Geographic Variation in the Profitability of Urban and Rural Hospitals

The popular business quote “No margin, no mission” succinctly states the importance of profitability. The notion that if a hospital doesn’t make enough money to keep its doors open, its higher purpose is moot may be a simplistic view, but historic and recent evidence suggest that unprofitability can reduce hospital services and quality, or worse,… Read more »

Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?

BACKGROUND Implementing the Patient Protection and Affordable Care Act (ACA) is changing hospital reimbursement in important ways.1 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,2 increased access to health insurance should, in theory,… Read more »

Identifying Rural Health Clinics in Medicaid Data

BACKGROUND 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.1 Some RHCs operate as independent medical practices, while others are part… Read more »

Characteristics of Medicaid Beneficiaries Who Use Rural Health Clinics

BACKGROUND 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… Read more »

Medicaid Expansion Affects Rural And Urban Hospitals Differently

Abstract Rural hospitals differ from urban hospitals in many ways. For example, rural hospitals are more reliant on public payers and have lower operating margins. In addition, enrollment in the health insurance Marketplaces of the Affordable Care Act (ACA) has varied across rural and urban areas. This study employed a difference-in-differences approach to evaluate the… Read more »

The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals

Background In response to the widening gap between rural and urban hospital profitability margins, the Medicare Payment Advisory Commission (MedPAC) asserted that Medicare payment policies penalized small-scale hospital operations and recommended that Congress authorize a Low Volume Hospital (LVH) payment adjustment.1 This designation and payment adjustment was created in the Medicare Prescription Drug, Improvement and… Read more »

The Financial Importance of the Sole Community Hospital Payment DesignaƟon

BACKGROUND 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.”1 A hospital qualifies… Read more »

To What Extent do Community Characteristics Explain Differences in Closure among Financially Distressed Rural Hospitals?

Abstract From January 2005 through December 2015, 105 rural hospitals closed. This study examined associations between community characteristics and rural hospital closure. Compared with other rural hospitals that were at high risk of financial distress but remained open over the same time period, closed rural hospitals had a smaller market share (p < .0001) despite… Read more »

Estimated Costs of Rural Freestanding Emergency Departments

OVERVIEW Since 2005, more than 100 rural hospitals have closed and more are at risk.1,2 Rural hospital closures jeopardize access to emergency services in the affected communities. As communities react to and/or prepare for closures, providers and policy makers seek a viable alternative for emergency services provided in a rural hospital setting. A rural freestanding… Read more »

Estimating Eligibility and Uptake of Federally Facilitated Marketplace Insurance in North Carolina in the Second Open Enrollment Period

Background As the Federally Facilitated Marketplace (FFM) enters its third open enrollment period, focus is shifting toward examining which communities have lower uptake in coverage and how to increase enrollment. In national analysis of the first open enrollment period, Holmes and colleagues found that rural areas had lower rates of plan selections.1 However, these estimates… Read more »

Rural Medicare Beneficiaries Have Fewer Follow-up Visits and Greater Emergency Department Use Postdischarge

Abstract Background: Hospitals are focused on improving postdischarge services for older adults, such as early follow-up care after hospitalization to reduce readmissions and unnecessary emergency department (ED) use. Rural Medicare beneficiaries face many barriers to receiving quality care, but little is known about their postdischarge care and outcomes. We hypothesize that rural Medicare beneficiaries compared with… Read more »

The Effect of Surgery on the Profitability of Rural Hospitals

Abstract   OBJECTIVE: The purpose of this research study is to determine the effect of surgery on the profitability of rural hospitals. BACKGROUND: Small rural hospitals are often the sole health care provider in their communities and the only source of care for many people.  The provision of surgery in rural hospitals saves the lives… Read more »

Minimum-distance requirements could harm high-performing critical-access hospitals and rural communities

Abstract Since the inception of the Medicare Rural Hospital Flexibility Program in 1997, over 1,300 rural hospitals have converted to critical-access hospitals, which entitles them to Medicare cost-based reimbursement instead of reimbursement based on the hospital prospective payment system (PPS). Several changes to eligibility for critical-access status have recently been proposed. Most of the changes… Read more »