Adverse Childhood Experiences, Health-Related Quality of Life, and Chronic Disease Risks in Rural Areas of the United States.

Exposure to adverse childhood experiences (ACEs) is associated with increased odds of high-risk behaviors and adverse health outcomes. This study examined whether ACE exposure among individuals living in rural areas of the United States is associated with adult activity limitations, self-reported general poor health status, chronic diseases, and poor mental health. Data from the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS) (N=79,810) from nine states were used to calculate the prevalence of ACEs in rural and urban areas.

Clinician feedback on using episode groupers with Medicare claims data.

CMS is investigating techniques that might help identify costly physician practice patterns. One method presently under evaluation is to compare resource use for certain episodes of care using commercially available episode grouping software. Although this software has been used by the private sector to classify insured individuals' medical claims into episodes of care, it has never been used with fee-for-service Medicare claims except in the studies by the Medicare Payment Advisory Commission (MedPAC) and CMS.

Contracting with Medicare Advantage plans: a brief for critical access hospital administrators.

This document summarizes the experience of CAH administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms administrators have been offered, their experiences negotiating with MA plans, and their advice for others dealing with this issue.

Rural implications of Medicare's post-acute-care transfer payment policy.

Context: Under the Medicare post-acute-care (PAC) transfer policy, acute-care hospitals are reimbursed under a per-diem formula whenever beneficiaries are discharged from selected diagnosis-related groups (DRGs) to a skilled nursing facility, home health care, or a prospective payment system (PPS)-excluded facility. Total per-diem payments are below the full DRG payment only when the patient's length of stay (LOS) is short relative to the geometric mean LOS for the DRG; otherwise, the full DRG payment is received. This policy originally applied to 10 DRGs beginning in fiscal year 1999 and was expanded to additional DRGs in FY2004.

A rural perspective regarding regulations implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

A Joint Publication of The Walsh Center for Rural Health Analysis, National Opinion Research Center, University of Chicago, W Series, No. 6 and the RUPRI Center for Rural Health Policy Analysis, University of Nebraska Medical Center, P2004-6.

Perspectives of rural hospitals on bioterrorism preparedness planning.

Even the smallest, most isolated rural hospitals are now required to have bioterrorism preparedness plans. From the perspective of many rural hospitals, however, there is a disparity between Federal expectations and the realities of small hospitals operating in geographically isolated communities. As part of an effort to better understand how to close this gap, the Walsh Center for Rural Health Analysis convened a panel of representatives of rural hospitals who are responsible for bioterrorism preparedness in their hospitals.

Insurance coverage of prescription drugs and the rural elderly.

Context: Rural impacts of a Medicare drug benefit will ultimately depend on the number of elderly who are currently without drug coverage, new demand by those currently without coverage, the nature of the new benefit relative to current benefits, and benefit design.

Purpose: To enhance understanding of drug coverage among rural elderly Medicare beneficiaries and their expenditures for pharmaceuticals.

Methods: Estimates of the extent of coverage, expenditures, and sources of drugs were obtained using data are from the 1997 Medicare Current Beneficiary Survey and the Pharmacy Verification and Household Components of the 1996 Medical Expenditure Panel Survey.