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 »
Urban Hospitals with a High Percentage of Inpatient Days for Rural Patients
To understand the variability in hospitals that qualify for special Medicare payment classifications, it is important to analyze characteristics of urban hospitals, particularly those with substantial rural patient populations. The NC Rural Health Research Program’s brief, , evaluates differences in urban hospitals with high and low percentages of rural inpatient days using several indicators. These… Read more »
Changes in Care‐Seeking after Rural Hospitals Merge
Rural hospital mergers have increased significantly since 2010. Enhanced financial performance and improved quality are often cited as benefits, but hospital mergers can also lead to changes in the services provided by acquired hospitals. This brief estimates the use of inpatient services delivered by acquired rural hospitals following a merger. The NC Rural Health… Read more »
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 »
Estimated Reduction in CAH Profitability from Loss of Cost‐Based Reimbursement for Swing Beds
Over the past several years, a few reports have suggested Medicare could reduce costs by changing swing bed reimbursement from cost-based to the Skilled Nursing Facility Prospective Payment System (SNF PPS). Rural communities and CAHs are concerned about the proposed change from cost-based reimbursement to the SNF PPS because it would reduce the amount of… 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 »