Keith J Mueller
Biographic Data
| ID | 712287 |
|---|---|
| NAME | Keith J Mueller |
| GIVEN NAMES | Keith J |
| FAMILY NAME | Mueller |
| SIGNATURE | MUELLER K J |
| AFFILIATIONS | University of Nebraska Medical Center |
| ORCID | 0000-0002-6533-3303 |
| VERIFIED | Yes |
| TOTAL WORKS | 50 |
| TOTAL CITATIONS | 16 |
| AUTHOR COUNT | 50 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1982 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 2 |
Growth in Medicare Advantage by organizational size across rural and urban counties
PURPOSE: To understand the changing landscape of Medicare Advantage (MA) markets in urban and rural counties with particular focus on the size of MA organizations. With MA covering more than half of all Medicare enrollees and notably different health and access conditions in rural areas, understanding the extent of participation in MA markets in both urban and rural areas is critical. In this paper, we establish which organizations are offering M…
Factors Influencing Rural Hospitals to Participate and Remain in Accountable Care Organizations
PURPOSE: Little is known about factors driving rural providers-who face unique challenges-to participate and remain in accountable care organization models. The purpose of this study was to investigate the specific factors that rural hospitals evaluate when weighing both initial and continued participation in Medicare as well as commercial ACO models. Furthermore, we explored policy implications to improve ACO models' capacity to attract, retain,…
Provider‐to‐provider telemedicine for sepsis is used less frequently in communities with high social vulnerability
PURPOSE: Sepsis disproportionately affects patients in rural and socially vulnerable communities. A promising strategy to address this disparity is provider-to-provider emergency department (ED)-based telehealth consultation (tele-ED). The objective of this study was to determine if county-level social vulnerability index (SVI) was associated with tele-ED use for sepsis and, if so, which SVI elements were most strongly associated. METHODS: We use…
Nursing home closures and access to post‐acute care and long‐term care services in rural areas
PURPOSE: Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. We estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures. METHODS: We identify nursing home closures and the availability of PAC and LTC services in nursing homes, home health agencies, and hospitals with swing beds using the Medicare Provider of Servi…
ACO Clinicians Have Higher Medicare Part B Medical Services Payments Than Mips Clinicians Under the Quality Payment Program
The Quality Payment Program (QPP) is a Medicare value-based payment program with 2 tracks: -Advanced Alternative Payment Models (A-APMs), including two-sided risk Accountable Care Organizations (ACOs), and Merit-based Incentive Payment System (MIPS). In 2020, A-APM eligible ACO clinicians received an additional 5% positive, and MIPS clinicians received up to 5% negative or 2% positive performance-based adjustments to their Medicare Part B medical…
Modernizing payment to critical access hospitals: A proposal for the next iteration of the Flex Program
The landmark Medicare Rural Hospital Flexibility Program (Flex) was enacted in 1997 as a public-policy answer to the untenability of the prospective payment system (PPS) applied to low-volume and/or rural hospitals. Fundamentally, the Flex originated the critical access hospital (CAH) designation that would receive cost-based reimbursement (CBR) for Medicare services. The Flex Program did more, however, including supporting rural emergency medica…
Medicare accountable care organization characteristics associated with participation in 2‐sided risk
PURPOSE: To examine the associations of accountable care organization (ACO) characteristics with the likelihood of participation in 2-sided risk tracks in the Medicare Shared Savings Program (SSP). METHODS: CMS ACO Public Use Files and Provider-Level Research Identifiable Files were used to trace Medicare ACOs' participation in the SSP between 2012 and 2020 and measure ACO characteristics, including size, rurality of the service area, affiliation…
Patient Aligned Care Team (Pact) Performance in Urban and Rural VHA Primary Care Clinics: A Mixed Methods Study
PURPOSE: To assess differences in Patient Aligned Care Team (PACT) performance between rural and urban primary care clinics within the Veterans Health Administration (VHA). METHODS: An Explanatory Sequential Mixed Methods design was conducted using VHA administrative data to assess performance of a national sample of 891 VHA primary care clinics. Generalized Estimating Equations with repeated measures were used to estimate associations between ru…
The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries
PURPOSE: High rates of potentially preventable hospitalizations and emergency department (ED) visits indicate limited primary care access. Rural Health Clinics (RHCs) are intended to increase access to primary care. The goal of this study was to evaluate the role of RHCs and their impact on potentially preventable hospitalizations and ED visits among Medicare beneficiaries based on actual individual-level utilization patterns. METHODS: With Medic…
