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 »
Patterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents
Hospital bypass, the tendency of local rural residents to not seek care at their closest hospital, is thought to be a contributing factor for rural hospital closure. To to update the knowledge base of determinants of bypass behavior, the NC Rural Health Research Program produced the brief, . We analyzed 2014-2016 Healthcare Cost and Utilization… Read more »
Occupancy Rates in Rural and Urban Hospitals: Value and Limitations in Use as a Measure of Surge Capacity
As policymakers deal with the effects of the novel coronavirus pandemic on the hospital infrastructure, understanding the differences in occupancy rates between rural and urban hospitals may help state and local officials in their planning for dealing with surge demand. Historically, rural hospitals have reported lower occupancy rates than urban hospitals and more licensed than… Read more »
Risk Factors and Potentially Preventable Deaths in Rural Communities
As the rural-urban mortality gap continues to expand, researchers have been exploring the reasons why the gap exists and how some of the deaths might be prevented. Studies show a higher percentage of rural residents die from preventable causes, specifically heart disease, cancer, unintentional injury, chronic lower respiratory disease,1 and stroke than urban residents.2,3 Researchers… Read more »
A Rural Urban Comparison of the Proposed 2020 Wage Index
On April 23, 2019, the Centers for Medicare & Medicaid Services (CMS) released its annual proposed update for the hospital Inpatient Prospective Payment System for fiscal year 2020 that starts in October 2019. In the proposed update, CMS recognizes that the current wage index system perpetuates and exacerbates the disparities between high and low wage… Read more »
Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries
Cost is often a significant barrier to accessing care for the rural Medicare population, so having a better understanding of the variations in cost-sharing at different types of safety-net facilities is important. The purpose of this study was to empirically investigate cost as a barrier to accessing care at Federally Qualified Health Centers (FQHCs) and… Read more »
Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
The Medicare hospital Inpatient Prospective Payment System (IPPS) is designed to pay hospitals for services provided to Medicare beneficiaries based on a national standardized amount adjusted for the patient’s condition and related treatment. Further, Social Security Act Section 1886(d)(3)(E) requires that the standardized amount be adjusted for differences in hospital wage levels among labor markets,… Read more »
Geographic Variation in the 2019 Risk of Financial Distress among Rural Hospitals
In 2016, the NC Rural Health Research Program developed and utilized the Financial Distress Index (FDI) model to identify hospitals at high risk of financial distress and assess trends in varying risk of financial distress over time to help inform strategies to prevent or mitigate the effects of closures. As part of that study, we… Read more »
Trends in Risk of Financial Distress among Rural Hospitals, 2015 to 2019
In 2016, the NC Rural Health Research Program developed and utilized the Financial Distress Index (FDI) model to identify hospitals at high risk of financial distress and assess trends in varying risk of financial distress over time to help inform strategies to prevent or mitigate the effects of closures. We found the proportion of rural… Read more »
Rural Hospital Mergers from 2005 through 2016
Hospital mergers and acquisitions are changing the face of health care in both rural and urban communities across the country. There are many factors driving mergers, such as cost savings, increased access to capital, increased access to technology, etc., but concerns about rural hospital mergers have also been voiced, including reduced negotiating power with insurers,… Read more »
Rural and Urban Provider Market Share of Inpatient Post-Acute Care Services Provided to Rural Medicare Beneficiaries
As new Medicare payment models are implemented, there is some concern about how it will affect inpatient post-acute care in rural areas. Changes in referral patterns and utilization could make maintaining these services financially difficult in rural areas, which could ultimately reduce access to local PAC for rural residents. To learn more, the NC Rural… Read more »
Market Characteristics Associated with Rural Hospitals’ Provision of Post-Acute Care
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 »
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 »