Sheps Center

More Americans are now aware of the financial challenges faced by rural hospitals. Media coverage of the 66 rural hospital closures between January 2010 and January 2016 has highlighted the health care access and economic challenges facing rural America. Rural hospital closures are not a new phenomenon – hundreds of rural hospitals closed in the… Read more »

From 2005 to 2015, 112 rural hospital closures have been identified (North Carolina Rural Health Research Program, 2015). Although six of these closed hospitals have since reopened, the remaining closures impact millions of rural residents in communities that are typically older and poorer, more dependent on public insurance programs, and in worse health than residents… Read more »

From 2005 through 2015, more than 100 rural hospitals have closed their doors to patients in need of inpatient services. Though a handful of these closed hospitals have since reopened, the remaining closures leave millions of rural residents at greater risk of negative health and economic hardship due to the loss of local acute care services.  Policymakers,… Read more »

From 2010 through 2014, 47 rural hospitals,  ceased providing inpatient services in 23 states across the country (“closed”). Among the 47 closed hospitals, 26 hospitals no longer provide any health care services (“abandoned”), and 21 continue to provide a mix of health services but no inpatient care (“converted”). These closures have affected approximately 800,000 people… Read more »

In March 2015, the Office of the Inspector General (OIG) issued a report on Medicare’s expenditures on swing beds in Critical Access Hospitals (“Medicare Could Have Saved Billions At Critical Access Hospitals If Swing Bed Services Were Reimbursed Using The Skilled Nursing Facility Prospective Payment System Rates.” Department of Health and Human Services, Office of… Read more »

The Affordable Care Act provided coverage through the Health Insurance Marketplace to nearly seven million people during the first open enrollment period. Yet, research suggests that the enrollment rates for eligible individuals living in rural areas was less than enrollment rates for those living in urban areas.  That may be due, in part, to specific challenges… Read more »

On September 18, 2014, the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS) released data showing that nearly five and a half million individuals had selected an insurance plan in the 36 states where the Federally Facilitated Marketplace was operating.  The NC Rural Health Research Program’s Findings Brief: Geographic… Read more »

Hospital mergers and acquisitions are changing the face of health care in both rural and urban communities across the country. Declining reimbursement levels, increased capital needs, a weak economy and easier access to credit have all contributed to a level of mergers not seen in more than a decade. The NC Rural Health Research Program’s Findings Brief: Rural… Read more »

The NC Rural Health Research Program’s Findings Brief: How Does Medicaid Expansion Affect Insurance Coverage of Rural Populations? examines how states’ decisions on Medicaid expansion are impacting rural areas in the U.S., we used population estimates, current status of state expansion, and state-level insurance estimates to answer two primary questions:  1) How is Medicaid expansion… Read more »

The NC Rural Health Research Program’s Findings Brief, Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where, examines health conditions of patients discharged from rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs). Patients discharged to facility-based, post-acute care from CAHs are sent… Read more »

This recent Findings Brief from the North Carolina Rural Health Research Program finds that Medicare beneficiaries who are admitted to rural hospitals tend to have lower outpatient costs than Medicare beneficiaries admitted to urban hospitals. These differences are due to multiple factors,  some of which were adjusted in the comparisons included in the Brief. The… Read more »

The NC Rural Health Research Program’s Findings Brief,  Implications for Beneficiary Travel Time if Financially Vulnerable Critical Access Hospitals Close, examines how changes to Critical Access Hospitals reimbursement that may spur some CAHs to close, with the most financially vulnerable more likely to close.  The average resident of these communities would experience an 80 percent… Read more »

The North Carolina Rural Health Research Program released their Findings Brief, .  It looks at how changes to Critical Access Hospitals (CAHs) reimbursement – notably a reversion to prospective payment – would have marked negative effects on CAH profitability and financial health.  Roughly three quarters of CAHs would operate at a loss.  The number of CAHs… Read more »

The NC Rural Health Research Program’s Findings Brief, Geographic Variation in the Profitability of Critical Access Hospitals, examines how the profitability of Critical Access Hospitals (CAHs) varies greatly across states and U.S. Census divisions. The decertification of CAHs and the loss of cost-based reimbursement are likely to reduce hospital profitability, with some states and regions… Read more »