North Carolina Rural Health Research and Policy Analysis Center

The North Carolina Rural Health Research and Policy Analysis Center extends and expands the work of the North Carolina Rural Health Research Program at UNC-CH. This center, one of seven federally-designated rural health research centers funded by the Federal Office of Rural Health Policy, primarily focuses on the federal insurance programs Medicare and Medicaid, and their effect on rural populations and providers. In addition, faculty and professionals working with the Center respond to short-term queries using the unique availability of multiple national and special datasets to investigate key rural health policy issues. While the Center is designed for flexibility in order to allow resources the ability to address additional topics as necessary, we currently have seven projects that are under investigation:

Current Projects

  • A Chartbook of Rural Population Health
    This project creates a chartbook of population health for rural areas. This resource is designed to allow policymakers and practitioners to better understand rural-urban disparities across a wide variety of population health indicators.
  • Ambulatory Care Provided to Rural Medicare Beneficiaries by Rural and Urban FQHCs, RHCs, and Acute Hospitals
    This project will characterize the volume, cost, and case mix of ambulatory care provided to rural Medicare beneficiaries by rural and urban federally qualified health centers (FQHCs), rural health clinics (RHCs), and acute hospitals. The study will include urban-rural and geographic comparisons of volume, cost, and case mix by provider type.
  • Do Rural Communities Have a Higher Rate of Avoidable Deaths?
    Based on some estimates, roughly half of deaths are avoidable in the sense they stem from risky behavior. What is less well known is the degree to which there is a rural-urban disparity in this rate.
  • Hospital Readmission Following Care in a Swing Bed
    This study builds on our portfolio of swing bed work by examining the rate of hospital readmission for patients who receive post-acute care in swing beds compared to skilled nursing facilities and will inform the discussion on use, cost, and benefit of swing bed care.
  • How Do Costs for Rural Medicare Beneficiaries Using Swing Beds Compare to Those Using Skilled Nursing Facilities?
    This study will estimate and compare total Medicare expenditures for episodes of care that include post-acute stays in either swing beds or skilled nursing facilities (SNFs). Results will inform 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.
  • How Rural Communities Respond and Recover after a Hospital Closure
    Current rates of rural hospital closures are the highest seen in the last few decades. What can we learn from the experiences of communities experiencing hospital closures?
  • Rural-Urban Variation in CMS Hierarchical Condition Categories (HCC) Risk Scores
    CMS uses hierarchical condition categories (HCC) to risk-adjust Medicare beneficiaries for multiple conditions. This adjustment is used for multiple programs, but it’s unknown whether the adjustment works similarly in rural and urban areas. This project investigates the distribution of beneficiaries’ and providers’ HCC risk scores across rurality.
  • Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
    Under current reimbursement methods, the Medicare program pays more per day for a skilled nursing patient in a critical access hospital swing bed than it does for a similar patient who is in a skilled nursing facility. This study will assess the financial impact of changing CAH swing bed reimbursement from the current cost-based system to the skilled nursing facility prospective payment system.
  • Patterns of inpatient care-seeking by rural residents
    The degree to which a community uses a hospital other than its local rural hospital – the bypass rate – is negatively correlated with the financial sustainability of the hospital. In an era of increasing financial pressure, an understanding of inpatient care-seeking behavior by rural residents can provide insight into drivers of bypass rates.
  • Changes in care-seeking after rural hospitals merge
    The number of mergers involving rural hospitals has recently increased. Evidence on the effect of care-seeking among those served by a merging rural hospital is mixed; this project seeks to understand how mergers affect the inpatient care-seeking of markets served by merging hospitals.
  • 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 like sequestration, 340B payment reductions, declining patient volumes, and increases in the under and uninsured. This project will distribute a web-based survey to all rural hospitals to assess the opinions of their executives about how they will respond to current and long-term challenges.


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