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.
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 »
Unstable Demand and Cost per Case in Low-Volume Hospitals
About this project This Findings Brief looks at the effects of year-to-year changes in annual inpatient discharges on costs per Medicare discharge. Low-volume hospitals, regardless of location, experience significantly greater total variability in inpatient demand across years, and greater changes in annual discharges that cannot be forecasted as part of an individual hospitals’ trend over… Read more »
Unpredictable Demand and Low-Volume Hospitals
Unpredictable Demand and Low-Volume Hospitals background This Findings Brief assesses the degree to which the annual number of patient discharges varies from year to year for low volume hospitals. To the extent that demand for inpatient services is unpredictable, it is hard for administrators to set budget and recruitment goals, which are generally based on… Read more »
Design of enhanced primary care case management programs operating in rural communities: Lessons learned from 3 states
Executive summary States are beginning to develop alternative managed care strategies for their Medicaid populations, including enhanced primary care case management (PCCM) programs that incorporate features originally developed for fully capitated managed care programs, such as care coordination and quality improvement efforts. Such alternative approaches have proven to be especially useful in rural communities, where… Read more »
Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities
In July of 1998, the method for determining payments for Medicare services in skilled nursing facilities (SNFs) began a three-year transition from retrospective cost-based reimbursement to a SNF prospective payment system (SNF PPS). SNF PPS is based on national rates with an adjustment for differences in local wages that is based upon the Medicare inpatient… Read more »
Cesarian section rates in rural hospitals
Executive summary Childbirth by cesarean section (c-section) is major abdominal surgery that carries risk to both mother and baby. There are reasons to suggest that c-section rates at rural hospitals might be different than c-section rates at urban hospitals. The diffusion of best practices, such as the safe delivery of infants by vaginal births to… Read more »
Contracting With Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
Contracting With Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators overview This document summarizes the experience of CAH administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms… 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 »
Mini-Studies to Inform Health Reform Efforts
About this project Project funded: September 2009 Project completed: August 2011 Characteristics of rural residents, combined with challenges faced by rural providers, make rural health care systems far more vulnerable to changes in federal health care policy than are those in urban areas. Because of the characteristics of rural residents and providers, federal health care… Read more »