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.
Rural Population Health in the United States: A Chartbook
This presents variations in U.S. population health in rural areas across all Census regions and states. Where the data allow, we also present rural population health findings stratified by sex, race, and ethnicity. This chartbook presents a full range of data across multiple geographic areas. When looking at data like these it is important to… Read more »
Characteristics of Rural Hospitals Eligible for Conversion to Rural Emergency Hospitals and Three Rural Hospitals Considering Conversion
This brief is a follow-up to the 2021 NC Rural Health Research Program’s brief, . The new brief, , presents updated data for REH-eligible hospitals, compares several financial and operational measures of three rural hospitals that are on public record as having expressed interest in REH conversion to the all REH-eligible hospitals, and discusses what… Read more »
Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
In the brief, , the NC Rural Health Research Program, examines differences between patients discharged to swing beds versus SNFs, stratifying by admitting hospital type (i.e., rural CAH versus rural PPS hospital). Identification of key differences between patients discharged to swing beds versus SNFs can help inform further discourse on this financially and clinically important… Read more »
Small Rural Hospitals with Low-Volume Emergency Departments that May Convert to a Rural Emergency Hospital (REH)
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 »
Changes in the Provision of Health Care Services by Rural CAHs and PPS Hospitals from 2009 to 2017
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.
Types of Rural and Urban Hospitals and Counties Where They Are Located
Recognizing that many rural hospitals are the only health care facility in their communities and that their survival is vital to ensure access to health care, Federal policymakers in the 1980s and 1990s created five special payment designations under Medicare: Critical Access Hospital (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), Essential Access Community… Read more »
Trends in Revenue Sources among Rural Hospitals
Possible issues with existing rural hospital financing models suggest that newer, outpatient-centric payment methods may be more effective in providing financial relief to rural hospitals. In light of this, the NC Rural Health Research Program explores the current financial importance of outpatient care to rural hospitals in the brief, Trends in Revenue Sources among Rural Hospitals.
Specifically, the objective of our study was to estimate changes in outpatient care as a source of revenue for rural hospitals from 2011-2019. Ideally, the results can provide stakeholders and lawmakers with additional support in understanding the contemporary role that outpatient service lines have in rural hospitals, thereby allowing them to develop policies that more effectively support rural health care providers and the communities they serve.
Rural Hospital Profitability during the Global COVID-19 Pandemic Requires Careful Interpretation
The North Carolina Rural Health Research Program has been tracking rural hospital profitability for more than a decade, as many small rural hospitals struggle with profitability compared to their urban counterparts. The findings brief, , describes the pre-pandemic (2011-19) trend of rural hospital profitability and explains why possible increases in reported profitability during the pandemic… Read more »
Predictors of Hospital Choice among Rural Patients Seeking Elective Surgery: A Scoping Review
Hospital choice for surgery affects both patient outcomes and hospital viability, a greater understanding of rural patients’ surgical care-seeking behavior could enhance rural health and rural hospital financial stability. Specifically, insight on modifiable determinants of care-seeking behavior can inform policies to promote behavior that is consistent with evidence-based public health recommendations (e.g., undergoing common, low-risk… Read more »
Since 1990, Rural Hospital Closures Have Increasingly Occurred in Counties that Are More Urbanized, Diverse, and Economically Unequal
The NC Rural Health Research Program tracks and studies rural hospital closures. Our most recent brief, , describes the socio‐economic, demographic, and health system characteristics for rural counties with and without hospital closures between 1990 and 2020. For the purposes of this analysis, we defined closures as either 1) facilities where health care services are no… Read more »
Rural Hospitals that Closed between 2017‐20: Profitability and Liquidity in the Year Before Closure
In a 2017 article, we presented the Financial Distress Index (FDI). The FDI is an algorithm that uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress. The model assigns every rural hospital to one of four financial risk categories: high, mid‐high, mid‐low,… Read more »
2021 CMS Hospital Quality Star Ratings of Rural Hospitals
In July of 2016, the Centers for Medicare & Medicaid Services (CMS) released a new Hospital Quality Star Rating system on the Hospital Compare website. Under this system, performance on a series of quality metrics is used to assign between one and five stars to a hospital, with a higher number of stars indicating better… Read more »
How Many Hospitals Might Convert to a Rural Emergency Hospital (REH)?
The Consolidated Appropriations Act of 2021 establishes a Rural Emergency Hospital (REH) designation under the Medicare program. It is difficult to predict rural hospital interest in conversion to REH because conditions of participation through rulemaking and guidance have yet to be established by the Centers for Medicare & Medicaid Services (CMS). However, some first… Read more »