Contracting With Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators overview This document summarizes the experience of CAH administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms… Read more »
Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals executive summary This study examines trends in the delivery of skilled nursing facility (SNF) services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on critical access hospitals (CAHs). In… Read more »
Rural Hospitals’ Experience with the 340B Drug Pricing Program
Overview The 340B Drug Pricing Program (hereafter referred to as the 340B program) enables certain types of safety net organizations to obtain deep discounts on medications delivered during outpatient care, at prices below what is typically offered to Medicaid agencies. Prior to the 2003 Medicare Modernization Act (MMA), few rural hospitals qualified for the 340B… Read more »
One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D
Background The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established funding to allow up to 43 million Medicare beneficiaries to enroll in plans providing comprehensive outpatient prescription drug coverage, beginning in January 2006. The new Medicare Part D program changed the means by which Medicare beneficiaries purchase prescription drugs, which affects the… Read more »
Rural-Urban Differences in Characteristics of Local EMS Agencies
BACKGROUND This Findings Brief describes the general characteristics of local rural EMS agencies and important ways that they differ from the characteristics of agencies located in urban areas. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-07. KEY FINDINGS Rural EMS agencies typically serve a smaller population… Read more »
Small Rural Hospitals with Low-Volume Emergency Departments that May Convert to a Rural Emergency Hospital (REH)
In the brief, , the NC Rural Health Research Program examines Critical Access Hospitals (CAHs) and Prospective Payment System (PPS) hospitals with no more than 50 beds in rural areas that are eligible to convert to a Rural Emergency Hospital (REH.) For this study, hospitals with low Emergency Department (ED) volume are considered to be… Read more »
Key Considerations for a Rural Hospital Assessing Conversion to Rural Emergency Hospital
Based on findings from a literature review and consultation with practitioners, the NC Rural Health Research Program developed a conceptual framework and checklist to organize and guide conversations about key considerations for conversion a Rural Emergency Hospital. The brief, , describes the methods and the framework. Conceptual framework. The framework includes considerations across five key… Read more »
Rural Hospitals Have Higher Percentages of Patients with COVID-19 than Urban Hospitals
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. On December 15, 2020, the U.S. DHHS published weekly data on each individual hospital’s status on key indicators for acute management of COVID-19 patients. We analyzed these data to compare the… Read more »
Rural Hospitals with Long‐term Unprofitability
Overview 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… Read more »
Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
Background 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, which the… Read more »
What Characteristics Influence Whether Rural Beneficiaries Receiving Care From Urban Hospitals Return Home for Skilled Nursing Care?
Abstract Purpose: Skilled nursing care (SNC) provides Medicare beneficiaries short-term rehabilitation from an acute event. The purpose of this study is to assess beneficiary, market, and hospital factors associated with beneficiaries receiving care near home. Methods: The population includes Medicare beneficiaries who live in a rural area and received acute care from an urban facility in 2013…. Read more »
What Should Be the Scope of a Health Network’s Obligation to Respond After a Hospital Closure?
Abstract As rural hospital closures become more common, many patients are left without sources of care, raising ethical questions about hospitals’ and clinicians’ responsibilities during and after closures. In many cases, such as the one considered in this article, hospitals have been economic hubs of some communities for many years and are obliged to consider… Read more »
The Sufficiency of Health Care Professional Supply in Rural North Carolina
Abstract For most health professions, rural North Carolina has lower relative supply than urban parts of the state. Although there are plenty of innovative models addressing this disparity, a holistic approach is necessary if we want to effect real change.
Predicting Financial Distress and Closure in Rural Hospitals
Abstract Purpose: Annual rates of rural hospital closure have been increasing since 2010, and hospitals that close have poor financial performance relative to those that remain open. This study develops and validates a latent index of financial distress to forecast the probability of financial distress and closure within 2 years for rural hospitals. Methods: Hospital and community… Read more »
How Would Rural Hospitals Be Affected by Loss of the Affordable Care Act’s Medicare Low-Volume Hospital Adjustment?
Abstract Purpose: The low-volume hospital (LVH) payment adjustment established in the Patient Protection and Affordable Care Act (ACA) of 2010 is scheduled to sunset on October 1, 2017. The purpose of this analysis was: (1) to estimate the effect of the ACA LVH adjustment on qualifying hospitals’ profitability margins; and (2) to examine hospital and market… Read more »