In the brief, , the NC Rural Health Research Program examines Critical Access Hospitals (CAHs) and Prospective Payment System (PPS) hospitals with no more than 50 beds in rural areas that are eligible to convert to a Rural Emergency Hospital (REH.) For this study, hospitals with low Emergency Department (ED) volume are considered to be… Read more »
Key Considerations for a Rural Hospital Assessing Conversion to Rural Emergency Hospital
Based on findings from a literature review and consultation with practitioners, the NC Rural Health Research Program developed a conceptual framework and checklist to organize and guide conversations about key considerations for conversion a Rural Emergency Hospital. The brief, , describes the methods and the framework. Conceptual framework. The framework includes considerations across five key… Read more »
Rural Hospitals Have Higher Percentages of Patients with COVID-19 than Urban Hospitals
Since the onset of COVID-19, public health leaders have emphasized reducing the rate of viral spread to ensure that hospitals did not become overwhelmed. On December 15, 2020, the U.S. DHHS published weekly data on each individual hospital’s status on key indicators for acute management of COVID-19 patients. We analyzed these data to compare the… Read more »
Rural Hospitals with Long‐term Unprofitability
Overview To remain open, businesses generally need to be profitable (have revenues greater than expenses). Hospitals are no different. Hospitals use profits to pay for new and upgraded buildings, equipment, technology, programs, and other patient care needs. To assess hospital profitability, we often look at total margin. Total margin measures the control of expenses relative… Read more »
Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
Background The Medicare hospital Inpatient Prospective Payment System (IPPS) is designed to pay hospitals for services provided to Medicare beneficiaries based on a national standardized amount adjusted for the patient’s condition and related treatment. Further, Social Security Act Section 1886(d)(3)(E) requires that the standardized amount be adjusted for differences in hospital wage levels, which the… Read more »
What Characteristics Influence Whether Rural Beneficiaries Receiving Care From Urban Hospitals Return Home for Skilled Nursing Care?
Abstract Purpose: Skilled nursing care (SNC) provides Medicare beneficiaries short-term rehabilitation from an acute event. The purpose of this study is to assess beneficiary, market, and hospital factors associated with beneficiaries receiving care near home. Methods: The population includes Medicare beneficiaries who live in a rural area and received acute care from an urban facility in 2013…. Read more »
What Should Be the Scope of a Health Network’s Obligation to Respond After a Hospital Closure?
Abstract As rural hospital closures become more common, many patients are left without sources of care, raising ethical questions about hospitals’ and clinicians’ responsibilities during and after closures. In many cases, such as the one considered in this article, hospitals have been economic hubs of some communities for many years and are obliged to consider… Read more »
The Sufficiency of Health Care Professional Supply in Rural North Carolina
Abstract For most health professions, rural North Carolina has lower relative supply than urban parts of the state. Although there are plenty of innovative models addressing this disparity, a holistic approach is necessary if we want to effect real change.
Predicting Financial Distress and Closure in Rural Hospitals
Abstract Purpose: Annual rates of rural hospital closure have been increasing since 2010, and hospitals that close have poor financial performance relative to those that remain open. This study develops and validates a latent index of financial distress to forecast the probability of financial distress and closure within 2 years for rural hospitals. Methods: Hospital and community… Read more »
How Would Rural Hospitals Be Affected by Loss of the Affordable Care Act’s Medicare Low-Volume Hospital Adjustment?
Abstract Purpose: The low-volume hospital (LVH) payment adjustment established in the Patient Protection and Affordable Care Act (ACA) of 2010 is scheduled to sunset on October 1, 2017. The purpose of this analysis was: (1) to estimate the effect of the ACA LVH adjustment on qualifying hospitals’ profitability margins; and (2) to examine hospital and market… Read more »
Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics
OVERVIEW In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. With over 3,900 certified sites located across the county, RHCs are an important component of the rural health care infrastructure.1 RHCs can be private/for-profit or non-profit. Some operate as independent medical practices, while… Read more »
Medicare, swing beds, and critical access hospitals
Effect of Swing Bed Use on Medicare Average Daily Cost and Reimbursement in Critical Access Hospitals Critical Access Hospitals (CAHs) receive cost-based reimbursement from Medicare for inpatient care, including post-acute skilled care provided in swing beds (skilled swing days). Because the reimbursement formula treats swing bed and acute days equally, there is concern that CAH… Read more »
Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
Abstract Purpose: To conduct a preliminary assessment of the quality of uncompensated care data included in Medicare Cost Report (MCR) Worksheet S-10 for rural hospitals and to identify the implications of data quality issues for research and policy decisions. Methods: 2011 MCR Worksheet S-10 data for all rural hospitals were collected from the Healthcare Cost… Read more »
The Rising Rate of Rural Hospital Closures
Purpose: Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. Methods: The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to… Read more »
Prediction of Financial Distress among Rural Hospitals
BACKGROUND From 2005 through 2015, more than 100 rural hospitals have closed their doors to patients in need of inpatient services.1 Though a handful of these closed hospitals have since reopened, the remaining closures leave millions of rural residents at greater risk of negative health and economic hardship due to the loss of local acute… Read more »