Abstract OBJECTIVE: The purpose of this research study is to determine the effect of surgery on the profitability of rural hospitals. BACKGROUND: Small rural hospitals are often the sole health care provider in their communities and the only source of care for many people. The provision of surgery in rural hospitals saves the lives… Read more »
Minimum-distance requirements could harm high-performing critical-access hospitals and rural communities
Abstract Since the inception of the Medicare Rural Hospital Flexibility Program in 1997, over 1,300 rural hospitals have converted to critical-access hospitals, which entitles them to Medicare cost-based reimbursement instead of reimbursement based on the hospital prospective payment system (PPS). Several changes to eligibility for critical-access status have recently been proposed. Most of the changes… Read more »
Emergency Department Use in the US-Mexico Border Region and Violence in Mexico: Is There a Relationship?
Abstract Purpose: This study assessed the association between homicide rates in northern Mexico and potentially avoidable use of emergency departments (ED) in the US-Mexico border region. The border region is largely rural and underserved, making the identification and correction of potential barriers to access crucial. Methods: We used secondary data from state inpatient and ED discharge databases… Read more »
Financially fragile rural hospitals: mergers and closures
Abstract Rural hospitals serve as major sources of health care and employment for their communities, but recently they have been under increased financial stress. What are the causes of this stress, and how have hospitals and their communities responded?
A Comparison of Closed Rural Hospitals and Perceived Impact
BACKGROUND From 2010 through 2014, 47 rural hospitals,1 ceased providing inpatient services in 23 states across the country (“closed”2 ). Among the 47 closed hospitals, 26 hospitals no longer provide any health care services (“abandoned”), and 21 continue to provide a mix of health services but no inpatient care (“converted”).3 These closures have affected approximately… Read more »
A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals
Purpose In March 2015, the Office of the Inspector General (OIG) issued a report on Medicare’s expenditures on swing beds in Critical Access Hospitals (“Medicare Could Have Saved Billions At Critical Access Hospitals If Swing Bed Services Were Reimbursed Using The Skilled Nursing Facility Prospective Payment System Rates.” Department of Health and Human Services, Office… Read more »
The 21st Century Rural Hospital: A Chart Book
Read the PDF.
Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants?
Background The financial performance of small, rural hospitals has long been a concern to federal and state agencies. Federal law makers have enacted legislation authorizing the Medicare program to develop reimbursement methods that provide higher payments to hospitals that serve rural communities.1 The Medicare Payment Advisory Commission (MedPAC) describes rural hospitals as follows. Critical Access… Read more »
Rural-Urban Differences in Continuity of Care among Medicare Beneficiaries
Background In response to the Affordable Care Act and other reforms in the health care market, new models of care are being tested and implemented across the country. Care and payment models such as patient-centered medical homes, Accountable Care Organizations (ACOs), and bundled payments depend on linkages between different types of health care providers to… Read more »
Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas
The Affordable Care Act provided coverage through the Health Insurance Marketplace to nearly seven million people during the first open enrollment period.1 Yet, research suggests that the enrollment rates for eligible individuals living in rural areas was less than enrollment rates for those living in urban areas.2 That may be due, in part, to specific… Read more »
Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace
Background One of the central and most visible components of the Affordable Care Act is the Health Insurance Marketplace (known as the Federally Facilitated Marketplace when administered by the federal government), which provides consumers a method to enroll in non-group health insurance coverage. It is the only enrollment method where qualifying individuals can get premium-… Read more »
Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward?
Background Hospital mergers and acquisitions1 are changing the face of health care in both rural and urban communities across the country. Declining reimbursement levels, increased capital needs, a weak economy and easier access to credit have all contributed to a level of mergers not seen in more than a decade.2,3 Studies from the 1980s and… Read more »
Health Insurance Coverage in North Carolina: The Rural-Urban Uninsured Gap
Background One of the primary drivers of health is being covered by health insurance. A review of available literature found a wide range of effects of health insurance, including a 20% relative reduction in mortality among previously uninsured people who become eligible for Medicare [1]. Many factors lead to lower rates of health insurance coverage… Read more »
Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients
Background Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are important primary care providers in rural communities. These safety net programs are similar in that they both are located in areas with inadequate access to health care services. In addition, RHCs and FQHCs are federally-designated entities reimbursed by Medicare based on all-inclusive… Read more »
Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
Background Swing beds are one option for post-acute skilled care in rural communities, and they are more likely to be the only option in the most rural areas.1 These transitional care beds allow a patient to be discharged from an acute hospital stay but remain in the hospital for skilled after care. Skilled nursing facilities… Read more »