Post-acute care (PAC) in rural hospitals, particularly Critical Access Hospitals (CAHs), represents an important source of PAC access in rural areas. In addition, a rural hospital’s financial health often depends on providing services that meet local need. Over time, some changes in Medicare payment policies have adversely affected rural providers. For example, when the Balanced… Read more »
Geographic Variation in the 2016 Profitability of Urban and Rural Hospitals
Rural hospital closures remain a worrisome issue for policy makers and communities: between 2010 and 2017, 83 rural hospitals closed. The NC Rural Health Research Program tracks these closures and studies potential predictors. Profitability is not the only predictor, but it is one of the main predictors of hospital closure. Researchers and policy makers are… Read more »
Evaluating the Workforce Outcomes of North Carolina’s Medical Education Programs
North Carolina Session Law 2017-57, Section 11J.2, the Current Operations Appropriations Act of 2017, directed the North Carolina Department of Health and Human Services (DHHS) and The University of North Carolina (UNC) to assess the degree to which physician training programs in North Carolina meet the healthcare needs of North Carolina’s citizens. The Program… Read more »
Range Matters: Rural Averages Can Conceal Important Information
Researchers often use averages to describe data. The average (or the mean) of a data set can be used to identify the central value of the group, or what is typical. While valuable, it’s also important to understand the range of data—the highs and lows. What might we miss by focusing on the average? When… Read more »
Access to Care: Populations in Counties with No FQHC, RHC, or Acute Care Hospital
Rural areas have more limited access to health care than urban areas. In 2013, there were 79.3 primary care physicians per 100,000 people in metropolitan counties, compared to only 55.1 per 100,000 people in non-metropolitan counties. To help provide a quick understanding of how many people may have more limited access to primary care and where… Read more »
Characteristics of Communities Served by Hospitals at High Risk of Financial Distress
Since 2005, there have been 124 rural hospital closures in the United States. Rural hospital closures can intensify already challenging health and economic issues for rural communities. People served by rural hospitals tend to be older, poorer, have access to fewer health care professionals, and have overall worse health outcomes than those served by urban hospitals. To… Read more »
Differences in Community Characteristics of Sole Community Hospitals
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 in a geographic area to Medicare beneficiaries.” A SCH is often… Read more »
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 Appalachia. It measures population health and documents disparities in health… Read more »
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 and known rural-urban disparities (e.g., patients of rural hospices have higher satisfaction), previous… Read more »
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 in mortality trends between urban and rural locations by… Read more »
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 the Federal Office… Read more »
Opioid Poisoning Related Hospital Use in North Carolina
Nationally, the opioid epidemic is expanding at a rapid pace. Deaths from opioid overdose quadrupled from 1999 to 2016. North Carolina is experiencing a faster increase in drug overdose deaths than the nation as a whole. However, opioid use does not always manifest in death. One report estimates that there are four inpatient visits and… Read more »
Trends in North Carolina Hospital Use Related to Prescription Opioid and Heroin Poisoning, 2012-2015
The opioid epidemic is expanding rapidly, and North Carolina is experiencing a faster increase in drug overdose deaths than the nation as a whole. A companion brief gave a cross-sectional description of hospital claims data to provide a broader lens to the opioid epidemic in North Carolina. This brief expands that analysis to review trends… Read more »
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 center where acute care was provided. Policy makers are considering… Read more »
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 large number of rural hospitals with no rating. In the… Read more »
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