 2010-2
• Rural Medicare Advantage: Modest Enrollment Growth in 2010 Brief No. 2010-5
• A Dramatic Shift Away from Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment Brief No. 2010-3
• Rural Medicare Advantage Enrollment Grows 15% in 2009. Brief No. 2010-1

2009

• Rural Primary Care Physician Payment 2006-2009: What a Difference Three Years Doesn't Make Brief No. 2009-12
• Profile of Sole Community Pharmacists Prescription Sales and Overall Financial Position. August 2009
• Rural Enrollment in Medicare Advantage Continues to Grow. Brief No. 2009-8
• Workforce Issues Among Sole Community Pharmacies. July 2009
• PPOs Driving Growth in Rural Medicare Advantage Enrollment. Brief No. 2009-7
• Impact of the Recession on Rural America: Rising Unemployment Leading to More Uninsured in 2009. Brief No. 2009-6
• A Rural-Urban Comparison of a Building Blocks Approach to Covering the Uninsured. Brief No. 2009-5
• Rural Enrollment in Medicare Advantage: Growith in PPOs Outpacing Growth in PFFS. Brief No. 2009-4
• Loss of Community Pharmacies Since 2006: State Experiences. Brief No. 2009-3
• The Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems. March 2009
• Rural Enrollment in Medicare Part D is Growing Slowly. Brief No. 2009-2
• Rural Enrollment in Medicare Advantage: Growth Slows in 2008. Brief No. 2009-1
  Additional Tables

2008

• Eligible But Not Enrolled? Potential for Targeting Over a Half-Million Rural Medicare Beneficiaries for Enrollment in the Low-Income Subsidy Prescription Drug Program. Brief No. 2008-5
  - State Tables
• Electronic Health Records Adoption: Rural Providers' Decision-Making Process. Brief No. 2008-4
• Rural Enrollment in Medicare Advantage Continues to Grow Rapidly in 2008, Led by Private Fee-for-Service Plans. Brief No. 2008-3
• Independently Owned Pharmacy Closures in Rural America. Brief No. 2008-2
  - State Table
• Critical Access Hospitals' Experiences with Medicare Advantage Plans. March, 2008.

2007

• One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D. October, 2007.
• Update on Rural Enrollment in Medicare Advantage: Growth Continues. PB2007-7.
  - Detailed data about Medicare Advantage enrollment and plans. PB2007-7 Tables.
  - State Updates on Medicare Advantage Enrollment. November 2007
• Reliance on Independently Owned Pharmacies in Rural America. PB2007-6.
  - State maps showing the locations of communities with only one pharmacy, independently owned.
• Regional Variation in Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions. PB2007-5.
• National Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions. PB2007-4.
• Rural Enrollment in Medicare Advantage Is Growing Rapidly in 2007, Especially in Private Fee-for-Service Plans. PB2007-3.
• Rural Enrollment in Medicare Advantage Is Concentrated in Private Fee-for- Service Plans. PB2007-2.
• Enrollment in Medicare Part D for Rural Beneficiaries is Encouraging. PB2007-1

2006

• Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries? PB2006-8
• Medicare Physician Payment: Impacts of Changes on Rural Physicians. PB2006-2
• Chronic Disease Management Systems (Registries) in Rural Health Care. PB2006-1

2005

• Why are Health Care Expenditures Increasing and Is There A Rural Differential? PB2005-7
• The Impact of Welfare Reform on Health Insurance Coverage in Rural Areas. PB2005-6
• Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators. PB2005-4
• Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results? PB2005-3
• Preparing for Medicare Part D: An Opportunity for State Offices of Rural Health and State Rural Health Associations. PB2005-2

2004

• Rural Physicians' Acceptance of New Medicare Patients. PB2004-5
• An Analysis of the Agreement Between Financial Data from the Medicare Cost Report and the Audited Hospital Financial Statement. PB2004-4

2003

• Medicare Physician Payment: Practice Expense. PB2003-9
• Enrollment in FEHBP Plans in Rural America: What are the Implications for Medicare Reform? PB2003-8
  - Enrollment in FEHBP Plans in Rural Areas: State-by-state FEHBP Enrollment Analysis and State-by-state FEHBP Enrollment Analysis - by County and Plan
• Rural Hospital HIPAA Readiness and Resource Needs. PB2003-6
• An Analysis of Availability of Medicare+Choice, Commercial HMO, and FEHBP Plans in Rural Areas: Implications for Medicare Reform. PB2003-5
• Medicare Physician Payment. PB2003-2

2002

• Health Services at Risk in "Vulnerable" Rural Places. PB2002-5
• An Update on Rural Medicare+Choice: Rural Medicare Beneficiaries Enrolled in Medicare+Choice Plans through September 2001. PB2002-4
• Inequitable Access: Medicare+Choice Program Fails to Serve Rural America. PB2002-2
• Comments on Regulatory and Contractor Reform Legislation. PB2002-1

2001

• Can Payment Policies Attract M+C Plans to Rural Areas? PB2001-8
• Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000. PB2001-4

2000

• Health Insurance in Rural America. PB2000-11