Publications

For publications issued between 1989-2011. See our Publication Archives. This webpage is being reviewed and is currently offline). We apologize for any inconvenience.

Publications 2012-Present This webpage is being reviewed and is currently offline. We apologize for any inconvenience.

2025

Malone TL, Pink GH, Holmes GM. A new model-based approach for estimating rural hospital markets. J Rural Health. 2025 Jan;41(1):e12924. doi: 10.1111/jrh.12924. PMID: 39853652.

2024

Friedman H, Thompson KW, Wang L, Holmes M. [Download not found] NC Rural Health Research Program, UNC Sheps Center, December 2024. Not currently available (March 13, 2025)
Thompson KW, Friedman H, Wang L, Holmes M. [Download not found] NC Rural Health Research Program, UNC Sheps Center, December 2024. Not currently available (March 13, 2025)
Kim YH, Perry JR, Thompson KW, Pink GH. [Download not found] NC Rural Health Research Program, UNC Sheps Center, October 2024. Not currently available (March 13, 2025)
Malone TL, Pink GH, Holmes GM. An updated model of rural hospital financial distress. J Rural Health. 2024 Oct 3. doi: 10.1111/jrh.12882. Epub ahead of print. PMID: 39363558.
Somanchi H, Perry k, Thompson K, Pink G. News Media Coverage of Rural Hospital Closures and the Causes NC Rural Health Research Program, UNC Sheps Center, October 2024.
Planey A. Characteristics of Communities Affected by Critical Access Hospital Mergers. Flex Monitoring Team. Findings Brief, September 2024. Not currently available (March 13, 2025)
Dai A, Malone T. Who Owns Rural Hospitals? A Comparison of Findings across Four National Datasets . NC Rural Health Research Program, UNC Sheps Center, September 2024.
Keesee EC, Gurzenda SB, Thompson KW, Pink GH. The Low-Volume Hospital Adjustment Before and During COVID-19 NC Rural Health Research Program. UNC Sheps Center. July 2024.
Malone TL, Pink GH, Thompson KW, Holmes GM. Using the Updated Financial Distress Index to Describe Relative Risk of Hospital Financial Distress NC Rural Health Research Program. UNC Sheps Center. April 2024.
Malavika Srinivasan S, Thompson K, Pink G. 2018-23 Profitability of Rural Hospitals with by System Affiliation and Ownership NC Rural Health Research Program. UNC Sheps Center. June 2024.
Malavika Srinivasan S, Thompson K, Pink G. 2018‐23 Profitability of Rural and Urban Hospitals by Medicare Payment Designation NC Rural Health Research Program. UNC Sheps Center. June 2024.
Malavika Srinivasan S, Kim J, Thompson K, Pink G. 2018-23 Profitability of Rural Hospitals by with and without Rural Health Clinics and Long-Term Care NC Rural Health Research Program. UNC Sheps Center. June 2024.
Ma J, Gurzenda S, Reiter K, Pink G. Differences in Measurement of Operating Margin-An Update . NC Rural Health Research Program. UNC Sheps Center. May 2024.
Keesee EC, Gurzenda SB, Thompson KW, Pink GH. COVID-19 Affected Rural and Urban Hospital Uncompensated Care NC Rural Health Research Program. UNC Sheps Center. Infographic. March 2024.
Keesee EC, Gurzenda SB, Thompson KW, Pink GH. A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership NC Rural Health Research Program. UNC Sheps Center. January 2024. FB 189.

