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Title
Rural-Urban Differences in the Rate of Health Insurance Coverage

Although national estimates of health insurance coverage rates typically show little or no difference between rural and urban areas in the per cent of residents with health insurance, if only individuals below the age of 65 are considered, rural residents are more likely to lack health insurance. Wh… Read more »

Article
1998
Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?

The NC Rural Health Research Program’s Findings Brief, Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where, examines health conditions of patients discharged from rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs) to swing beds and skilled nursing fa… Read more »

Findings Brief
1998
Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward?

Hospital mergers and acquisitions 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… Read more »

Findings Brief
1998
Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace

On September 18, 2014, the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS) released data showing that nearly five and a half million individuals had selected an insurance plan in the 36 states where the Federally Facilitated Marketplac… Read more »

Findings Brief
1998
Location of CAHs, June 30, 2014

Location of CAHs, June 30, 2014

Map
1998
Safety Net Clinics Serving the Elderly in Rural Areas

Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients. (May, 2014). Radford, A., Freeman, V., Kirk, D., Howard, A., Holmes, G.M. FB115

Findings Brief
1998
Location of Critical Access Hospitals (February, 2014)

Location of Critical Access Hospitals.(February, 2014). Cartographic.

Map
1998
State Medicaid Profiles

Nationally, Medicaid provides health insurance to a larger share of the population in rural areas than in urban areas. Both Medicaid and the Children’s Health Insurance Program (CHIP) are also critical sources of income for rural health care providers and help contribute to economic development with… Read more »

Final Report
1998
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. Yet, research suggests that the enrollment rates for eligible individuals living in rural areas was less than enrollment rates for those living i… Read more »

Findings Brief
1998
Rural-Urban Differences in Continuity of Care among Medicare Beneficiaries

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 b… Read more »

Findings Brief
1998
Profitability in Rural Hospitals

The North Carolina Rural Health Research Program recently released Profitability in Rural Hospitals, authored by George H. Pink, PhD; Victoria Freeman, RN, DrPH; Randy Randolph, MRP; and G. Mark Holmes, PhD. This new findings brief compares the profitability between 2010 and 2012 for urban and rural… Read more »

Findings Brief
1999
Geographic Variation in the Profitability of Critical Access Hospitals

The NC Rural Health Research Program’s Findings Brief, Geographic Variation in the Profitability of Critical Access Hospitals, examines how the profitability of Critical Access Hospitals (CAHs) varies greatly across states and U.S. Census divisions. The decertification of CAHs and the loss of cost-b… Read more »

Findings Brief
1999
Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement

The North Carolina Rural Health Research Program has released their new Findings Brief, Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement.  It looked at how changes to Critical Access Hospitals (CAHs) reimbursement – notably a reversion… Read more »

Findings Brief
1999
Implications for Beneficiary Travel Time if Financially Vulnerable Critical Access Hospitals Close

The NC Rural Health Research Program’s Findings Brief,  Implications for Beneficiary Travel Time if Financially Vulnerable Critical Access Hospitals Close, examines how changes to Critical Access Hospitals reimbursement that may spur some CAHs to close, with the most financially vulnerable more like… Read more »

Findings Brief
1999
Rural and Urban Differences in Inpatient Related Costs and Use among Medicare Beneficiaries

This recent Findings Brief from the North Carolina Rural Health Research Program finds that Medicare beneficiaries who are admitted to rural hospitals tend to have lower outpatient costs than Medicare beneficiaries admitted to urban hospitals. These differences are due to multiple factors,  some of… Read more »

Findings Brief
1999
Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement

Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement. (December, 2013). Holmes, G.M. and Pink, G. FB112

Findings Brief
1999
Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close

Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close. (December, 2013). Freeman, V., Randolph, R., Pink, G., Holmes, G.M. FB111

Findings Brief
1999
NC Rural Health Research Program December 2013 Newsletter

NC Rural Health Research Program December 2013 Newsletter

Other
1999
Rural/Urban Differences in Inpatient Related Costs and Use Among Medicare Beneficiaries

Rural/Urban Differences in Inpatient Related Costs and Use Among Medicare Beneficiaries. (December, 2013). Toth, M., Holmes, G.M., Freeman, V., Pink, G. FB113

Findings Brief
1999
Using “Plasticity” to Model a Community’s Need for Health Care Services

Using “Plasticity” to Model a Community’s Need for Health Care Services. (November, 2013). Beavers, L. Post

