Background The financial performance of small, rural hospitals has long been a concern to federal and state agencies. Federal law makers have enacted legislation authorizing the Medicare program to develop reimbursement methods that provide higher payments to hospitals that serve rural communities.1 The Medicare Payment Advisory Commission (MedPAC) describes rural hospitals as follows. Critical Access… Read more »
Tagged: Rural Product
Rural-Urban Differences in Continuity of Care among Medicare Beneficiaries
Background In response to the Affordable Care Act and other reforms in the health care market, new models of care are being tested and implemented across the country. Care and payment models such as patient-centered medical homes, Accountable Care Organizations (ACOs), and bundled payments depend on linkages between different types of health care providers to… Read more »
Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas
The Affordable Care Act provided coverage through the Health Insurance Marketplace to nearly seven million people during the first open enrollment period.1 Yet, research suggests that the enrollment rates for eligible individuals living in rural areas was less than enrollment rates for those living in urban areas.2 That may be due, in part, to specific… Read more »
Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace
Background One of the central and most visible components of the Affordable Care Act is the Health Insurance Marketplace (known as the Federally Facilitated Marketplace when administered by the federal government), which provides consumers a method to enroll in non-group health insurance coverage. It is the only enrollment method where qualifying individuals can get premium-… Read more »
Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward?
Background Hospital mergers and acquisitions1 are changing the face of health care in both rural and urban communities across the country. Declining reimbursement levels, increased capital needs, a weak economy and easier access to credit have all contributed to a level of mergers not seen in more than a decade.2,3 Studies from the 1980s and… Read more »
Health Insurance Coverage in North Carolina: The Rural-Urban Uninsured Gap
Background One of the primary drivers of health is being covered by health insurance. A review of available literature found a wide range of effects of health insurance, including a 20% relative reduction in mortality among previously uninsured people who become eligible for Medicare [1]. Many factors lead to lower rates of health insurance coverage… Read more »
Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients
Background Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are important primary care providers in rural communities. These safety net programs are similar in that they both are located in areas with inadequate access to health care services. In addition, RHCs and FQHCs are federally-designated entities reimbursed by Medicare based on all-inclusive… Read more »
Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
Background Swing beds are one option for post-acute skilled care in rural communities, and they are more likely to be the only option in the most rural areas.1 These transitional care beds allow a patient to be discharged from an acute hospital stay but remain in the hospital for skilled after care. Skilled nursing facilities… Read more »
Using “Plasticity” to Model a Community’s Need for Health Care Services
Researchers at the University of North Carolina’s Cecil G. Sheps Center for Health Services Research have introduced a new way of thinking about how to determine physician supply and medical specialty configurations in order to meet health care needs. In an article published in Academic Medicine (November 2013), the authors explore how the concept of “plasticity” could… Read more »
Rural/Urban Differences in Inpatient Related Costs and Use Among Medicare Beneficiaries
Background A recent Institute of Medicine report suggests that care received after a hospitalization is a primary driver of regional variation in health care costs in the United States. 1 While evidence suggests that health care utilization varies by rural setting, 2 it is unknown how pre- and post-hospital admission costs and use differ between… Read more »
Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close
Background Policy makers have recently focused on the relative locations of Critical Access Hospitals (CAHs), whether changes are needed to current mileage requirements and the impact changes would have on how Medicare pays for services in smaller, low-volume hospitals. CAHs can have no more than 25 beds and must be 1) at least 15 miles… Read more »
Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement
About this project This brief is part of a series of three briefs providing information for policy makers and stakeholders as policy changes for Critical Access Hospitals (CAHs) are considered. This one focuses on the projected financial impact that a reduction in Medicare payments might have on CAHs. The others focus on the potential increases… Read more »
Predictors of hospital bypass for rural residents seeking common elective surgery
Abstract Background Surgical bypass occurs when rural residents receive surgical care at a nonlocal hospital. Given limited knowledge of current bypass rates, we evaluated rates and predictors of bypass for common procedures. Methods We used 2014 to 2016 all-payer claims data from the Healthcare Cost and Utilization Project State Inpatient Databases to study rural patients… Read more »
Achieving benchmark financial performance in CAHs: lessons from high performers
Abstract CEOs and CFOs of 19 critical access hospitals (CAHs) that achieved benchmark financial performance over three years were interviewed regarding the strategies they use. The interviews identified nine success factors for exemplary financial performance that were common to all or most of the 19 hospitals. All of the participating executives agreed that other CAHs… Read more »
Adoption and perceived effectiveness of financial improvement strategies in critical access hospitals
Purpose: To ascertain the use and perceived success of strategies to improve the financial performance of Critical Access Hospitals (CAHs). Methods: Information about the use and perceived effectiveness of 44 specific strategies to improve financial performance was collected from an online survey of 291 CAH Chief Executive Officers and Chief Financial Officers. Responses were merged with financial… Read more »