2023

Pitcher A, Zhang R, Gurzenda S, Pink GH, Reiter K. A Comparison of Non-Operating Revenue between Rural and Urban Hospitals. Flex Monitoring Team. Findings Brief, November 2023.
Keesee E, Gurzenda S, Thompson K, Pink GH. Uncompensated Care is Highest for Rural Hospitals, Particularly in Non-Expansion States. Med Care Res Rev. 2023 Nov 18:10775587231211366. doi: 10.1177/10775587231211366. Epub ahead of print. PMID: 37978844.
Pitcher A, Zhang R, Gurzenda S, Pink G, Reiter K. Non-operating revenue is an important source of funding for rural hospitals, especially those that are government-owned. J Rural Health. 2023 Sep 29. doi: 10.1111/jrh.12797. Epub ahead of print. PMID: 37771305.
Malone TL, Gurzenda S, Reiter KL, Pink GH, Greenwood-Ericksen MB. Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation. Ann Emerg Med. 2023 Sep 22:S0196-0644(23)01189-7. doi: 10.1016/j.annemergmed.2023.08.492. Epub ahead of print. PMID: 37747385.
Reiter KL, Gurzenda S, Thompson K, Holmes GM, Pink GH. Supporting Critical Access Hospital operational and financial improvement through the Medicare Rural Hospital Flexibility Program. J Rural Health. 2023 Sep;39(4):710-715. doi: 10.1111/jrh.12762. Epub 2023 Apr 21. PMID: 37085885.
McFadyen L. Pink G, Gurzenda S, Thompson KW, Reiter, KL. The Impact of COVID-19 Funding on Profitability of Critical Access Hospitals. Flex Monitoring Team. Findings Brief, June 2023.
McFadyen L. Pink G, Gurzenda S, Thompson KW, Reiter, KL. The Impact of COVID-19 on CAH Financial Indicators. Flex Monitoring Team. Findings Brief, June 2023.
Randolph R; Holmes R; Thompson K; Thomas S; Perry J; John R; Gurzenda S; Ricks K; Maxwell A. Rural Population Health Chartbook. February 2023. Not currently available (March 13, 2025)

2022

Pink G, Gurzenda S, Thompson K, Howard HA. Characteristics of Rural Hospitals Eligible for Conversion to Rural Emergency Hospitals and Three Rural Hospitals Considering Conversion . Rural Health Research Program. UNC Sheps Center. December 2022. FB 188. Not currently available (March 13, 2025)
Malone TL, Holmes GM. Factors Predicting Swing Bed Versus Skilled Nursing Facility Use . NC Rural Health Research Program. UNC Sheps Center. November 2022. FB 187. Not currently available (March 13, 2025)
Reiter KL, Grant TJ, Gurzenda S, Budko A, Greenwood-Ericksen M, Pink GH. Key Considerations for a Rural Hospital Assessing Conversion to Rural Emergency Hospital . NC Rural Health Research Program. UNC Sheps Center. October, 2022. FB 186. Not currently available (March 13, 2025)
Greenwood-Ericksen M, Grant TJ, Gurzenda S, Malone T, Budko A, Reiter KL, Pink GH. Small Rural Hospitals with Low Volume ED that May Convert to a Rural Emergency Hospital . NC Rural Health Research Program. UNC Sheps Center. October, 2022. FB 185.
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.
Randall J; Knocke K; Thomas S; Thompson K; Holmes M; Pink G. Changes in the Provision of Health Care Services by Rural Critical Access Hospitals and Prospective Payment System Hospitals in 2009 compared to 2017 . NC Rural Health Research Program. UNC Sheps Center. August 2022. FB 184.
Pink GH, Howard, HA. Types of Rural and Urban Hospitals and Counties Where They Are Located . NC Rural Health Research Program. UNC Sheps Center. July 2022. FB 183.
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.
John R, Malone TL, Knocke K, Pink GH. Trends in Revenue Sources among Rural Hospitals. NC Rural Health Research Program. UNC Sheps Center. May 2022. FB 182. Not currently available (March 13, 2025)
Malone TL, Knocke K, Pink GH, Thompson KW, Randolph RK, Holmes M. Association between Rural Hospital Service Changes and Community Demographics . NC Rural Health Research Program. UNC Sheps Center. May 2022. FB 181. Not currently available (March 13, 2025)
Khushalani JS, Holmes M, Song S, Arifkhanova A, Randolph R, Thomas S, Hall DM. Impact of rural hospital closures on hospitalizations and associated outcomes for ambulatory and emergency care sensitive conditions. J Rural Health. 2022 May 5. doi: 10.1111/jrh.12671. Epub ahead of print. PMID: 35513356.
Zhang Y, Malone TL, et al. Predictors of Hospital Choice among Rural Patients Seeking Elective Surgery–A Scoping Review . NC Rural Health Research Program. UNC Sheps Center. April 2022. FB 180. Not currently available (March 13, 2025)
Malone, TL, Planey AM, Bozovich LB, Thompson KW, Pink GH, Holmes GM. The economic effects of rural hospital closures, Health Services Research, March 21, 2022. https://doi.org/10.1111/1475-6773.13965.
Pink GH, Gurzenda S, Holmes, GM. Rural Hospital Profitability during the Global COVID-19 Pandemic Requires Careful Interpretation . NC Rural Health Research Program. UNC Sheps Center. March 2022. FB 179.
Osgood AS, Pink G. Rural Hospitals that Closed between 2017‐20: Profitability and Liquidity in the Year Before Closure . NC Rural Health Research Program. UNC Sheps Center. January 2022. FB 177.

