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 »
Profile of Rural Health Clinics: Medicare Payments & Common Diagnoses
Overview In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. With over 3,900 certified sites located across the county, RHCs are an important component of the rural health care infrastructure.1 RHCs receive cost-based reimbursement for core Medicare services, subject to tests of reasonableness…. Read more »
A comparative study of financial data sources for critical access hospitals: audited financial statements, the Medicare cost report, and the Internal Revenue Service form 990
About this article Purpose Medicare cost reports (MCR), Internal Revenue Service form 990s (IRS 990), and audited financial statements (AFS) vary in their content, detail, purpose, timeliness, and certification. The purpose of this study was to compare selected financial data elements and characterize the extent of differences in financial data and ratios across the MCR,… Read more »
Predictors of hospital bypass for rural residents seeking common elective surgery
Y Zhang, TL Malone, CD Scales, and GH Pink. Predictors of hospital bypass for rural residents seeking common elective surgery, Surgery, August 2022. https://doi.org/10.1016/j.surg.2022.06.009.
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals Friedman HR, Holmes GM. Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals. Health Services Research. 2022 Oct;57(5):1029-1034. doi: 10.1111/1475-6773.14017. Epub 2022 Jul 13. PMID: 35773787.
Changes in the Provision of Health Care Services by Rural CAHs and PPS Hospitals from 2009 to 2017
The purpose of this brief is to explore changes in the availability and provision of different health care services among rural CAHs and PPS hospitals in 2009 compared to 2017.
Types of Rural and Urban Hospitals and Counties Where They Are Located
Recognizing that many rural hospitals are the only health care facility in their communities and that their survival is vital to ensure access to health care, Federal policymakers in the 1980s and 1990s created five special payment designations under Medicare: Critical Access Hospital (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), Essential Access Community… Read more »
Policy Analysis Using the Financial Distress Model: Does Medicaid Expansion Affect the Risk of Hospital Financial Distress and Closure?
About this project Lead researcher: Mark Holmes, PhD Project completed: August 2016 The NC RHRC has recently developed a model to predict financial distress in rural hospitals. This study will demonstrate the use of this model to analyze policies affecting rural hospitals. In particular, the purpose of this study is to determine: 1) Are there… Read more »
Association between Rural Hospital Service Changes and Community Demographics
The purpose of the brief, Association between Rural Hospital Service Changes and Community Demographics, was to investigate the association between the proportion of a rural community belonging to an AHRQ-identified priority population and local hospital service changes. Our results suggest that recent trends in service availability are often similar when comparing hospitals in non-metro counties with larger versus smaller priority populations. In aggregate, from 2011-2017, hospitals in non-metro counties generally experienced a net decrease in the availability of obstetric services and skilled nursing services and a net increase in the availability of oncology services, hospital-based outpatient services, orthopedic services, and emergency psychiatric services. Aggregate changes in the availability of home health and chemotherapy were generally smaller in magnitude. These aggregate results are consistent with previous work on rural hospital-based service availability.
Trends in Revenue Sources among Rural Hospitals
Possible issues with existing rural hospital financing models suggest that newer, outpatient-centric payment methods may be more effective in providing financial relief to rural hospitals. In light of this, the NC Rural Health Research Program explores the current financial importance of outpatient care to rural hospitals in the brief, Trends in Revenue Sources among Rural Hospitals.
Specifically, the objective of our study was to estimate changes in outpatient care as a source of revenue for rural hospitals from 2011-2019. Ideally, the results can provide stakeholders and lawmakers with additional support in understanding the contemporary role that outpatient service lines have in rural hospitals, thereby allowing them to develop policies that more effectively support rural health care providers and the communities they serve.
A comparative study of financial data sources for critical access hospitals: audited financial statements, the Medicare cost report, and the Internal Revenue Service form 990
A Comparative Study of Financial Data Sources for Critical Access Hospitals: Audited Financial Statements, the Medicare Cost Report, and the Internal Revenue Service Form 990
Current and Longer Term Challenges of Rural Hospitals: A Survey of Rural Hospital Executives
Rural hospitals are being adversely affected by short-term and long-term challenges related to financial and regulatory burdens such as sequestration, 340B payment reductions, declining patient volumes, and increases in the under and uninsured.
How Do Costs for Rural Medicare Beneficiaries Using Swing Beds Compare to Those Using Skilled Nursing Facilities?
This study estimated and compared total Medicare expenditures for episodes of care that include post-acute stays in either swing beds or skilled nursing facilities (SNFs). Results informed federal and state agencies, rural providers and communities as to how post-acute care in swing bed versus a SNF affects the trajectory of costs and utilization for rural Medicare beneficiaries.
Hospital Readmission Following Care in a Swing Bed
About this project Lead researcher: Mark Holmes, PhD Project funded: September 2012 Project completed: July 2021 Preventable hospital readmissions are a significant problem for patients and insurers. Swing beds are the only post-acute care in many very rural communities but research on the ability of swing bed care to prevent readmission is limited. A better… Read more »