Other
1999
Provision of Uncompensated Care by Rural Hospitals

Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10. (August, 2013). WP-

Other
1999
Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics

Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics (March, 2013). Radford, A., Kirk, D., Howard, A., Holmes, G.M. FB108

Findings Brief
1999
Metropolitan and Micropolitan CBSAs

Metropolitan and Micropolitan Core Based Statistical Areas (CBSAs) November 2013 Office of Management and Budget CBSA Designations by County

Map
1999
Metropolitan and Micropolitan CBSAs (2013 and 2009)

Metropolitan and Micropolitan Core Based Statistical Areas (CBSAs) November 2013 Office of Management and Budget CBSA Designations by County

Map
1999
Metropolitan and Micropolitan CBSAs (Puerto Rico included)

Metropolitan and Micropolitan Core Based Statistical Areas (CBSAs) November 2013 Office of Management and Budget CBSA Designations by County

Map
1999
2013 Metropolitan/Micropolitan Status by County

Defining Rural: 2013 Metropolitan/Micropolitan Status by County

Map
1999
Profile of Rural Health Clinics: Medicare Payments & Common Diagnoses

Profile of Rural Health Clinics: Medicare Payments & Common Diagnoses (December, 2012). Radford, D., Kirk, D., Howard, H.A. FB107

Findings Brief
2000
Flux in Loan Repayment Programs for Healthcare Professionals With States’ Budget Cuts and National Health Service Corps Budget Increases

Flux in Loan Repayment Programs for Healthcare Professionals With States’ Budget Cuts and National Health Service Corps Budget Increases (May, 2012). Pathman, D., Goldberg, L., Konrad, T., Kerwin, K., Morgan, J. FB106

Findings Brief
2000
Why Use Swing Beds? Conversations with Hospital Administrators and Staff

Why Use Swing Beds? Conversations with Hospital Administrators and Staff (April, 2012). Freeman, V., Radford, A. FB105

Findings Brief
2000
Communities Served by Rural Medicare Dependent Hospitals

Communities Served by Rural Medicare Dependent Hospitals (March, 2012). Reiter, K., Holmes, G.M., Karim, S., Pink, G.H. FB104

Findings Brief
2000
Adoption and perceived effectiveness of financial improvement strategies in Critical Access Hospitals

Adoption and perceived effectiveness of financial improvement strategies in Critical Access Hospitals. The Journal of Rural Health 28 (1): 92-100. A108

Article
2000
Achieving benchmark financial performance in Critical Access Hospitals

Achieving benchmark financial performance in Critical Access Hospitals: Lessons from high performers. Healthcare Financial Management : Journal of the Healthcare Financial Management Association 66 (4): 116. A107

Article
2000
Financial Status of Independent Pharmacies and Rural Providers

The relationship between the financial status of sole community independent pharmacies and their broader involvement with other rural providers. The Journal of Rural Health 27 (2): 176-83. A105

Article
2001
Effect of Swing Bed Use on Medicare Average Daily Cost and Reimbursement in Critical Access Hospitals

Effect of Swing Bed Use on Medicare Average Daily Cost and Reimbursement in Critical Access Hospitals

Findings Brief
2001
Trends in the Provision of Surgery by Rural Hospitals

Trends in the Provision of Surgery by Rural Hospitals (July, 2011). Holmes, G.M., Karim, S., Pink, G. FB101

Findings Brief
2001
Recent Changes in Health Insurance Coverage in Rural and Urban Areas

Recent Changes in Health Insurance Coverage in Rural and Urban Areas (May, 2011). King, J., Holmes, G.M. FB100

Findings Brief
2001
Trends in Skilled Nursing Facility and Swing Bed Use (Post Medicare Modernization Act of 2003)

Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003. (April, 2011). ORHP. Reiter, K., Freeman, V. FR101

Final Report
2001
A Rural-Urban Comparison of Allied Health Professionals’ Average Hourly Wage

A Rural-Urban comparison of allied health professionals’ average hourly wage. Journal of Allied Health 39 (3): E91. A104

Article
2002
Projected Changes in North Carolina Health Insurance Coverage Due to Health Reform

Running the numbers: Projected changes in North Carolina health insurance coverage due to health reform. North Carolina Medical Journal 71 (3): 306-308. A102

Article
2002
Rural and Urban Differences in Children’s Medicaid and CHIP Participation

Rural and urban differences in children’s medicaid and CHIP participation. Inquiry 47 (2): 150-61. A101

Article
2002
What Does the Clinical Doctorate in Physical Therapy Mean for Rural Communities?

