Background One of the central and most visible components of the Affordable Care Act is the Health Insurance Marketplace (known as the Federally Facilitated Marketplace when administered by the federal government), which provides consumers a method to enroll in non-group health insurance coverage. It is the only enrollment method where qualifying individuals can get premium-… Read more »
Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward?
Background Hospital mergers and acquisitions1 are changing the face of health care in both rural and urban communities across the country. Declining reimbursement levels, increased capital needs, a weak economy and easier access to credit have all contributed to a level of mergers not seen in more than a decade.2,3 Studies from the 1980s and… Read more »
Health Insurance Coverage in North Carolina: The Rural-Urban Uninsured Gap
Background One of the primary drivers of health is being covered by health insurance. A review of available literature found a wide range of effects of health insurance, including a 20% relative reduction in mortality among previously uninsured people who become eligible for Medicare [1]. Many factors lead to lower rates of health insurance coverage… Read more »
Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients
Background Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are important primary care providers in rural communities. These safety net programs are similar in that they both are located in areas with inadequate access to health care services. In addition, RHCs and FQHCs are federally-designated entities reimbursed by Medicare based on all-inclusive… Read more »
Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
Background Swing beds are one option for post-acute skilled care in rural communities, and they are more likely to be the only option in the most rural areas.1 These transitional care beds allow a patient to be discharged from an acute hospital stay but remain in the hospital for skilled after care. Skilled nursing facilities… Read more »
Using “Plasticity” to Model a Community’s Need for Health Care Services
Researchers at the University of North Carolina’s Cecil G. Sheps Center for Health Services Research have introduced a new way of thinking about how to determine physician supply and medical specialty configurations in order to meet health care needs. In an article published in Academic Medicine (November 2013), the authors explore how the concept of “plasticity” could… Read more »
Rural/Urban Differences in Inpatient Related Costs and Use Among Medicare Beneficiaries
Background A recent Institute of Medicine report suggests that care received after a hospitalization is a primary driver of regional variation in health care costs in the United States. 1 While evidence suggests that health care utilization varies by rural setting, 2 it is unknown how pre- and post-hospital admission costs and use differ between… Read more »
Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close
Background Policy makers have recently focused on the relative locations of Critical Access Hospitals (CAHs), whether changes are needed to current mileage requirements and the impact changes would have on how Medicare pays for services in smaller, low-volume hospitals. CAHs can have no more than 25 beds and must be 1) at least 15 miles… Read more »
Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement
About this project This brief is part of a series of three briefs providing information for policy makers and stakeholders as policy changes for Critical Access Hospitals (CAHs) are considered. This one focuses on the projected financial impact that a reduction in Medicare payments might have on CAHs. The others focus on the potential increases… Read more »
Predictors of hospital bypass for rural residents seeking common elective surgery
Abstract Background Surgical bypass occurs when rural residents receive surgical care at a nonlocal hospital. Given limited knowledge of current bypass rates, we evaluated rates and predictors of bypass for common procedures. Methods We used 2014 to 2016 all-payer claims data from the Healthcare Cost and Utilization Project State Inpatient Databases to study rural patients… Read more »
Achieving benchmark financial performance in CAHs: lessons from high performers
Abstract CEOs and CFOs of 19 critical access hospitals (CAHs) that achieved benchmark financial performance over three years were interviewed regarding the strategies they use. The interviews identified nine success factors for exemplary financial performance that were common to all or most of the 19 hospitals. All of the participating executives agreed that other CAHs… Read more »
Adoption and perceived effectiveness of financial improvement strategies in critical access hospitals
Purpose: To ascertain the use and perceived success of strategies to improve the financial performance of Critical Access Hospitals (CAHs). Methods: Information about the use and perceived effectiveness of 44 specific strategies to improve financial performance was collected from an online survey of 291 CAH Chief Executive Officers and Chief Financial Officers. Responses were merged with financial… Read more »
Communities Served by Rural Medicare Dependent Hospitals
Overview The Medicare Dependent Hospital (MDH) program provides enhanced reimbursement to support rural health infrastructure and to support small rural hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges. This greater dependence on Medicare may make these hospitals more financially vulnerable to prospective payment, and the MDH designation is… Read more »
Why Use Swing Beds? Conversations with Hospital Administrators and Staff
Overview Swing beds are one option for post-acute skilled care in rural communities; they are more likely to be the only option in the most rural areas.1 How are they being used? What do they mean for the hospital and the community? We explored these issues with hospital staff to inform our analytic studies on… Read more »
Flux in Loan Repayment Programs for Healthcare Professionals With States’ Budget Cuts and National Health Service Corps Budget Increases
Overview Repaying education loans is the most popular incentive now used to attract early-career healthcare practitioners into rural and other shortage areas. The federal National Health Service Corps Loan Repayment Program (NHSC LRP), by far the largest loan repayment program for health professionals, recently doubled in size with increased funding from the American Recovery and… Read more »