Publications

2023 Winter 2023 NC RHRP Newsletter. Randolph R; Holmes R; Thompson K; Thomas S; Perry J; John R; Gurzenda S; Ricks K; Maxwell A. Rural Population Health Chartbook. February 2023. 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 181. Fall 2022 NC RHRP Newsletter. Malone TL, Holmes GM. Factors Predicting Swing Bed Versus Skilled Nursing Facility Use. NC Rural Health Research Program. UNC Sheps Center. November 2022. FB 180. 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 179. 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 178. 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 177. 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 176. 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 175. 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 174. 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 173. 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 172. Planey AM, Perry JR, Kent EE, Thomas SR, Friedman H, Randolph RK, Holmes GM. Since 1990, Rural Hospital Closures Have Increasingly Occurred in Counties that Are More Urbanized, Diverse, and Economically Unequal. NC Rural Health Research Program. UNC Sheps Center. March 2022. FB 171. 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 170.	Publication Archives Browse Archives by Type: Findings Briefs Final Reports & Working Papers Articles Other Publications/Reports Cartographic Archives Please note that these papers are intended for reference use only. They may not be copied or distributed without permission of the North Carolina Rural Health Research Program. Our staff are also members of the Flex Monitoring Team, a consortium of three Rural Health Research Centers. Click here to view a list of those publications.
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 169. 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 168. 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. 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 174. 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 173.
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 172. 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 171. Rural-Hospitals-Have-Higher-Percentages-COVID-19-Patients.pdf. NC Rural Health Research Program, UNC Sheps Center. December 2020, NC Infographic. Rural-Hospitalizations-for-COVID-19_Snapshot-on-December-10-2020.pdf. NC Rural Health Research Program, UNC Sheps Center. December 2020, NC Infographic. 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 170. 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 169. 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 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. 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. 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. Holmes, GM. Rural Health 101--An Overview of Rural Health Research. (February 2020). Presentation.
2019
Randolph RK, Thompson KW, Thomas SR, Holmes, GM. Delineating Rural Areas in the US (November 2019). Poster. 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). 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. 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. Thomas SR, Pink GH, Reiter KL. Characteristics of Communities Served by Rural Hospitals Predicted to be at High Risk of Financial Distress in 2019 (April 2019). FB 151. Hoffman AF, Pink GH, Kirk DA, Randolph RK, Holmes GM. What Characteristics Influence Whether Rural Beneficiaries Receiving Care From Urban Hospitals Return Home for Skilled Nursing Care? J Rural Health, 2019 Apr 5. [Epub ahead of print] Holmes GM, Thomas SR. What Should Be the Scope of a Health Network’s Obligation to Respond After a Hospital Closure? AMA Journal of Ethics, March 2019;21(3):215-222. Schulte A, Kirk D, Thompson K, Pink G. Facility-Based Ambulatory Care Provided to Rural Medicare Beneficiaries in 2014: A Chartbook (March 2019). FB 150.
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. 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. PDF 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. Differences in Community Characteristics of Sole Community Hospitals (November 2017). Thomas SR, Holmes GM, Pink GH. FB 140. 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. 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. 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. 