Abstract For most health professions, rural North Carolina has lower relative supply than urban parts of the state. Although there are plenty of innovative models addressing this disparity, a holistic approach is necessary if we want to effect real change.

Abstract Purpose: Annual rates of rural hospital closure have been increasing since 2010, and hospitals that close have poor financial performance relative to those that remain open. This study develops and validates a latent index of financial distress to forecast the probability of financial distress and closure within 2 years for rural hospitals. Methods: Hospital and community… Read more »

Abstract Purpose: The low-volume hospital (LVH) payment adjustment established in the Patient Protection and Affordable Care Act (ACA) of 2010 is scheduled to sunset on October 1, 2017. The purpose of this analysis was: (1) to estimate the effect of the ACA LVH adjustment on qualifying hospitals’ profitability margins; and (2) to examine hospital and market… Read more »

OVERVIEW In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. With over 3,900 certified sites located across the county, RHCs are an important component of the rural health care infrastructure.1 RHCs can be private/for-profit or non-profit. Some operate as independent medical practices, while… Read more »

Effect of Swing Bed Use on Medicare Average Daily Cost and Reimbursement in Critical Access Hospitals Critical Access Hospitals (CAHs) receive cost-based reimbursement from Medicare for inpatient care, including post-acute skilled care provided in swing beds (skilled swing days). Because the reimbursement formula treats swing bed and acute days equally, there is concern that CAH… Read more »

Abstract Purpose: To conduct a preliminary assessment of the quality of uncompensated care data included in Medicare Cost Report (MCR) Worksheet S-10 for rural hospitals and to identify the implications of data quality issues for research and policy decisions. Methods: 2011 MCR Worksheet S-10 data for all rural hospitals were collected from the Healthcare Cost… Read more »

Purpose: Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. Methods: The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to… Read more »

BACKGROUND From 2005 through 2015, more than 100 rural hospitals have closed their doors to patients in need of inpatient services.1 Though a handful of these closed hospitals have since reopened, the remaining closures leave millions of rural residents at greater risk of negative health and economic hardship due to the loss of local acute… Read more »

OVERVIEW From 2005 to 2015, 112 rural hospital closures have been identified (North Carolina Rural Health Research Program, 2015)1 . Although six of these closed hospitals have since reopened, the remaining closures impact millions of rural residents in communities that are typically older and poorer, more dependent on public insurance programs, and in worse health… Read more »

The popular business quote “No margin, no mission” succinctly states the importance of profitability. The notion that if a hospital doesn’t make enough money to keep its doors open, its higher purpose is moot may be a simplistic view, but historic and recent evidence suggest that unprofitability can reduce hospital services and quality, or worse,… Read more »

OVERVIEW More Americans are now aware of the financial challenges faced by rural hospitals. Media coverage of the 66 rural hospital closures between January 2010 and January 2016 has highlighted the health care access and economic challenges facing rural America. Rural hospital closures are not a new phenomenon – hundreds of rural hospitals closed in… Read more »

BACKGROUND Implementing the Patient Protection and Affordable Care Act (ACA) is changing hospital reimbursement in important ways.1 The most significant changes stem from increasing access to health insurance coverage for previously uninsured or under-insured populations. Since rural residents are more likely than urban residents to be uninsured,2 increased access to health insurance should, in theory,… Read more »

BACKGROUND In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. RHCs must be located in non-urban areas with documented health care shortages. There are currently more than 4,100 RHCs across the U.S.1 Some RHCs operate as independent medical practices, while others are part… Read more »

BACKGROUND For almost four decades, Rural Health Clinics (RHCs) (currently numbering about 4,100) have served patients from underserved rural areas. Although Medicaid is an important payer for RHCs, little is known about Medicaid patients and the services provided to them partly because of the complexity of identifying claims generated from RHCs in Medicaid claims data… Read more »

Abstract Rural hospitals differ from urban hospitals in many ways. For example, rural hospitals are more reliant on public payers and have lower operating margins. In addition, enrollment in the health insurance Marketplaces of the Affordable Care Act (ACA) has varied across rural and urban areas. This study employed a difference-in-differences approach to evaluate the… Read more »