About this project This Findings Brief looks at the effects of year-to-year changes in annual inpatient discharges on costs per Medicare discharge. Low-volume hospitals, regardless of location, experience significantly greater total variability in inpatient demand across years, and greater changes in annual discharges that cannot be forecasted as part of an individual hospitals’ trend over… Read more »
Tagged: Rural Product
Unpredictable Demand and Low-Volume Hospitals
Unpredictable Demand and Low-Volume Hospitals background This Findings Brief assesses the degree to which the annual number of patient discharges varies from year to year for low volume hospitals. To the extent that demand for inpatient services is unpredictable, it is hard for administrators to set budget and recruitment goals, which are generally based on… Read more »
Design of enhanced primary care case management programs operating in rural communities: Lessons learned from 3 states
Executive summary States are beginning to develop alternative managed care strategies for their Medicaid populations, including enhanced primary care case management (PCCM) programs that incorporate features originally developed for fully capitated managed care programs, such as care coordination and quality improvement efforts. Such alternative approaches have proven to be especially useful in rural communities, where… Read more »
Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities
In July of 1998, the method for determining payments for Medicare services in skilled nursing facilities (SNFs) began a three-year transition from retrospective cost-based reimbursement to a SNF prospective payment system (SNF PPS). SNF PPS is based on national rates with an adjustment for differences in local wages that is based upon the Medicare inpatient… Read more »
Cesarian section rates in rural hospitals
Executive summary Childbirth by cesarean section (c-section) is major abdominal surgery that carries risk to both mother and baby. There are reasons to suggest that c-section rates at rural hospitals might be different than c-section rates at urban hospitals. The diffusion of best practices, such as the safe delivery of infants by vaginal births to… Read more »
Contracting With Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
Contracting With Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators overview This document summarizes the experience of CAH administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms… Read more »
Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals executive summary This study examines trends in the delivery of skilled nursing facility (SNF) services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on critical access hospitals (CAHs). In… Read more »
Rural Hospitals’ Experience with the 340B Drug Pricing Program
Overview The 340B Drug Pricing Program (hereafter referred to as the 340B program) enables certain types of safety net organizations to obtain deep discounts on medications delivered during outpatient care, at prices below what is typically offered to Medicaid agencies. Prior to the 2003 Medicare Modernization Act (MMA), few rural hospitals qualified for the 340B… Read more »
One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D
Background The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established funding to allow up to 43 million Medicare beneficiaries to enroll in plans providing comprehensive outpatient prescription drug coverage, beginning in January 2006. The new Medicare Part D program changed the means by which Medicare beneficiaries purchase prescription drugs, which affects the… Read more »
Rural-Urban Differences in Characteristics of Local EMS Agencies
BACKGROUND This Findings Brief describes the general characteristics of local rural EMS agencies and important ways that they differ from the characteristics of agencies located in urban areas. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-07. KEY FINDINGS Rural EMS agencies typically serve a smaller population… Read more »
Rural Hospitals Have Higher Percentages of Patients with COVID-19 than Urban Hospitals
Since the onset of COVID-19, public health leaders have emphasized reducing the rate of viral spread to ensure that hospitals did not become overwhelmed. On December 15, 2020, the U.S. DHHS published weekly data on each individual hospital’s status on key indicators for acute management of COVID-19 patients. We analyzed these data to compare the… Read more »
Rural Hospitals with Long‐term Unprofitability
Overview To remain open, businesses generally need to be profitable (have revenues greater than expenses). Hospitals are no different. Hospitals use profits to pay for new and upgraded buildings, equipment, technology, programs, and other patient care needs. To assess hospital profitability, we often look at total margin. Total margin measures the control of expenses relative… Read more »
Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
Background The Medicare hospital Inpatient Prospective Payment System (IPPS) is designed to pay hospitals for services provided to Medicare beneficiaries based on a national standardized amount adjusted for the patient’s condition and related treatment. Further, Social Security Act Section 1886(d)(3)(E) requires that the standardized amount be adjusted for differences in hospital wage levels, which the… Read more »
What Characteristics Influence Whether Rural Beneficiaries Receiving Care From Urban Hospitals Return Home for Skilled Nursing Care?
Abstract Purpose: Skilled nursing care (SNC) provides Medicare beneficiaries short-term rehabilitation from an acute event. The purpose of this study is to assess beneficiary, market, and hospital factors associated with beneficiaries receiving care near home. Methods: The population includes Medicare beneficiaries who live in a rural area and received acute care from an urban facility in 2013…. Read more »
What Should Be the Scope of a Health Network’s Obligation to Respond After a Hospital Closure?
Abstract As rural hospital closures become more common, many patients are left without sources of care, raising ethical questions about hospitals’ and clinicians’ responsibilities during and after closures. In many cases, such as the one considered in this article, hospitals have been economic hubs of some communities for many years and are obliged to consider… Read more »