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 »
Rural Hospitalizations for COVID-19: A Snapshot for December10, 2020
Since the onset of COVID-19, public health leaders have emphasized reducing the rate of viral spread to ensure that hospitals did not become overwhelmed. The U.S. DHHS publishes weekly data on individual hospital’s indicators for management of COVID-19 patients. The NC Rural Health Research Program analyzed these data to compare the percent of hospitalized patients… Read more »
Rural Hospitals Have Higher Percentages of Patients with COVID-19 than Urban Hospitals (October-December 2020)
Since the onset of COVID-19, public health leaders have emphasized reducing the rate of viral spread to ensure that hospitals did not become overwhelmed. The U.S. DHHS publishes weekly data on individual hospital’s indicators for management of COVID-19 patients. The NC Rural Health Research Program analyzed these data to compare the percent of hospitalized patients… Read more »
CMS Hierarchical Condition Category (HCC) 2014 Risk Scores Are Lower for Rural Medicare Beneficiaries than for Urban Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) use Hierarchical Condition Categories (HCC) and demographic information to calculate beneficiary risk scores, which predict expected Medicare spending by beneficiaries. CMS-HCC risk scores may be underestimating expected health care utilization among rural beneficiaries compared to urban beneficiaries. Incorrect estimation of expected health care utilization can lead to… Read more »
Association of CMS‐HCC Risk Scores with Health Care Utilization among Rural and Urban Medicare Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) use Hierarchical Condition Categories (HCC) and demographic information to calculate beneficiary risk scores, which predict expected Medicare spending by beneficiaries. CMS-HCC risk scores may be underestimating expected health care utilization among rural beneficiaries compared to urban beneficiaries. Incorrect estimation of expected health care utilization can lead to… Read more »
Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
For decades, health care has been shifting from inpatient care to outpatient care. As hospitals reduce inpatient care, revenue from outpatient care becomes critically important. In most rural hospitals, the greatest portion of net patient revenue is from outpatient services versus urban hospitals that have, on average, about half from outpatient and half from inpatient… Read more »
A Comparison of Rural and Urban Specialty Hospitals
Specialty hospitals are important providers in both urban and rural areas. However, they are not evenly distributed across these areas. The NC Rural Health Research Program in the brief, , addresses three types of specialty hospitals: Long Term Acute Care Hospitals (LTCHs), Inpatient Psychiatric Facilities (IPFs), and Inpatient Rehabilitation Facilities (IRFs). We compared urban and… Read more »