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 »
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 »
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 »
The Financial Importance of the Sole Community Hospital Payment Designation
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.” As such, Medicare SCH… Read more »
The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals
Thanks to a temporary, but substantial expansion of the Centers for Medicare & Medicaid Services (CMS) Low Volume Hospital (LVH) Program, around 500 rural hospitals benefit from LVH payment adjustment. When it was originally implemented in 2005 only five rural hospitals qualified. Under the program, CMS provides an additional payment to qualifying hospitals for the higher costs associated with… Read more »
Trends in Risk of Financial Distress among Rural Hospitals
From January 2005 to July 2016, 118 rural hospitals have closed permanently, not including seven others that closed and subsequently reopened. The number of closures has increased each year since 2010, and in the first half of 2016, the closure rate surpassed two closures per month. Hospital closures impact millions of rural residents in communities… Read more »
Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?
The implementation of the Patient Protection and Affordable Care Act (ACA) is changing hospital reimbursement in important ways. The most significant changes stem from increasing access to health insurance coverage for previously uninsured or under-insured populations. Since rural residents are more likely than urban residents to be uninsured, increased access to health insurance should, in… Read more »
Characteristics of Medicaid Beneficiaries Who Use Rural Health Clinics
For almost four decades, Rural Health Clinics (RHCs) (currently numbering about 4,100) have served patients from underserved rural areas. Although Medicaid is an important payer for RHCs, little is known about Medicaid patients and the services provided to them partly because of the complexity of identifying claims generated from RHCs in Medicaid claims data sources…. Read more »
Identifying Rural Health Clinics in Medicaid Data
In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. RHCs must be located in non-urban areas with documented health care shortages. There are currently more than 4,100 RHCs across the U.S. Some RHCs operate as independent medical practices, while others are part of… Read more »
2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
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 »
Geographic Variation in Risk of Financial Distress among Rural Hospitals
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 »
Prediction of Financial Distress among Rural Hospitals
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 »
A Comparison of Closed Rural Hospitals and Perceived Impact
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 »
A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals
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 »