Financial Performance of Rural Medicare ACOs
PURPOSE: The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence. METHODS: We used the 2014 performance data for Medicare A…
Variation in Primary Care Service Patterns by Rural‐Urban Location
BACKGROUND: Rural communities have disproportionately faced primary care shortages for decades in spite of policy efforts to prepare and attract primary care health professionals to practice in rural locales. Insight into how primary care physicians' service patterns in rural areas differ from those in less rural places is important to better inform recruitment strategies that target primary care providers and rural communities. OBJECTIVES: The p…
From Health Care Volume to Health Care Value—Success Strategies for Rural Health Care Providers
Are Primary Care Practices Ready to Become Patient‐Centered Medical Homes
Purpose: To measure the readiness of rural primary care practices to qualify as patient‐centered medical homes (PCMHs), one step toward participating in changes underway in health care finance and delivery. Methods: We used the 2008 Health Tracking Physician Survey to compare PCMH readiness scores among metropolitan and nonmetropolitan primary care practices. The National Committee on Quality Assurance (NCQA) assessment system served as a framewo…
The March to Accountable Care Organizations-How Will Rural Fare: The March to Accountable Care Organizations
PURPOSE: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). METHODS: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA) makes contracts with ACOs a permanent option under Medicare. This article explores ACA implications, usi…
Trends in Community Pharmacy Counts and Closures Before and After the Implementation of Medicare Part D: Medicare Part D and Retail Pharmacy Availability
PURPOSE: Medicare Part D provided 3.4 million American seniors with prescription drug insurance. It may also have had an unintended effect on pharmacy viability. This study compares trends in the number of pharmacies and rate of pharmacy closures before and after the implementation of Medicare Part D. METHODS: This retrospective observational study used data from National Council for Prescription Drug Programs (NCPDP) to track retail pharmacy clo…
Defining “Rural” for Veterans’ Health Care Planning: Defining “Rural” for Veterans’ Health Care Planning
PURPOSE: The Veterans Health Administration (VHA) devised an algorithm to classify veterans as Urban, Rural, or Highly Rural residents. To understand the policy implications of the VHA scheme, we compared its categories to 3 Office of Management and Budget (OMB) and 4 Rural-Urban Commuting Area (RUCA) geographical categories. METHOD: Using residence information for VHA health care enrollees, we compared urban-rural classifications under the VHA, …
Uninsured Hospitalizations: Rural and Urban Differences
Context: Few studies have examined hospitalization patterns among the uninsured, especially from the perspective of rural and urban differences. Purpose: To examine whether the patterns of uninsured hospitalizations differ in rural and urban hospitals and to identify the most prevalent and costly diagnoses among uninsured hospitalizations. Methods: We conducted a cross‐sectional analysis of the Healthcare Cost and Utilization Project's National I…
The Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
Context: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created prescription drug coverage for Medicare beneficiaries through a new Part D program, the single largest addition to Medicare since its creation in 1965. Prior to program implementation in January 2006, concerns had been voiced as to how independent pharmacies, which represent a higher proportion of all retail pharmacies in rural areas, would fare unde…
Care Across the Continuum: Access to Health Care Services in Rural America
The Role of Rural Health Clinics in Hospitalization due to Ambulatory Care Sensitive Conditions: A Study in Nebraska
Context: Hospitalization due to ambulatory care sensitive conditions (ACSCs) is often used as an indicator for measuring access to primary care. Rural health clinics (RHCs) provide basic primary care services for rural residents in health professional shortage areas (HPSAs). The relationship between RHCs and ACSCs is unclear. Purpose: The purpose of this study was to examine the relationship between the presence of RHCs in rural HPSAs and the lik…
Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
Sweeping changes to the Medicare program embodied in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), including a new prescription drug benefit, changes in payment policies, and reform of the Medicare managed-care program, have major implications for rural health care. The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced conc…
The Federal Employees Health Benefits Program: Model for Competition in Rural America
Context : The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created the Medicare Advantage (MA) program, which promotes the entry of private Preferred Provider Organization (PPO) plans into regions that have not previously had Medicare managed care plans. The assumption that a competitive environment will develop is based on experiences in the Federal Employees Health Benefits Program (FEHBP). Purpose : The authors …
