About this project Lead researcher: Mark Holmes, PhD Contact: Mark Holmes, PhD Project funded: September 2016 Project completed: August 2017 This brief builds upon previous research and explores the differences in mortality trends between urban and rural locations by census division from 1999 to 2015. Using data from CDC WONDER’s Compressed Mortality File, we calculated… Read more »
Characteristics of Rural Hospitals at High Risk of Financial Distress
About this project The project updates the Financial Distress Index Model (FDI) with current hospital and market data and evaluates changes in risk status and geographic distribution over time. Research center: North Carolina Rural Health Research and Policy Analysis Center Lead researcher: George H. Pink, PhD Project funded: September 2016 Project completed: December 2017 We… Read more »
Post-Acute Care for Rural Medicare Beneficiaries
About this project Increasingly, attention on Medicare payment policy has turned to post-acute services. Research has shown that discharges to post-acute care (PAC) facilities have increased substantially over the past two decades. Lead researcher: Mark Holmes, PhD Project funded: September 2016 Project completed: April 2018 Concurrently, hospital lengths of stay progressively decreased, particularly for discharges… Read more »
How Rural Communities Respond and Recover after a Hospital Closure
About this project Previous research has shown hospital closures have immediate negative health and economic effects on a rural community. Lead researcher: Mark Holmes, PhD Project funded: September 2016 Project completed: July 2019 What is less understood is the longer-term recovery period: does the healthcare infrastructure adapt to the loss of the hospital, or does… Read more »
Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
About this project Under current reimbursement methods, the Medicare program pays more per day for a skilled nursing patient in a Critical Access Hospital (CAH) swing bed than it does for a similar patient who is in a skilled nursing facility. Lead researcher: Kristin Reiter, PhD, 919.843.8619, reiter@email.unc.edu Project funded: September 2018 Project completed: August… Read more »
Ambulatory Care Provided to Rural Medicare Beneficiaries by Rural and Urban FQHCs, RHCs, and Acute Hospitals
About the project In the Rural Healthy People 2020 survey, 78% of respondents identified “access” as the top rural health priority. Research center: North Carolina Rural Health Research and Policy Analysis Center Lead researcher: George H. Pink, PhD Project funded: September 2017 Project completed: March 2019 In many rural communities, FQHCs, RHCs, and acute hospitals… Read more »
Medicare Rural Hospital Flexibility Program Evaluation (Flex Program)
About the Flex Program Lead researcher: Melissa A. Fruhbeis, MSPH Project completed: August 2002 The North Carolina Rural Health Research and Policy Analysis Center and the UNC Department of Health Policy and Administration are collaborating with the other rural health research and policy analysis centers in a comprehensive review of the Rural Hospital Flexibility Program… 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 »
Rural Hospitals that Closed between 2017‐20: Profitability and Liquidity in the Year Before Closure
In a 2017 article, we presented the Financial Distress Index (FDI). The FDI is an algorithm that uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress. The model assigns every rural hospital to one of four financial risk categories: high, mid‐high, mid‐low,… Read more »
2021 CMS Hospital Quality Star Ratings of Rural Hospitals
In July of 2016, the Centers for Medicare & Medicaid Services (CMS) released a new Hospital Quality Star Rating system on the Hospital Compare website. Under this system, performance on a series of quality metrics is used to assign between one and five stars to a hospital, with a higher number of stars indicating better… 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 »