2021

Bozovich LB, John R, Thompson K, Pink G. 2021 CMS Hospital Quality Star Ratings of Rural Hospitals . NC Rural Health Research Program. UNC Sheps Center. September 2021. FB 176. Not currently available (March 13, 2025)
Sana P, Pink G. Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas . NC Rural Health Research Program. UNC Sheps Center. September 2021. FB 175.
Pink G, Thompson K, Howard HA, Holmes M. How Many Hospitals Might Convert to a Rural Emergency Hospital . NC Rural Health Research Program, UNC Sheps Center. July 2021.FB 174.
Malone T, Pink G, Holmes, M. Decline in Inpatient Volume at Rural Hospitals. The Journal of Rural Health, Spring 2021;37(2):347-352. https://doi.org/10.1111/jrh.12553.
Knocke K, Pink G, Thompson K, Randolph R, Holmes M. Changes in Provision of Selected Services by Rural and Urban Hospitals between 2009 and 2017. NC Rural Health Research Program, UNC Sheps Center. April 2021. FB 173. Not currently available (March 13, 2025)
Malone T, Kirk D, Reiter K. The Effect of Medicare Payment Standardization Methods on the Perceived Cost of Post-Acute Swing Bed Care in Critical Access Hospitals . NC Rural Health Research Program, UNC Sheps Center. March 2021. FB 172. Not currently available (March 13, 2025)

2020

Thomas ST, Thompson KW, Knocke K, Pink G. Health System Challenges for Critical Access Hospitals: Findings from a National Survey of CAH Executives. NC Rural Health Research Program, UNC Sheps Center. December 2020. FB 171.
Thomas ST, Thompson KW, Knocke K, Pink G. Alternatives to Hospital Closure: Findings from a National Survey of CAH Executives. NC Rural Health Research Program, UNC Sheps Center. December 2020. FB 170.
Rural-Hospitals-Have-Higher-Percentages-COVID-19-Patients.pdf . NC Rural Health Research Program, UNC Sheps Center. December 2020, NC Infographic. Not currently available (March 13, 2025)
Rural-Hospitalizations-for-COVID-19_Snapshot-on-December-10-2020.pdf . NC Rural Health Research Program, UNC Sheps Center. December 2020, NC Infographic. Not currently available (March 13, 2025)
Malone T, Kirk D, Randolph R, Reiter K. CMS Hierarchical Condition Category (HCC) 2014 Risk Scores Are Lower for Rural Medicare Beneficiaries than for Urban Beneficiaries . NC Rural Health Research Program, UNC Sheps Center. December 2020. FB 169. Not currently available (March 13, 2025)
Malone T, Kirk D, Randolph R, Reiter K. Association of CMS‐HCC Risk Scores with Health Care Utilization among Rural and Urban Medicare Beneficiaries . NC Rural Health Research Program, UNC Sheps Center. December 2020. FB 168. Not currently available (March 13, 2025)
Pink G, Osgood A, Sana P. A Comparison of Rural and Urban Specialty Hospitals . NC Rural Health Research Program. UNC Sheps Center. October 2020. FB 167.
John R, Knocke K, Pink G. Urban Hospitals with a High Percentage of Inpatient Days for Rural Patients . NC Rural Health Research Program. UNC Sheps Center. September 2020. FB 166.
Three Levels of Rural Definition at FORHP MAP, August 2020 Not currently available (March 13, 2025)
Malone T, Kirk D, Randolph R, Pink G Holmes, M. Changes in Care Seeking after Rural Hospitals Merge. NC Rural Health Research Program. July 2020. FB 165.
Broussard DM & Reiter KL. Estimated Reduction in CAH Profitability from Loss of Cost-Based Reimbursement for Swing Beds . NC Rural Health Research Program. May 2020. FB 164.
Most Rural Hospitals Have Little Cash Going into COVID . NC Rural Health Research Program. May 2020. Infographic.
Malone TL, Holmes GM. Patterns of Hospital Bypass and Inpatient Care‐Seeking by Rural Residents . NC Rural Health Research Program. April 2020. FB 163. Not currently available (March 13, 2025)
Maxwell AW, Howard HA, Pink GH. Rural Hospitals with Long‐term Unprofitability . NC Rural Health Research Program. April 2020. FB 162.
Maxwell AW, Howard HA, Pink GH. Geographic Variation in the 2018 Profitability of Urban and Rural Hospitals . NC Rural Health Research Program. April 2020. FB 161. Not currently available (March 13, 2025)
Maxwell AW, Howard HA, Pink GH. 2016‐18 Profitability of Urban and Rural Hospitals by Medicare Payment Classification . NC Rural Health Research Program. April 2020. FB 160.
Maxwell AW, Howard HA, Pink GH. Understanding the Broader Context of Rural Hospitals and Profitability . NC Rural Health Research Program. April 2020. FB 159.
Occupancy Rates in Rural and Urban Hospitals: Value and Limitations in Use as a Measure of Surge Capacity . March 2020. NC Rural Health Research Program. FB 158. Not currently available (March 13, 2025)
Holmes, GM. Rural Health 101–An Overview of Rural Health Research . (February 2020). Presentation. Not currently available (March 13, 2025)