What does the clinical doctorate in physical therapy mean for rural communities? Physiotherapy Research International : The Journal for Researchers and Clinicians in Physical Therapy 15 (1): 24,n/a. A100

Article
2002
Rural Hospital Support for Emergency Medical Services

Rural Hospital Support for Emergency Medical Services (November, 2010). Freeman, V., Howard, H.A., Lavergne, R. FB99

Findings Brief
2002
Rural Volunteer EMS: Reports from the Field

Rural Volunteer EMS: Reports from the Field (September, 2010). Freeman, V., Rutledge, S., Hamon, M., Slifkin, R. FB98

Findings Brief
2002
Prospective Payment Compared to Special Medicare Payment Provisions

Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals with Special Medicare Payment Provisions (September, 2010). Holmes, G.M., Pink, G.H., Howard, H.A. FB97

Findings Brief
2002
Pediatric Care in Rural Hospital Emergency Departments

Pediatric Care in Rural Hospital Emergency Departments (May, 2010). Freeman, V., Randolph, R., Poley, S., Friedman, S., Slifkin, R. FB96

Findings Brief
2002
Rural Hospital Support for Emergency Medcial Services

Rural Hospital Support for Emergency Medcial Services. (November, 2010). ORHP. Freeman, V., Howard A., Lavergne, R. FR100

Final Report
2002
Rural Volunteer EMS: Reports from the Field

Rural Volunteer EMS: Reports from the Field. (August, 2010). ORHP. Freeman, V., Rutledge, S., Hamon, M., Slifkin, R. FR99

Final Report
2002
The Effect of Medicare Part D Plan Switching on Sole Community Pharmacies and the Patients

The Effect of Medicare Part D Plan Switching and Formulary Changes on Sole Community Pharmacies and the Patients They Serve (March, 2010). Lampman, M., Radford, A., Nguyen, A. FB93

Findings Brief
2002
States’ Use of Cost-Based Reimbursement for Medicaid Services at Critical Access Hospitals

States’ Use of Cost-Based Reimbursement for Medicaid Services at Critical Access Hospitals (April, 2010). Radford, A., Hamon, M., Nelligan, C. FB94

Findings Brief
2002
Comparison of Rural Hospitals with Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment

A Comparison of Rural Hospitals with Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment. (August, 2010). ORHP. Holmes, M., Pink, G., Friedman, S., Howard, A. FR98

Final Report
2002
Pediatric Care in Rural Hospital Emergency Departments

Pediatric Care in Rural Hospital Emergency Departments. (May, 2010). ORHP. Freeman, V., Randolph, R., Poley, S., Friedman, S., Slifkin, R. FR97

Final Report
2002
Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment

A Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (April, 2010). Pink, G., Slifkin, R., Howard, H.A. FB95

Findings Brief
2002
Rural Health Snapshots

Rural Health Snapshot 2010 Disparities in health status and access to health care exist between people living in rural areas and those in urban areas. Rural Health Snapshot 2010 displays selected indicators of access to health care, health behavior/risk factors, and mortality rates, comparing rural… Read more »

Other
2002
Designated Medical Directors for Emergency Medical Services

Designated medical directors for emergency medical services: Recruitment and roles. The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association 25 (4): 392. A98

Article
2003
Developing Financial Benchmarks for Critical Access Hospitals

Developing financial benchmarks for critical access hospitals. Health Care Financing Review 30 (3): 55-69. A97

Article
2003
Continuing Effects of Medicare Part D on Rural Independent Pharmacies

Continuing effects of medicare part D on rural independent pharmacies who are the sole retail provider in their community. Research in Social & Administrative Pharmacy: RSAP 5 (1): 17-30. A96

Article
2003
Recruitment and Retention in Rural and Urban EMS

Recruitment and retention in rural and urban EMS: Results from a national survey of local EMS directors. Journal of Public Health Management and Practice : JPHMP 15 (3): 246. A95

Article
2003
Profile of Sole Community Pharmacists’ Prescription Sales and Overall Financial Position

Profile of Sole Community Pharmacists’ Prescription Sales and Overall Financial Position (August, 2009). Radford, A., Lampman, M., Richardson, I., Rutledge, S. FB92

Findings Brief
2003
Characteristics of Rural & Urban Children Who Qualify For Medicaid or CHIP But Are Not Enrolled

Characteristics of Rural & Urban Children Who Qualify For Medicaid or CHIP But Are Not Enrolled (July, 2009). King, J., Slifkin, R., Holmes, G. FB91

