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 number of projects that are under investigation:
Current Projects
- Decline in inpatient volume at rural hospitals
The purpose of this study is to compare the services offered by rural hospitals (to urban hospitals) over time (2009-2017) and among rural hospitals of different size, region, rurality, and payment type. - Change in service provision at rural hospitals
The purpose of this study is to compare the services offered by rural hospitals (to urban hospitals) over time (2009-2017) and among rural hospitals of different size, region, rurality, and payment type. - How Medicare payment standardization affects the perceived “cost” of post-acute care provided in Critical Access Hospital swing beds
To facilitate comparisons of Medicare spending within or across settings and geographic areas, Medicare-allowed charges are adjusted for geographic cost differences and payments that support larger Medicare program goals. This study aims to identify the effects of the payment standardization method on the perceived “cost” of post-acute care provided in Critical Access Hospital swing beds. - 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. - 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. - 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. - 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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