Sheps Center

The COVID-19 pandemic showed that hospital closures and other reductions in inpatient capacity can limit a hospital’s ability to respond to sudden surges in demand. To help policymakers and stakeholders consider trade-offs between cost-saving reductions and emergency preparedness, the NC Rural Health Research Program describes how rural inpatient capacity has changed over time in the… Read more »

In the brief, the NC Rural Health Research Program examines whether hospital ownership changes—specifically transitions between government or nonprofit ownership and for-profit status—are associated with differences in staffing levels, an important indicator of care quality and local economic impact. Using CMS HCRIS data from 2011–2023, we analyzed 1,917 hospital-year observations from 162 rural hospitals that… Read more »

The NC Rural Health Research Program brief, , provides a preliminary look at the types of communities with hospitals that converted to Rural Emergency Hospitals (REHs) in 2023. We: 1) describe the socio-economic, race and ethnicity, and health status and access characteristics of the communities served by REHs, and 2) compare the characteristics of counties… Read more »

The NC Rural Health Research Program wrote the brief, . to augment previous research with findings from a structured framework of attributed causes of closures through the analysis of news media reports. Media reports of closures offer a qualitative dimension that goes beyond numbers, allowing us to understand the deeper context surrounding a hospital closure…. Read more »

The NC Rural Health Research Program has been tracking the Low Volume Hospital (LVH) adjustment’s impact on rural hospitals. As policy makers consider legislation to maintain or alter the LVH adjustment before its expiration on December 31, 2024, the impact on more vulnerable communities is a relevant consideration.  Read our July 2024 brief, . The… Read more »

Access to care in many communities has been reduced by rural hospital closures. The causes of rural hospital closures are complex and multifaceted, but unprofitability has been identified as a major contributor. In this study, the NC Rural Health Research Program focuses on system affiliation and ownership as additional contributing factors. Using hospital cost report… Read more »

The NC Rural Health Research Program has been tracking profitability of rural hospitals more than a decade. In a 2020 study, we found that: overall, profitability of rural hospitals decreased while the profitability of urban hospitals increased between 2016 and 2018.  Since our 2020 study was published, the global COVID-19 pandemic emerged, and the federal… Read more »

Access to care in many communities has been reduced by rural hospital closures. The causes of rural hospital closures are complex and multifaceted, but unprofitability has been identified as a major contributor. In this study, the NC Rural Health Research Program focuses on whether hospitals operate rural health clinics (RHCs) or provide long-term care. Using… Read more »

Profitability is a determinant of hospital financial distress and closure. Operating margin is one of the key measures of hospital profitability. Accurate use of the measure relies on the quality of data, and previous studies found inconsistencies in how operating margin is calculated and reported.  There are three definitions of operating margin; each will produce… Read more »

Using a recent revision of the Financial Distress Index (FDI) model, the NC Rural Health Research Program brief, describes the relative risk of experiencing financial distress for rural hospitals and selected urban hospitals (urban Critical Access Hospitals [CAHs], urban Medicare Dependent Hospitals [MDHs], and urban Sole Community Hospitals [SCHs] earning $500,000,000 or less in net… Read more »

The NC Rural Health Research Program’s brief, , extends our 2018 study of geographic variation in uncompensated care between rural and urban hospitals. In this study, we investigate the association of uncompensated care with net patient revenue, system affiliation, and ownership.

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 »

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 »

The purpose of this brief is to explore changes in the availability and provision of different health care services among rural CAHs and PPS hospitals in 2009 compared to 2017.