OVERVIEW Since 2005, more than 100 rural hospitals have closed and more are at risk.1,2 Rural hospital closures jeopardize access to emergency services in the affected communities. As communities react to and/or prepare for closures, providers and policy makers seek a viable alternative for emergency services provided in a rural hospital setting. A rural freestanding… Read more »
Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?
Abstract The number of stand-alone rural hospitals has been shrinking as larger health systems target these hospitals for mergers and acquisitions (M and As). However, little research has focused specifically on rural hospital M and A transactions. Using data from Irving Levin Associates’ Healthcare M and A Report and Medicare Cost Reports from 2005 to… Read more »
Uncompensated Care Burden May Mean Financial Vulnerability For Rural Hospitals In States That Did Not Expand Medicaid
Abstract The implementation of the Affordable Care Act has led to a large decrease in the number of uninsured people. Yet uncompensated care will still occur, particularly in states where eligibility for Medicaid is not expanded. We compared rural hospitals in Medicaid expansion and nonexpansion states in terms of the amount of uncompensated care they… Read more »
Estimating Eligibility and Uptake of Federally Facilitated Marketplace Insurance in North Carolina in the Second Open Enrollment Period
Background As the Federally Facilitated Marketplace (FFM) enters its third open enrollment period, focus is shifting toward examining which communities have lower uptake in coverage and how to increase enrollment. In national analysis of the first open enrollment period, Holmes and colleagues found that rural areas had lower rates of plan selections.1 However, these estimates… Read more »
Rural Medicare Beneficiaries Have Fewer Follow-up Visits and Greater Emergency Department Use Postdischarge
Abstract Background: Hospitals are focused on improving postdischarge services for older adults, such as early follow-up care after hospitalization to reduce readmissions and unnecessary emergency department (ED) use. Rural Medicare beneficiaries face many barriers to receiving quality care, but little is known about their postdischarge care and outcomes. We hypothesize that rural Medicare beneficiaries compared with… Read more »
The Effect of Surgery on the Profitability of Rural Hospitals
Abstract OBJECTIVE: The purpose of this research study is to determine the effect of surgery on the profitability of rural hospitals. BACKGROUND: Small rural hospitals are often the sole health care provider in their communities and the only source of care for many people. The provision of surgery in rural hospitals saves the lives… Read more »
Minimum-distance requirements could harm high-performing critical-access hospitals and rural communities
Abstract Since the inception of the Medicare Rural Hospital Flexibility Program in 1997, over 1,300 rural hospitals have converted to critical-access hospitals, which entitles them to Medicare cost-based reimbursement instead of reimbursement based on the hospital prospective payment system (PPS). Several changes to eligibility for critical-access status have recently been proposed. Most of the changes… Read more »
Emergency Department Use in the US-Mexico Border Region and Violence in Mexico: Is There a Relationship?
Abstract Purpose: This study assessed the association between homicide rates in northern Mexico and potentially avoidable use of emergency departments (ED) in the US-Mexico border region. The border region is largely rural and underserved, making the identification and correction of potential barriers to access crucial. Methods: We used secondary data from state inpatient and ED discharge databases… Read more »
Financially fragile rural hospitals: mergers and closures
Abstract Rural hospitals serve as major sources of health care and employment for their communities, but recently they have been under increased financial stress. What are the causes of this stress, and how have hospitals and their communities responded?
A Comparison of Closed Rural Hospitals and Perceived Impact
BACKGROUND From 2010 through 2014, 47 rural hospitals,1 ceased providing inpatient services in 23 states across the country (“closed”2 ). Among the 47 closed hospitals, 26 hospitals no longer provide any health care services (“abandoned”), and 21 continue to provide a mix of health services but no inpatient care (“converted”).3 These closures have affected approximately… Read more »
A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals
Purpose In March 2015, the Office of the Inspector General (OIG) issued a report on Medicare’s expenditures on swing beds in Critical Access Hospitals (“Medicare Could Have Saved Billions At Critical Access Hospitals If Swing Bed Services Were Reimbursed Using The Skilled Nursing Facility Prospective Payment System Rates.” Department of Health and Human Services, Office… Read more »
The 21st Century Rural Hospital: A Chart Book
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Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants?
Background The financial performance of small, rural hospitals has long been a concern to federal and state agencies. Federal law makers have enacted legislation authorizing the Medicare program to develop reimbursement methods that provide higher payments to hospitals that serve rural communities.1 The Medicare Payment Advisory Commission (MedPAC) describes rural hospitals as follows. Critical Access… Read more »
Rural-Urban Differences in Continuity of Care among Medicare Beneficiaries
Background In response to the Affordable Care Act and other reforms in the health care market, new models of care are being tested and implemented across the country. Care and payment models such as patient-centered medical homes, Accountable Care Organizations (ACOs), and bundled payments depend on linkages between different types of health care providers to… Read more »
Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas
The Affordable Care Act provided coverage through the Health Insurance Marketplace to nearly seven million people during the first open enrollment period.1 Yet, research suggests that the enrollment rates for eligible individuals living in rural areas was less than enrollment rates for those living in urban areas.2 That may be due, in part, to specific… Read more »