Findings Brief
2003
Medicare Beneficiaries’ Access to Pharmacy Services in Small Rural Towns

Medicare Beneficiaries’ Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans. (January, 2009). ORHP. Freeman, V., Richardson, I., Slifkin, R. FR95

Final Report
2003
Medicaid & CHIP Participation Among Rural & Urban Children

Medicaid & CHIP Participation Among Rural & Urban Children (July, 2009). King, J., Slifkin, R., Holmes, M. FB90

Findings Brief
2003
Workforce Issues Among Sole Community Pharmacies

Workforce Issues Among Sole Community Pharmacies (July, 2009). Klepser, D., Lampman, M., Radford, A., Richardson, I., Rutledge, S. FB89

Findings Brief
2003
The Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems

The Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems (March, 2009). Radford, A., Richardson, I., Mason, M., Rutledge, S. FB88

Findings Brief
2003
Sole Community Pharmacies and Part D Participation: Implications for Rural Residents

Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (February, 2009). Freeman, V., Richardson, I., Slifkin, R. FB87

Findings Brief
2003
A Case Study of Rural Health Care in the Economic Downturn

A Case Study of Rural Health Care in the Economic Downturn. (2009). ORHP. No author.

Other
2003
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2009

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2009

Map
2003
The Occupational Mix Adjustment to the Medicare Hospital Wage Index

The Occupational Mix Adjustment to the Medicare Hospital Wage Index: Why the rural impact is less than expected. The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association 24 (2): 148-54. A94

Article
2004
The Trend Towards the Clinical Doctorate in Allied Health

The Trend Towards the Clinical Doctorate in Allied Health: Implications for Rural Communities. (August, 2008). ORHP. Freburger, J., King, J., Slifkin, R. FR94

Final Report
2004
Issues in Staffing Emergency Medical Services

Issues in Staffing Emergency Medical Services: Results from a National Survey of Local Rural and Urban EMS Directors. (May, 2008). ORHP. Freeman, V., Slifkin, R., Patterson, D. FR93

Final Report
2004
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2008

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2008

Map
2004
Cartographic Defining Rural Maps – Frontier Counties 2007

Cartographic Defining Rural Maps – Frontier Counties 2007

Map
2005
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) December, 2007

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) December, 2007

Map
2005
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) December, 2006

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) December, 2006

Map
2006
The Effect of Rural Hospital Closures on Community Economic Health

The purpose of this work was to examine the effect of rural hospital closures on the local economy. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702512/

Article
2006
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) December, 2005

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) December, 2005

Map
2007
County-level Estimates of the Number of Uninsured in North Carolina 2004 Update

This report provides county-level estimates of the number and percentage of people under the age of 65 who are uninsured in 2004.

Findings Brief
2008
Core Based Statistical Areas and the Medicare Wage Index

Core Based Statistical Areas and the Medicare Wage Index. (February, 2004). ORHP. Dalton, Kathleen, Rebecca Slifkin.

Other
2008
Cartographic Defining Rural Maps – Frontier Counties 2004

Cartographic Defining Rural Maps – Frontier Counties 2004

Map
2008
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2004

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2004

Map
2008
A Primer on Interpreting Hospital Margins

A Primer on Interpreting Hospital Margins. (July, 2003). ORHP. Dalton, Kathleen, Rebecca Slifkin.

Other
2009
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) December, 2003

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) December, 2003

Map
2009
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) June, 2003

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) June, 2003

Map
2009
Rural Populations and Health Care Providers: A Map Book

Rural Populations and Health Care Providers: A Map Book (September, 2002). ORHP. Randy Randolph, Katherine Gaul, Rebecca Slifkin.

Other
2010
Tracking Medicaid Managed Care in Rural Communities: A 50-State Follow Up

Tracking Medicaid Managed Care in Rural Communities: A 50-State Follow Up (July, 2002). Health Affairs. Silberman, Pam, Stephanie Poley, Kerry James, and Rebecca Slifkin.

Other
2010
2010 Rural-Urban Commuting Area Codes by Census Tract

2010 Rural-Urban Commuting Area Codes by Census Tract

Map
2010
Urbanized Areas and Urbanized Clusters 2010

Urbanized Areas and Urbanized Clusters 2010

Map
2010
Background on the Wage-related Portion of the Medicare DRG Payments

Background on the Wage-related Portion of the Medicare DRG Payments. (September, 2000). ORHP. Dalton, Kathleen.

