Most Rural Hospitals Have Little Cash Going into COVID-19

In the infographic, , The North Carolina Rural Health Research Program uses recent Medicare Cost Report data to illustrate the type of rural hospitals most likely to struggle financially during the pandemic as measured by lower median days cash on hand. Days cash on hand is a common measure of an organization’s level of cash… Read more »

Patterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents

Hospital bypass, the tendency of local rural residents to not seek care at their closest hospital, is thought to be a contributing factor for rural hospital closure. To to update the knowledge base of determinants of bypass behavior, the NC Rural Health Research Program produced the brief, . We analyzed 2014-2016 Healthcare Cost and Utilization… Read more »

Understanding the Broader Context of Rural Hospitals and Profitability

Rural hospital closures remain a worrisome issue for policy makers and communities. Since 2005, 170 rural hospitals closed. The North Carolina Rural Health Research Program and Policy Analysis Center tracks these closures and studies potential predictors. Profitability (revenue greater than expenses) is not the only predictor, but it is one of the main predictors of… Read more »

Rural Hospitals with Long‐term Unprofitability

To remain open, businesses generally need to be profitable (have revenues greater than expenses). Hospitals are no different. Hospitals use profits to pay for new and upgraded buildings, equipment, technology, programs, and other patient care needs. To assess hospital profitability, we often look at total margin. Total margin measures the control of expenses relative to… Read more »

Geographic Variation in the 2018 Profitability of Urban and Rural Hospitals

Rural hospital closures remain a worrisome issue for policy makers and communities. Since 2005, 170 rural hospitals closed. The North Carolina Rural Health Research Program and Policy Analysis Center tracks these closures and studies potential predictors. Profitability (revenue greater than expenses) is not the only predictor, but it is one of the main predictors of… Read more »

Occupancy Rates in Rural and Urban Hospitals: Value and Limitations in Use as a Measure of Surge Capacity

As policymakers deal with the effects of the novel coronavirus pandemic on the hospital infrastructure, understanding the differences in occupancy rates between rural and urban hospitals may help state and local officials in their planning for dealing with surge demand. Historically, rural hospitals have reported lower occupancy rates than urban hospitals and more licensed than… Read more »

Rural Health 101: An Overview of Rural Health Research

The PDF is a shorter primer on rural health for researchers in health and health services. It provides information on: a spectrum of rural definitions and the importance of selecting a standardized definition; rural mortality; and some common challenges with rural data analysis.

Delineating Rural Areas in the United States

One challenge in addressing rural-urban disparities is the lack of a common definition. Multiple federal systems exist using different levels of geography (e.g, county versus census tract). Multiple definitions of the “rurality” of a place or population means that the degree of the disparity may vary (or even switch direction) depending on the definition. The… Read more »

Risk Factors and Potentially Preventable Deaths in Rural Communities

As the rural-urban mortality gap continues to expand, researchers have been exploring the reasons why the gap exists and how some of the deaths might be prevented. Studies show a higher percentage of rural residents die from preventable causes, specifically heart disease, cancer, unintentional injury, chronic lower respiratory disease,1 and stroke than urban residents.2,3 Researchers… Read more »

A Rural Urban Comparison of the Proposed 2020 Wage Index

On April 23, 2019, the Centers for Medicare & Medicaid Services (CMS) released its annual proposed update for the hospital Inpatient Prospective Payment System for fiscal year 2020 that starts in October 2019.  In the proposed update, CMS recognizes that the current wage index system perpetuates and exacerbates the disparities between high and low wage… Read more »

Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index

The Medicare hospital Inpatient Prospective Payment System (IPPS) is designed to pay hospitals for services provided to Medicare beneficiaries based on a national standardized amount adjusted for the patient’s condition and related treatment. Further, Social Security Act Section 1886(d)(3)(E) requires that the standardized amount be adjusted for differences in hospital wage levels among labor markets,… Read more »

2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals

The Medicare hospital Inpatient Prospective Payment System (IPPS) is designed to pay hospitals for services provided to Medicare beneficiaries based on a national standardized amount adjusted for the patient’s condition and related treatment. Further, Social Security Act Section 1886(d)(3)(E) requires that the standardized amount be adjusted for differences in hospital wage levels among labor markets,… Read more »