The NC Rural Health Research Program brief, , provides a preliminary look at the types of communities with hospitals that converted to Rural Emergency Hospitals (REHs) in 2023. We: 1) describe the socio-economic, race and ethnicity, and health status and access characteristics of the communities served by REHs, and 2) compare the characteristics of counties… Read more »
News Media Coverage of Rural Hospital Closures and the Causes
The NC Rural Health Research Program wrote the brief, . to augment previous research with findings from a structured framework of attributed causes of closures through the analysis of news media reports. Media reports of closures offer a qualitative dimension that goes beyond numbers, allowing us to understand the deeper context surrounding a hospital closure…. Read more »
The Low-Volume Hospital Adjustment Before and During COVID-19
The NC Rural Health Research Program has been tracking the Low Volume Hospital (LVH) adjustment’s impact on rural hospitals. As policy makers consider legislation to maintain or alter the LVH adjustment before its expiration on December 31, 2024, the impact on more vulnerable communities is a relevant consideration. Read our July 2024 brief, . The… Read more »
2018-23 Profitability of Rural Hospitals by Ownership and System Affiliation
Access to care in many communities has been reduced by rural hospital closures. The causes of rural hospital closures are complex and multifaceted, but unprofitability has been identified as a major contributor. In this study, the NC Rural Health Research Program focuses on system affiliation and ownership as additional contributing factors. Using hospital cost report… Read more »
2018‐23 Profitability of Rural and Urban Hospitals by Medicare Payment Designation
The NC Rural Health Research Program has been tracking profitability of rural hospitals more than a decade. In a 2020 study, we found that: overall, profitability of rural hospitals decreased while the profitability of urban hospitals increased between 2016 and 2018. Since our 2020 study was published, the global COVID-19 pandemic emerged, and the federal… Read more »
2018-23 Profitability of Rural Hospitals by with and without Rural Health Clinics and Long-Term Care
Access to care in many communities has been reduced by rural hospital closures. The causes of rural hospital closures are complex and multifaceted, but unprofitability has been identified as a major contributor. In this study, the NC Rural Health Research Program focuses on whether hospitals operate rural health clinics (RHCs) or provide long-term care. Using… Read more »
Differences in Measurement of Operating Margin: An Update
Profitability is a determinant of hospital financial distress and closure. Operating margin is one of the key measures of hospital profitability. Accurate use of the measure relies on the quality of data, and previous studies found inconsistencies in how operating margin is calculated and reported. There are three definitions of operating margin; each will produce… Read more »
Using the Updated Financial Distress Index to Describe Relative Risk of Hospital Financial Distress
Using a recent revision of the Financial Distress Index (FDI) model, the NC Rural Health Research Program brief, describes the relative risk of experiencing financial distress for rural hospitals and selected urban hospitals (urban Critical Access Hospitals [CAHs], urban Medicare Dependent Hospitals [MDHs], and urban Sole Community Hospitals [SCHs] earning $500,000,000 or less in net… Read more »
COVID-19 Affected Rural and Urban Hospital Uncompensated Care
Uncompensated care are services provided that are never reimbursed, including charity care and unanticipated bad debt. High uncompensated care burden is a concern because it may contribute to smaller operating margins and rural hospital closures. This infographic, , compliments previous work The NC Rural Health Research Program has produced on uncompensated care. For the infographic. … Read more »
A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership
The NC Rural Health Research Program’s brief, , extends our 2018 study of geographic variation in uncompensated care between rural and urban hospitals. In this study, we investigate the association of uncompensated care with net patient revenue, system affiliation, and ownership.
Unstable Demand and Cost per Case in Low-Volume Hospitals
About this project This Findings Brief looks at the effects of year-to-year changes in annual inpatient discharges on costs per Medicare discharge. Low-volume hospitals, regardless of location, experience significantly greater total variability in inpatient demand across years, and greater changes in annual discharges that cannot be forecasted as part of an individual hospitals’ trend over… Read more »
Unpredictable Demand and Low-Volume Hospitals
Unpredictable Demand and Low-Volume Hospitals background This Findings Brief assesses the degree to which the annual number of patient discharges varies from year to year for low volume hospitals. To the extent that demand for inpatient services is unpredictable, it is hard for administrators to set budget and recruitment goals, which are generally based on… Read more »
Design of enhanced primary care case management programs operating in rural communities: Lessons learned from 3 states
Executive summary States are beginning to develop alternative managed care strategies for their Medicaid populations, including enhanced primary care case management (PCCM) programs that incorporate features originally developed for fully capitated managed care programs, such as care coordination and quality improvement efforts. Such alternative approaches have proven to be especially useful in rural communities, where… Read more »
Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities
In July of 1998, the method for determining payments for Medicare services in skilled nursing facilities (SNFs) began a three-year transition from retrospective cost-based reimbursement to a SNF prospective payment system (SNF PPS). SNF PPS is based on national rates with an adjustment for differences in local wages that is based upon the Medicare inpatient… Read more »
Cesarian section rates in rural hospitals
Executive summary Childbirth by cesarean section (c-section) is major abdominal surgery that carries risk to both mother and baby. There are reasons to suggest that c-section rates at rural hospitals might be different than c-section rates at urban hospitals. The diffusion of best practices, such as the safe delivery of infants by vaginal births to… Read more »