Rural policy brief最新文献

Purpose: The Medicare Advantage (MA) program allows Medicare beneficiaries to receive benefits from private plans rather than from traditional fee-for-service (FFS) Medicare. Little is known about the rural and urban differences in the populations that enroll in the MA program, and these differences may be important for setting policy. This brief uses data from the 2012-13 Medicare Current Beneficiary Survey (MCBS) to describe these differences, and combined with county-level data on MA issuer participation, this dataset also allows us to assess the degree to which issuers may engage in selective MA market entry on the basis of demographic characteristics.

Key findings: (1) Rural and urban MA and FFS populations did not differ much on average by any characteristics reported in the data, including age, self-reported health status, cancer diagnosis, smoking status, Medicaid status, or by other variables assessing frailty and presence of chronic conditions. (2) Most measures of access were similar across rural and urban respondents. However, in terms of cost, urban enrollees were less likely to pay an additional premium (beyond Medicare Part A and B) to obtain MA coverage: 42 percent reported doing so in urban places, while 54 percent did so in rural places. (3) While rurality on its own was often a significant predictor of lower issuer participation in a county’s MA market, the addition of other demographic characteristics did not influence the prediction. In other words, we found no evidence, based upon MCBS data, that issuers exclude rural counties due to other demographics.

This brief highlights key regulatory changes to the Merit-based Incentive Payment System (MIPS) in 2018. We discuss the importance of these changes, particularly as they affect small and rural practices.

Purpose: This policy brief updates a RUPRI Center brief published in 20141 and documents the continued growth in system affiliation by both metropolitan and non-metropolitan hospitals.

Key findings: (1) From 2007 to 2016, hospital system affiliation continued to increase across all categories of hospital size, metropolitan/non-metropolitan location, and Critical Access Hospital (CAH)status. (2) From 2007 to 2016, hospital system affiliation increased in all census regions except in the West census region among non-metropolitan hospitals.

Purpose: This RUPRI Center data report describes Medicare accountable care organization (ACO) growth in non-metropolitan U.S. counties from 2016 to 2017. This data report, which includes data through December 2017, follows a similar analysis released in October 2016 that described ACO trends from 2013 to 2015.

Key findings: The following findings are based on activity through 2017: (1) Medicare ACOs operate (an ACO provider is present) in 60.3 percent of all nonmetropolitan counties, up from 41.8 percent in 2016, (2) As of December 2017, no nonmetropolitan ACOs were participating in ACO models that included downside risk (meaning they are liable for expenditures exceeding a benchmark).

Purpose: Since 2014, when the Health Insurance Marketplaces (HIMs) authorized by the Patient Protection and Affordable Care Act (PPACA) 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 2018, before accounting for subsidies, with an emphasis on the widening variation across rural and urban places, providing information during Congressional debates on the future of the program.

Key findings: (1) Insurance issuers reduced HIM participation across both rural and urban places (with 1.7 and 2.2 issuers, respectively), both in states that expanded Medicaid under the PPACA and in non-expansion states. (2) The average adjusted premium (before premium subsidy) continues to rise across all of the above categories, and the gap has widened between the 32 Medicaid expansion and 19 non-expansion states. Average premiums in rural counties are higher than average premiums in urban counties in both expansion and non-expansion states (by $43 per month and $27 per month, respectively). (3) Prior trends of lower premium changes at greater population densities are no longer observed in the 2018 data. (4) In 2018, 1,581 counties (52 perent) have one participating insurance issuer. Nationwide, 42 percent of all urban counties and 55 percent of all rural counties only have one issuer.

This Policy Brief continues the series of reports from the RUPRI Center updating the number of pharmacy closures in rural America with annual data. See our website for other analyses of trends and assessment of issues confronting rural pharmacies. Key Findings: (1) Over the last 16 years, 1,231 independently owned rural pharmacies (16.1 percent) in the United States have closed. The most drastic decline occurred between 2007 and 2009. This decline has continued through 2018, although at a slower rate. (2) 630 rural communities that had at least one retail (independent, chain, or franchise) pharmacy in March 2003 had no retail pharmacy in March 2018.

