Research

Current Projects

Causal Effect of Nursing Home Closure on Resident Outcomes in Rural Areas

We will evaluate the causal impact of nursing home closure on two key outcomes: distance to the transitioned nursing home, and resident physical and mental health outcomes. We will compare the effect of closures on outcomes for rural and urban areas using resident-level data from 2010-2019 and advanced difference-in-differences regression methods.
Funder: Office of Rural Health Policy
Lead Researcher: Hari Sharma, PhD

Changes in Rural Health Insurance Coverage, 2020-2023

This project uses secondary data sources to characterize changes in health insurance coverage during the public health emergency (2020-2023) for rural and urban people according to demographic, employment, and geographic characteristics, and to describe how changes in federal policies impacted coverage. Researchers also assess the potential impact of maintaining more robust marketplace subsidies on rural and urban coverage rates once the "unwinding" of continuous Medicaid enrollment is complete.
Funder: Office of Rural Health Policy
Lead Researcher: Abigail Barker, PhD

Concordance Between Social Needs Screening Provision, Programming, and Partnerships in Rural PPS Hospitals

This study will examine how rural Prospective Payment System (PPS) hospitals differ from urban hospitals concerning social needs screening practices and alignment between social needs screening performance and corresponding programs/strategies and/or community partnerships to address social needs.
Funder: Office of Rural Health Policy
Lead Researcher: Whitney E. Zahnd, PhD

Non-Metropolitan/Metropolitan Differences in Barriers to Care and Utilization of Preventive Care and Wellness Visits Among Traditional Medicare and Medicare Advantage

This project proposes to use the Medicare Current Beneficiaries Survey to examine differences across geography and plan type (Medicare Advantage vs. traditional) with regards to barriers to care (e.g., costs) and use of preventive services (e.g., flu shot).
Funder: Office of Rural Health Policy
Lead Researcher: Dan Shane, PhD

Retention and Expansion of Hospital Services Offered by Rural Hospitals After Enrollment in 340B

The 340B Federal program is designed to provide hospitals with financial stability through provision of drug discounts which may, in turn, allow hospitals to maintain or expand their service line offerings. Using a series of event study analyses over an 11-year period, this study will examine the impact of enrollment in the 340B program on discontinuing services, maintaining services, and adding new services in eligible rural hospitals.
Funder: Office of Rural Health Policy
Lead Researcher: Whitney E. Zahnd, PhD

RHCs and CAHs Participating in SSP: Characteristics of the Providers and Communities

This project describes characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the Medicare Shared Savings Program (SSP), and the communities they serve. Comparisons will be made to RHCs and CAHs not participating in the SSP.
Funder: Office of Rural Health Policy
Lead Researcher: Keith Mueller, PhD

Rural Implications of Increased Medicare Beneficiary Enrollment in ACOs and MA Plans

This project will leverage Centers for Medicare & Medicaid Services data showing the number of Medicare beneficiaries assigned to Accountable Care Organizations, in combination with enrollment in Medicare Advantage in rural counties, to describe implications for rural health care organizations.
Funder: Office of Rural Health Policy
Lead Researcher: Keith Mueller, PhD

Rural Nursing Home Staffing, and Resident Health, Closure, and Financial Performance

There are concerns about availability and quality of care provided in nursing homes in rural areas. This project aims to evaluate staffing levels and shortages, the health status of residents, closures, and financial performance of rural nursing homes both before and during the COVID-19 pandemic.
Funder: Office of Rural Health Policy
Lead Researcher: Hari Sharma, PhD

Rural-Urban Differences in Medicare Advantage Plan Quality Scores

This project updates previous RUPRI Center publications focused on rural-urban differences in access to, and enrollment in, Medicare Advantage plans with four- and five-star quality ratings.
Funder: Office of Rural Health Policy
Lead Researcher: Tim McBride, PhD

Differences in Rural and Urban Hospital Cost Structures: Evidence and Implications

The project will compare fixed-to-variable cost ratios in U.S. rural and urban hospitals. We hypothesize that rural hospitals will realize proportionally greater fixed costs than urban hospitals, suggesting important hospital payment system implications.
Funder: Office of Rural Health Policy
Lead Researcher: Tim McBride, PhD

Rural-based Accountable Care Organizations Accepting Downside Risk

The RUPRI Center will update its studies of rural provider participation in accountable care organizations, including differences between those who exit the program, those who remain, and those who enter. In particular, this project will address participation decisions made after a rule change in July 2019 that requires conversion to two-sided risk.
Funder: Office of Rural Health Policy
Lead Researcher: Keith Mueller, PhD