2019

Randolph RK, Thompson KW, Thomas SR, Holmes, GM. Delineating Rural Areas in the US (November 2019). Poster. Not currently available (March 13, 2025)
Holmes, GM, Thompson KW. Risk Factors and Potentially Preventable Deaths in Rural Communities . (October 2019). FB. 157.
Holmes, GM, Thompson KW, Pink GH. A Rural Urban Comparison of the Proposed 2020 Wage Index . (June 2019). FB 156.
Schulte AR, Pink GH, Holmes GM, Denise K. Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries . Working paper (June 2019). Not currently available (March 13, 2025)
Thompson KW, Howard AH, Pink GH. Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index (May 2019). FB 155.
Pink GH, Thompson KW, Howard AH. 2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals (May 2019). FB 154. Not currently available (March 13, 2025)
Thomas SR, Pink GH, Reiter KL. Trends in Risk of Financial Distress among Rural Hospitals from 2015 to 2019 (April 2019). FB 153.
Thomas SR, Pink GH, Reiter KL. Geographic Variation in the 2019 Risk of Financial Distress among Rural Hospitals (April 2019). FB 152. Not currently available (March 13, 2025)

2018

Holmes M. The Sufficiency of Health Care Professional Supply in Rural North Carolina. North Carolina Medical Journal, 2018;79(6):372-377.
Randolph R. Health Insurance Coverage in North Carolina: The Rural-Urban Uninsured Gap. Running the Numbers, North Carolina Medical Journal, 2018;79(6):397-401.
Rural Hospital Mergers from 2005 through 2016 (August 2018). Williams JD, Thomas SR, Howard HA, Pink GH. FB 149.
Average Beneficiary CMS Hierarchical Condition Category (HCC) Risk Scores for Rural and Urban Providers (July 2018). Hoffman AF, Reiter KL, Randolph, RK. FB 148. Not currently available (March 13, 2025)
Geographic Variation in Uncompensated Care between Rural Hospitals and Urban Hospitals (June 2018). Garcia KG, Thompson K, Howard H, Pink G. FB 147.
NC Rural Health Research Program Senate Finance Testimony on Rural Hospital Closures: May 24, 2018. Not currently available (March 13, 2025)
Market Characteristics Associated with Rural Hospitals’ Provision of Post-Acute Care (April 2018). Hoffman A, Randolph R, Schulte A, Pink G. FB 146.
Rural and Urban Provider Market Share of Inpatient Post-Acute Care Services Provided to Rural Medicare Beneficiaries (April 2018). Schulte A, Kirk D, Randolph R, Pink G. FB 145.
Geographic Variation in 2016 Profitability of Urban and Rural Hospitals (March 2018). Pink G, Thompson K, Howard H, Holmes M. FB 144. (Revised May 21, 2018)
Range Matters: Rural Averages Can Conceal Important Information (January 2018). Clawar M, Thompson K, Pink G. FB 143.
Access to Care: Populations in Counties with No FQHC, RHC, or Acute Care Hospital (January 2018). Clawar M, Randolph R, Thompson K, Pink G. FB 142.

