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 »

Differences in Measurement of Operating Margin: An Update

Operating Margin - Distribution

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 »

Rural Population Health in the United States: A Chartbook

This presents variations in U.S. population health in rural areas across all Census regions and states. Where the data allow, we also present rural population health findings stratified by sex, race, and ethnicity. This chartbook presents a full range of data across multiple geographic areas. When looking at data like these it is important to… Read more »

Characteristics of Rural Hospitals Eligible for Conversion to Rural Emergency Hospitals and Three Rural Hospitals Considering Conversion

This brief is a follow-up to the 2021 NC Rural Health Research Program’s brief, .  The new brief, , presents updated data for REH-eligible hospitals, compares several financial and operational measures of three rural hospitals that are on public record as having expressed interest in REH conversion to the all REH-eligible hospitals, and discusses what… Read more »

Factors Predicting Swing Bed Versus Skilled Nursing Facility Use

In the brief, , the NC Rural Health Research Program, examines differences between patients discharged to swing beds versus SNFs, stratifying by admitting hospital type (i.e., rural CAH versus rural PPS hospital). Identification of key differences between patients discharged to swing beds versus SNFs can help inform further discourse on this financially and clinically important… Read more »

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 »

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 »