Translating Research Into Practice: Voluntary Reporting of Medication Errors in Critical Access Hospitals
Context: Low service volume, insufficient information technology, and limited human resources are barriers to learning about and correcting system failures in small rural hospitals. Purpose: This paper describes the implementation of and initial findings from a voluntary medication error reporting program developed by the Nebraska Center for Rural Health Research (NCRHR) to overcome these barriers in 6 Nebraska critical access hospitals (CAHs). M…
A Method for Identifying Places in Rural America at Risk of Not Being Able to Support Adequate Health Services
Context : Public policymakers and their advisers struggle with the problem of specifying criteria by which health care providers in rural areas are eligible for special consideration in payment policies and for special grant programs. A means of designating places can provide a basis for assistance and can help target public resources for any providers who deliver services in those places. Purpose : This paper provides the details underlying a pl…
Rural Health Services Research: Past, Present, Future
Explaining Variation and Change in Gubernatorial Powers, 1960-1982
State Government Policies and Rural Hospitals: Facilitating Change
Health insurance in the near elderly population
Local Government Implementation Nationally Inspired Programs: A Comparative Analysis
This paper examines situations in which local governments are called upon to cooperate with each other in implementing national programs. Classic notions of incrementalism are used to explain the actions of local officials, and are found wanting. Nonincremental change seems likely to occur when national programs compel local officials lo embark on heretofore avoided programs under the pressure of defined deadlines
Local Implementation of National Policy
This article is an examination of failures in implementing intergovernmental programs. The programs were failures in the sense that actions to implement programs were delayed far beyond the expected dates of completion. Two such failures in cities implementing two different programs (wastewater management and Section 8 housing programs) are contrasted with one instance of success (in Section 8 housing). If a Sharkansky's discussion of political a…
The Politics of Functional Realignment: Consolidating Wastewater Management in an Urban County
One possible solution to the fiscal problems confronting many American cities is structural reform-changing the patterns of responsibility for delivering urban services. This research assesses the possibilities of functional realignment through transferring responsibility from city governments in metropolitan areas to county governments. Based on findings in Pima County. Arizona, we conclude that functional realignment in metropolitan areas is a …
Disinnovation in the American States: Policy toward Health Systems Agencies
Requiring the states to involve consumers in health planning through local health planning boards (HSAs) was an attempt by the federal government to control health care costs. Elimination of this requirement more recently has meant some states have discontinued the program. The elimination of HSAs can be considered a case of policy disinnovation. Drawing on the innovation literature, the following variables were expected to correlate, although ne…
Local Government Implementation Nationally Inspired Programs: A Comparative Analysis
This paper examines situations in which local governments are called upon to cooperate with each other in implementing national programs. Classic notions of incrementalism are used to explain the actions of local officials, and are found wanting. Nonincremental change seems likely to occur when national programs compel local officials lo embark on heretofore avoided programs under the pressure of defined deadlines
Local Implementation of National Policy
This article is an examination of failures in implementing intergovernmental programs. The programs were failures in the sense that actions to implement programs were delayed far beyond the expected dates of completion. Two such failures in cities implementing two different programs (wastewater management and Section 8 housing programs) are contrasted with one instance of success (in Section 8 housing). If a Sharkansky's discussion of political a…
Explaining Variation and Change in Gubernatorial Powers, 1960-1982
ORMAL powers of state governors have increased since 1960 (Ransone 1982), to such an extent that one author has concluded: In most of the states, as a result, the governor is now truly the master of his own house, not just the father figure (Sabato 1983: 57). The meaning of Sabato's generalization will be tested empirically by comparing current powers with those first described and quantified by Joseph Schlesinger in 1960. The comparison will imp…
Explaining Variation and Change in Gubernatorial Powers, 1960-1982
Books in review
Changing Gubernatorial Power: [The Measure vs. Reality]: A Rejoinder
A Rejoinder
The National Organ Transplant Act of 1984: Congressional Response to Changing Biotechnology
Federal Programs to Expire: The Case of Health Planning