Other
2012
Cartographic Defining Rural Maps – Frontier Counties 2000

Cartographic Defining Rural Maps – Frontier Counties 2000

Map
2012
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2013

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2013

Map
2013
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2013 (Puerto Rico included)

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2013 (Puerto Rico included)

Map
2013
Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2013 (2013 and 2009)

Defining Rural Maps OMB Core Based Statistical Areas (CBSAs) November, 2013 (2013 and 2009)

Map
2013
Rural-Urban Continuum Codes by County, 2013

Rural-Urban Continuum Codes by County, 2013  

Map
2013
How Does Medicaid Expansion Affect Insurance Coverage of Rural Populations?

The NC Rural Health Research Program’s Findings Brief: How Does Medicaid Expansion Affect Insurance Coverage of Rural Populations? examines how states’ decisions on Medicaid expansion are impacting rural areas in the U.S., we used population estimates, current status of state expansion, and state-le… Read more »

Findings Brief
2014
Medicaid Managed Care in Rural Areas: A Ten-State Follow-Up Study

Medicaid Managed Care in Rural Areas: A Ten-State Follow-Up Study. (March, 1999). Health Affairs. Felt-Lisk, Suzanne, Pam Silberman, Sheila Hoag, and Rebecca Slifkin.

Other
2014
Medicaid Managed Care Programs in Rural Areas: A Fifty State Overview

Medicaid Managed Care Programs in Rural Areas: A Fifty State Overview. (November, 1998). Health Affairs. Slifkin, Rebecca, Sheila D. Hoag, Pam Silberman, Suzanne Felt-Lisk, and Benjamin Popkin.

Other
2015
Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants?

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 (Critical Ac… Read more »

Findings Brief
2015
Rural Provider Perceptions of the ACA: Case Studies in Four States

The Affordable Care Act (ACA) expanded health insurance coverage to previously uninsured populations by allowing states to expand Medicaid coverage to adults with incomes up to 138% of the federal poverty level (FPL) as well as by creating health insurance marketplaces to subsidize affordable covera… Read more »

Findings Brief
2015
The 21st Century Rural Hospital: A Chart Book

Hospitals have changed over recent decades. Hospital stays are shorter. Procedures once requiring hospitalization are now done in an outpatient setting. Hospitals have moved beyond providing mainly inpatient and emergency department care. They have become vertically integrated systems with “one-stop… Read more »

Other
2015
A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals

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 Paymen… Read more »

Other
2015
A Comparison of Closed Rural Hospitals and Perceived Impact

From 2010 through 2014, 47 rural hospitals,  ceased providing inpatient services in 23 states across the country (“closed”). 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… Read more »

Findings Brief
2015
Estimating Eligibility and Uptake of Federally Facilitated Marketplace Insurance in North Carolina in the Second Open Enrollment Period

As the Federally Facilitated Marketplace (FFM) enters its third open enrollment period, focus is shifting toward examining which communities have lower uptake in coverage and how to increase enrollment. In national analysis of the first open enrollment period, Holmes and colleagues found that rural… Read more »

Findings Brief
2015
Estimated Costs of Rural Freestanding Emergency Departments

Since 2005, more than 100 rural hospitals have closed and more are at risk. Rural hospital closures jeopardize access to emergency services in the affected communities. As communities react to and/or prepare for closures, providers and policy makers seek a viable alternative for emergency services p… Read more »

Findings Brief
2015
Rural and Urban Hospitals in the United States

The table below shows the number of rural and urban hospitals in the United States as of January 1, 2016. The source of the data is the 2016 Provider of Services file produced by the Centers for Medicare and Medicaid Services.  Hospitals are classified as rural by using the definition provided by th… Read more »

2015
Prediction of Financial Distress among Rural Hospitals

From 2005 through 2015, more than 100 rural hospitals have closed their doors to patients in need of inpatient services. 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 d… Read more »

Findings Brief
2016
Geographic Variation in Risk of Financial Distress among Rural Hospitals

From 2005 to 2015, 112 rural hospital closures have been identified (North Carolina Rural Health Research Program, 2015). Although six of these closed hospitals have since reopened, the remaining closures impact millions of rural residents in communities that are typically older and poorer, more dep… Read more »

Findings Brief
2016
2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification

More Americans are now aware of the financial challenges faced by rural hospitals. Media coverage of the 66 rural hospital closures between January 2010 and January 2016 has highlighted the health care access and economic challenges facing rural America. Rural hospital closures are not a new phenome… Read more »

