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 »
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 »
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 »
Changes in Provision of Selected Services by Rural and Urban Hospitals between 2009 and 2017
During the past decade, access to health care services provided by rural hospitals has changed in two major ways. First, there has been a substantial increase in the number of rural hospitals that have completely closed or converted (provide some health care services, but not inpatient care). Second, and less understood, many rural hospitals have… Read more »
The Effect of Medicare Payment Standardization Methods on the Perceived Cost of Post-Acute Swing Bed Care in Critical Access Hospitals
The Centers for Medicare & Medicaid (CMS) use standardized payments to compare Medicare resource use across locations and settings. Currently, CMS uses different payment systems to reimburse post-acute care provided in CAH swing beds versus inpatient prospective payment system (IPPS) hospital swing beds or skilled nursing facilities (SNFs). This results in differential payments for theoretically… Read more »
Health System Challenges for Critical Access Hospitals: Findings from a National Survey of CAH Executives
Despite the numerous challenges of operating a CAH, there is little research examining the perspectives of CAH executives on potential community health care options if the CAH were to close. This brief presents a subset of results from a national survey of CAH executive perspectives on pressing challenges. In the brief, , the NC Rural… Read more »
Alternatives to Hospital Closure: Findings from a National Survey of CAH Executives
Despite the numerous challenges of operating a CAH, there is little research examining the perspectives of CAH executives on potential community health care options if the CAH were to close. The NC Rural Health Research Program produced the brief, , to provide rural health policy makers with a better understanding of what CAH executives think… Read more »
CMS Hierarchical Condition Category (HCC) 2014 Risk Scores Are Lower for Rural Medicare Beneficiaries than for Urban Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) use Hierarchical Condition Categories (HCC) and demographic information to calculate beneficiary risk scores, which predict expected Medicare spending by beneficiaries. CMS-HCC risk scores may be underestimating expected health care utilization among rural beneficiaries compared to urban beneficiaries. Incorrect estimation of expected health care utilization can lead to… Read more »
Association of CMS‐HCC Risk Scores with Health Care Utilization among Rural and Urban Medicare Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) use Hierarchical Condition Categories (HCC) and demographic information to calculate beneficiary risk scores, which predict expected Medicare spending by beneficiaries. CMS-HCC risk scores may be underestimating expected health care utilization among rural beneficiaries compared to urban beneficiaries. Incorrect estimation of expected health care utilization can lead to… Read more »