This is a study of how a major federal program met its demise. In 1986 Congress passed legislation which ended federal involvement in health planning, repealing the 1974 National Health Planning and Resources Development Act. This unusual action, ending (at least for now) over 20 years of federal involvement in health planning, was precipitated by changes in the policy-relevant environment and the arrival of new actors into the issue network. Fed…
The Role of Policy Analysis in Agenda Shting: Applications to the Problem of Indigent Health Care in the United States
State Government Policies and Rural Hospitals: Facilitating Change
An Expert Panel Approach to Assessing the Rural Implications of Health Care Reform: The Case of the Health Security Act
The policy arena is hungry for objective information regarding the potential effects of comprehensive national and state health care reform. Such information reduces the dependence of policy-makers on information generated solely by advocacy groups and serves as a checkpoint for such information. Unfortunately, the academic community is often unable to mobilize its resources quickly enough to help meet this information need. This article describe…
Access to Health Care: Urban‐Rural Comparisons from a Midwestern Agricultural State
Lack of access to quality health care for a large number of Americans, particularly those living in rural areas, is a major health care problem. Differences in access between rural and urban areas are caused by obstacles to providing adequate care, such as hospital closures and physician shortages, and low income and/or employment that does not provide health insurance as an employee benefit. This study, based on a random sample of 6,000 househol…
Legislative and Policy Strategies for Supporting Rural Health Network Development: Lessons from the 103rd Congress
There was considerable support in most major health reform bills considered by the 103rd Congress for the development of rural integrated service networks. The demise of comprehensive health reform, together with the pace of current market‐driven changes in the health care system, suggests the need to assess the impact of specific policy strategies considered in the last Congress on rural integrated service network development. Toward this end, t…
Lessons From the Great Debate Over National Health Care Reform
Lengthening Spells of Uninsurance and Their Consequences
The lengths of time adults are without health insurance have increased since 1988, as shown by data from 1,235 household interviews completed during 1992 in Nebraska. Rural residents without insurance have experienced longer such spells than their urban counterparts. Thus, while rates of uninsurance are nearly the same between urban and rural residents, important differences exist. The relationship between insurance status and physician utilizati…
Building a Research Agenda: Responding to the Needs of Community and Migrant Health Centers
This article summarizes the results of an invitational conference designed to establish a research agenda for collaborative projects involving university‐based health services researchers and staff (administrative and clinical) from Community and Migrant Health Centers (CIMHCs). More research related to CIMHCs needs to be developed, preferably by collaborative teams of researchers and CIMHC personnel. Specific research ideas are summarized, and f…
AHCPR‐funded Rural Managed Care Centers: Report From the Field
In 1994, the Agency for Health Care Policy and Research awarded cooperative agreements to five University‐based groups to promote the establishment of managed care institutions and development of rural health networks. This paper summarizes the experiences of these rural managed care centers in the first three years of this initiative. Key ingredients for achieving the project's goals that are identified by the project directors are reported as “…
Tracking the Response to the Balanced Budget Act of 1997: Impact on Medicare Managed Care Enrollment in Rural Counties
The impact of the Balanced Budget Act of 1997 on recent changes in enrollment of Medicare beneficiaries into managed care plans is examined. The Balanced Budget Act of 1997 created a new payment structure for Medicare risk contracts, which, in 1998, resulted in all counties receiving either a minimum payment or a payment with the increase restricted at 2 percent growth over the 1997 rate. Using a baseline of December 1997 and enrollment data thro…
Health insurance in the near elderly population
Medicare+Choice Experiences in Rural Areas: Health Policy: State and Federal
Rural Health Services Research: Past, Present, Future
Effect of Medicare Payment on Rural Health Care Systems
Medicare payments constitute a significant share of patient‐generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in for‐service payment policy, prospects for change because of the payment to Medicare +Choice ri…
Medicine (34 works) · Health care (31 works) · Healthcare Policy and Management (31 works) · Business (24 works) · Political science (20 works) · Primary Care and Health Outcomes (20 works) · Economic growth (18 works) · Nursing (18 works) · Global Health Workforce Issues (15 works) · Rural area (14 works)