2015 Estimated Costs of Rural Freestanding Emergency Departments (November 2015) Williams JD, Song PH, Pink GH. FB 125. Noles M, Reiter K, Boortz-Marx J, Pink G. Rural Hospital Mergers & Acquisitions: Which hospitals are being acquired and how are they performing afterwards? Journal of Healthcare and Management, 2015 Nov-Dec;60(6):395-407. Reiter K. Uncompensated care burden may mean financial vulnerability for rural hospitals in states that did not expand Medicaid. Health Affairs October 2015;34(10):1721-1729. Estimating Eligibility and Uptake of Federally Facilitated Marketplace Insurance in North Carolina in the Second Open Enrollment Period (October 2015) Rutledge R, Holmes M, Silberman P. FB 124. Toth M, Holmes M, Van Houtven C, Toles M, Weinberger M, Silberman P. 2015. Rural Medicare beneficiaries have fewer follow-up visits and greater emergency department use post-discharge. Medical Care 53(9):800–808. Holmes G. 2015. Capsule Commentary for Tsilimingras et al., Post-discharge adverse events among urban and rural patients of an urban community hospital: A prospective cohort study. Journal of General Internal Medicine 30(8):1190. Karim S, Holmes M, Pink G. 2015. The effect of surgery on the profitability of rural hospitals. Journal of Health Care Finance. Spring. Casey M, Moscovice I, Holmes M, Pink G, Hung P. 2015. Minimum-distance requirements could harm high-performing Critical-Access Hospitals and rural communities. Health Affairs 34(4):627-635. Geissler KH, Holmes GM. 2015. Emergency Department use in the US-Mexico border region and violence in Mexico: Is there a relationship? Journal of Rural Health 31(1):316-25. Holmes M. 2015. Financially fragile rural hospitals: Mergers and closures. NC Medical Journal 76(1):37-40. A Comparison of Closed Rural Hospitals and Perceived Impact (April 2015) Thomas SR, Kaufman BG, Randolph RK, Thompson KW, Perry JR, Pink GH. FB123. A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals (March 2015) Reiter K and Holmes M. FB 122. The 21st Century Rural Hospital: A Chart Book (March 2015) Freeman V, Thompson K, Howard HA, Randolph R, Holmes M. Rural Provider Perceptions of the ACA: Case Studies in Four States (February 2015) Kaufman, B; Silberman, P; Holmes, M. FB121. Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants? (February 2015) Moss K, Holmes M, Pink G. FB120. Location of Critical Access Hospitals (December 2015). Cartographic. Location of Critical Access Hospitals. (June 2015). Cartographic. Location of Critical Access Hospitals. (April 2015). Cartographic. 2014 Rural-Urban Differences in Continuity of Care among Medicare Beneficiaries (December 2014) Toth M, Quach C, Holmes M. FB119. Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas (December 2014) Silberman P, Thomas S, Kaufman B, Perry J, Holmes M. FS01 Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace (September 2014) Holmes M, Silberman P, Thompson K, Freeman V, Randolph R. FB118. Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward? (August 2014) Noles M, Reiter KL, Pink GH, Holmes GM. FB117. How Does Medicaid Expansion Affect Insurance Coverage of Rural Populations? (July 2014) Thompson K, Kaufman B, Holmes M. FB116. Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients. (May, 2014) Radford A, Freeman V, Kirk D, Howard A, Holmes GM. FB115. Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where? (February, 2014) Freeman V, Randolph R, Holmes GM. FB11. Location of Critical Access Hospitals. (June 2014). Cartographic. Location of Critical Access Hospitals. (February 2014). Cartographic. 2013 Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement. (December 2013). Holmes GM, Pink G. FB112. Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close. (December 2013). Freeman V, Randolph R, Pink G, Holmes GM. FB111. NC Rural Health Research Program December 2013 Newsletter Rural/Urban Differences in Inpatient Related Costs and Use Among Medicare Beneficiaries. (December 2013). Toth M, Holmes GM, Freeman V, Pink G. FB113. Using “Plasticity” to Model a Community’s Need for Health Care Services. (November 2013). Beavers L. Post Geographic Variation in the Profitability of Critical Access Hospitals. (September 2013). Pink G, Freeman V, Randolph R, Holmes GM. FB110. Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10. (August 2013). WP- Profitability of Rural Hospitals. (August 2013). Pink G, Freeman V, Randolph R, Holmes GM. FB109. Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics (March 2013). Radford A, Kirk D, Howard, A, Holmes GM. FB108. Reiter KL, Holmes GM, Broyles I. Medicare, swing beds, and Critical Access Hospitals. Medical Care Research and Review 2013;70(2):206-17. 2012 Profile of Rural Health Clinics: Medicare Payments & Common Diagnoses (December 2012). Radford D, Kirk D, Howard HA. FB107. Flux in Loan Repayment Programs for Healthcare Professionals With States’ Budget Cuts and National Health Service Corps Budget Increases (May 2012). Pathman D, Goldberg L, Konrad T, Kerwin K, Morgan J. FB106. Why Use Swing Beds? Conversations with Hospital Administrators and Staff (April 2012). Freeman V, Radford A. FB105. Communities Served by Rural Medicare Dependent Hospitals (March 2012). Reiter K, Holmes GM, Karim S, Pink GH. FB104. Holmes GM, Pink GH. Adoption and perceived effectiveness of financial improvement strategies in Critical Access Hospitals. The Journal of Rural Health 2012;28 (1):92-100. A108. Kirk MA, Holmes GM, Pink GH. Achieving benchmark financial performance in Critical Access Hospitals: Lessons from high performers. Healthcare Financial Management : Journal of the Healthcare Financial Management Association 2012;66(4):116. A107. Ozmeral, Alisha Bhadelia, Kristin L. Reiter, George M. Holmes, and George H. Pink. 2012. 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. The Journal of Rural Health 28(4):416-24. A106.