Findings Brief
2016
Geographic Variation in the Profitability of Urban and Rural Hospitals

The popular business quote “No margin, no mission” succinctly states the importance of profitability. The notion that if a hospital doesn’t make enough money to keep its doors open, its higher purpose is moot may be a simplistic view, but historic and recent evidence suggest that unprofitability can… Read more »

Findings Brief
2016
Identifying Rural Health Clinics in Medicaid Data

In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. RHCs must be located in non-urban areas with documented health care shortages. There are currently more than 4,100 RHCs across the U.S. Some RHCs ope… Read more »

Findings Brief
2016
Characteristics of Medicaid Beneficiaries Who Use Rural Health Clinics

For almost four decades, Rural Health Clinics (RHCs) (currently numbering about 4,100) have served patients from underserved rural areas. Although Medicaid is an important payer for RHCs, little is known about Medicaid patients and the services provided to them partly because of the complexity of id… Read more »

Findings Brief
2016
Profitability of Rural and Urban Hospitals (Infographic)

More Americans are now aware of the financial challenges faced by rural hospitals. Media coverage of the 76 rural hospital closures between January 2010 and July 2016 has highlighted the health care access and economic challenges facing rural America. Rural hospital closures are not a new phenomenon… Read more »

Other
2016
Trends in Risk of Financial Distress among Rural Hospitals

From January 2005 to July 2016, 118 rural hospitals have closed permanently, not including seven others that closed and subsequently reopened. The number of closures has increased each year since 2010, and in the first half of 2016, the closure rate surpassed two closures per month. Hospital closure… Read more »

Findings Brief
2016
The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals

Thanks to a temporary, but substantial expansion of the Centers for Medicare & Medicaid Services (CMS) Low Volume Hospital (LVH) Program, around 500 rural hospitals benefit from LVH payment adjustment. When it was originally implemented in 2005 only five rural hospitals qualified. Under the prog… Read more »

Findings Brief
2016
The Financial Importance of the Sole Community Hospital Payment Designation

In 1983, Congress created the Sole Community Hospital (SCH) program to support small rural hospitals for which “by reason of factors such as isolated location, weather conditions, travel conditions, or absence of other hospitals, is the sole source of inpatient hospital services reasonably available… Read more »

Findings Brief
2016
U.S. Hospital List (2016)

The North Carolina Rural Health Research Program produces a list of rural and urban U.S. hospitals each year.  This list includes 4,768 acute and 1,373 specialty hospitals that were reported open on January 1, 2016. U.S. Hospital List (2016)  

Other
2016
Rural Health Snapshot (2017)

Disparities in health status and access to health care exist between people living in rural areas and those in urban areas.   The Rural Health Snapshot 2017 displays selected indicators of access to health care, health behavior/risk factors, and mortality rates, comparing rural to urban residents.

Other
2017
CMS Hospital Quality Star Rating: for 762 Rural Hospitals, No Stars Is the Problem

In April 2017, the Centers for Medicare & Medicaid Services (CMS) released their fourth Hospital Quality Star Rating list. Since the first release, stakeholders have been publicly debating the star rating scale’s usefulness in comparing hospital quality, but little focus has been given to the la… Read more »

Findings Brief
2017
The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals

The provision of post-acute (PAC) and hospice care by rural hospitals allows patients to receive such care locally, avoiding unnecessary travel and staying close to family and friends.  Typically, rural residents discharged from an acute care facility receive PAC either locally or in the urban cente… Read more »

Findings Brief
2017
Regional Differences in Urban and Rural Mortality Trends

Previous research has established both that there is a gap in nationwide urban-rural mortality and that this gap is increasing over time. Existing and ongoing work has found that the urban-rural mortality gap may vary regionally. This brief builds upon previous research and explores the differences… Read more »

Findings Brief
2017
Rural-Urban Variations in Medicare Live Discharge Patterns from Hospice, 2012-2013

For the last decade-and-a-half, the proportion of patients discharged from the Medicare hospice program prior to death – known as a “live discharge” – has increased across the country with significant hospice-level geographic variations. Despite clear geographic variations in live discharge rates an… Read more »

Findings Brief
2017
Health Disparities in Appalachia

“Creating a Culture of Health in Appalachia: Disparities and Bright Spots” is an innovative research initiative that aims to identify factors that support a culture of health in Appalachian communities. “Health Disparities in Appalachia” is the first report in a series exploring health issues in App… Read more »

Final Report
2017