2017

Characteristics of Communities Served by Hospitals at High Risk of Financial Distress (December 2017). Richman EC, Pink, GH. FB 141. Not currently available (March 13, 2025)
Differences in Community Characteristics of Sole Community Hospitals (November 2017). Thomas SR, Holmes GM, Pink GH. FB 140. Not currently available (March 13, 2025)
Rural-Urban Variations in Medicare Live Discharge Patterns from Hospice, 2012-2013 (September 2017). Dolin R, Kirk D, Holmes GM. FB 139.
Regional Differences in Rural and Urban Mortality Trends (August 2017). Hoffman A, Holmes GM. FB 138.
Number of Rural and Urban Hospitals in the U.S. (August 2017).
GM Holmes, BG Kaufman and GH Pink. Predicting Financial Distress in Rural Hospitals, Journal of Rural Health, Summer 2017;33(3):239-249.
The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals (July 2017). Schulte A, Howard HA, Pink, GH. FB 137.
CMS Hospital Quality Star Rating: for 762 Rural Hospitals, No Stars Is the Problem (June 2017). Thompson KT, Randolph RK, Reiter KL, Pink GH, Holmes GM. FB 136.
Rural Health Snapshot 2017 (May 2017).
RG Whitaker, GM Holmes, and GH Pink. Has the Affordable Care Act’s Medicare Low Volume Hospital Adjustment Improved the Financial Performance of Qualifying Rural Hospitals? Journal of Rural Health, Spring 2017;33(2):227-233.

2016

Sharita R. Thomas, George M. Holmes, George H. Pink. To What Extent do Community Characteristics Explain Differences in Closure among Financially Distressed Rural Hospitals? Journal of Health Care for the Poor and Underserved Nov 2016 Supplement;(27,4):194-203.
The Financial Importance of the Sole Community Hospital Payment Designation (November 2016) Thomas SR, Randolph R, Holmes GM, Pink GH. FB 135. Not currently available (March 13, 2025)
The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals (October 2016) Whitaker RG, Pink GH, Holmes GM. FB 134.
Trends in Risk of Financial Distress among Rural Hospitals (October 2016) Kaufman BG, Randolph R, Pink G, Holmes M. FB 133.
Kaufman BG, Reiter KL, Pink GH, Holmes GM. Medicaid Expansion Affects Rural and Urban Hospitals Differently. Health Affairs September 2016;35:1665-1672.
Characteristics of Medicaid Beneficiaries Who Use Rural Health Clinics (May 2016) Domino M, Tyree S, Rutledge R, Randolph R, Pink G, Holmes M. FB 132. Not currently available (March 13, 2025)
Identifying Rural Health Clinics in Medicaid Data (May 2016) Domino M, Tyree S, Rutledge R, Holmes M. FB 131.
Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals? (April 2016) Thompson K, Reiter K, Whitaker R, Thomas S. FB 130.
2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification (March 2016) Thomas S, Holmes M, Pink G. FB 128.
Geographic Variation in the Profitability of Urban and Rural Hospitals (March 2016) Thomas S, Pink G, Holmes M. FB 129.
Geographic Variation in Risk of Financial Distress among Rural Hospitals (January 2016) Kaufman B, Rutledge R, Pink G, Holmes M. FB 127.
Prediction of Financial Distress among Rural Hospitals (January 2016) Kaufman B, Pink G, Holmes M. FB 126.
Kaufman BG, Thomas SR, Randolph RK, Perry JR, Thompson KW, Holmes GM, and Pink GH. The rising rate of rural hospital closures. Journal of Rural Health 2016;32(1):35-43.
Location of Critical Access Hospitals (March 2016). Cartographic.