Purpose: Rural enrollment of Medicare beneficiaries in the Medicare Part D prescription drug programhas historically lagged urban enrollment. Rural Part D enrollees are overwhelmingly in standaloneprescription drug plans (PDPs), whereas urban beneficiaries are more likely to beenrolled in Medicare Advantage with Prescription Drug (MA-PD) plans. This analysis updatesprior briefs on the rural-urban enrollment differential in Medicare Part D plans, and highlightsstate-to-state variation in PDP and MA-PD enrollment by rural-urban residence.

Key findings: (1) As of June 2017, more than 72 percent of eligible Medicare beneficiaries had prescription drug coverage through Medicare Part D plans, a significantly higher proportion than the 55.6 percent in December 2008.  (2) The percentage of rural enrollment in Part D plans still lags that of urban enrollment, despite growth in both rural and urban participation in Part D plans. (3) Rural enrollees continue to have much higher enrollment in stand-alone PDP plans than do urban enrollees, though rural participation in MA-PD plans has almost doubled since December 2008.

Purpose: This policy brief provides data assessing effects of Medicaid Disproportionate Share Hospital (DSH) payment on rural hospitals in 47 states. While the allocation of DSH funds to the state is determined by federal legislation utilizing a formula developed by the Centers for Medicare & Medicaid Services (CMS), each state determines distribution to hospitals using an approved State Plan Amendment (SPA) that meets minimum federal requirements. Our findings suggest that distribution to rural hospitals, and critical access hospitals (CAHs) in particular, varies considerably across states. Data presented in this document helps ground any changes to either federal requirements or to SPAs by showing the impact of DSH payment from the most recent data available.

Key findings: (1) Medicaid DSH payment methodology and distribution to hospitals varies considerably across states. (2) The percentage of rural hospitals in a state receiving any Medicaid DSH payment ranged from 0 percent to 100 percent. (3) For rural hospitals receiving Medicaid DSH payments, the impact on total patient revenue ranged from less than 0.5 percent to 8.8 percent.

Purpose: The RUPRI Center for Rural Health Policy Analysis reports annually on rural beneficiary enrollment in Medicare Advantage (MA) plans, noting any trends or new developments evident in the data. These reports are based on data through March of each year, capturing results of open enrollment periods.

Key findings: (1) Nationally, 1 in 3 Medicare beneficiaries is enrolled in an MA plan. In non-metropolitan areas, nearly 1 in 4 (23.5 percent) beneficiaries is enrolled in an MA plan. (2) Enrollment in MA plans, measured either as an overall count or as a proportion of eligible Medicare beneficiaries, has increased in both metropolitan and non-metropolitan populations since 2004. (3) Between 2015 and 2017, the proportion of non-metropolitan Medicare-eligible beneficiaries enrolled in local preferred provider organization (PPO), regional PPO, and "other" plans (including cost, health care pre-payment [HCPP], medical savings account [MSA] and demonstration plans) remained relatively steady. During the same period, the proportion of Medicare-eligible beneficiaries enrolled in health maintenance organization (HMO) plans increased slightly (from 28.5 percent in 2015 to 29.8 percent in 2017) while the proportion enrolled in private fee-for-service (PFFS) plans decreased slightly (from 5.6 percent in 2015 to 3.8 percent in 2017).

Purpose. The RUPRI Center for Rural Health Policy Analysis has been monitoring the status of rural independent pharmacies since the implementation of Medicare Part D in 2005. After a decade of Part D, we reassess in this brief the issues that concern rural pharmacies and may ultimately challenge their provision of services. This reassessment is based on survey responses from rural pharmacists. Key Findings: (1) Rural pharmacists indicated that two challenges--direct and indirect remuneration (DIR) fees, and delayed maximum allowable cost (MAC) adjustment--ranked highest on scales of both magnitude and immediacy. Nearly eighty (79.8) percent of respondents reported DIR fees as a very large magnitude challenge, with 83.3 percent reporting this as a very immediate challenge. Seventy-eight percent of respondents reported MACs not being updated quickly enough to reflect changes in wholesale drug costs as a very large magnitude challenge, with 79.7 percent indicating it as a very immediate challenge. (2) Medicare Part D continues to be a concern for rural pharmacies--58.8 percent of pharmacists said being an out-of-network pharmacy for Part D plans was a very large magnitude challenge (an additional 29.0 percent said large magnitude) and 60.5 percent said it was a very immediate challenge (an additional 28.1 percent said moderately immediate). (3) Pharmacy staffing, competition from pharmacy chains, and contracts for services for Medicaid patients were less likely to be reported as significant or immediate challenges.