For decades, health care has been shifting from inpatient care to outpatient care. As hospitals reduce inpatient care, revenue from outpatient care becomes critically important. In most rural hospitals, the greatest portion of net patient revenue is from outpatient services versus urban hospitals that have, on average, about half from outpatient and half from inpatient… Read more »
Tagged: Rural Product
A Comparison of Rural and Urban Specialty Hospitals
Specialty hospitals are important providers in both urban and rural areas. However, they are not evenly distributed across these areas. The NC Rural Health Research Program in the brief, , addresses three types of specialty hospitals: Long Term Acute Care Hospitals (LTCHs), Inpatient Psychiatric Facilities (IPFs), and Inpatient Rehabilitation Facilities (IRFs). We compared urban and… Read more »
Changes in Care‐Seeking after Rural Hospitals Merge
Rural hospital mergers have increased significantly since 2010. Enhanced financial performance and improved quality are often cited as benefits, but hospital mergers can also lead to changes in the services provided by acquired hospitals. This brief estimates the use of inpatient services delivered by acquired rural hospitals following a merger. The NC Rural Health… Read more »
Most Rural Hospitals Have Little Cash Going into COVID-19
In the infographic, , The North Carolina Rural Health Research Program uses recent Medicare Cost Report data to illustrate the type of rural hospitals most likely to struggle financially during the pandemic as measured by lower median days cash on hand. Days cash on hand is a common measure of an organization’s level of cash… Read more »
Estimated Reduction in CAH Profitability from Loss of Cost‐Based Reimbursement for Swing Beds
Over the past several years, a few reports have suggested Medicare could reduce costs by changing swing bed reimbursement from cost-based to the Skilled Nursing Facility Prospective Payment System (SNF PPS). Rural communities and CAHs are concerned about the proposed change from cost-based reimbursement to the SNF PPS because it would reduce the amount of… Read more »
Patterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents
Hospital bypass, the tendency of local rural residents to not seek care at their closest hospital, is thought to be a contributing factor for rural hospital closure. To to update the knowledge base of determinants of bypass behavior, the NC Rural Health Research Program produced the brief, . We analyzed 2014-2016 Healthcare Cost and Utilization… Read more »
Geographic Variation in the 2018 Profitability of Urban and Rural Hospitals
Rural hospital closures remain a worrisome issue for policy makers and communities. Since 2005, 170 rural hospitals closed. The North Carolina Rural Health Research Program and Policy Analysis Center tracks these closures and studies potential predictors. Profitability (revenue greater than expenses) is not the only predictor, but it is one of the main predictors of… Read more »
Occupancy Rates in Rural and Urban Hospitals: Value and Limitations in Use as a Measure of Surge Capacity
As policymakers deal with the effects of the novel coronavirus pandemic on the hospital infrastructure, understanding the differences in occupancy rates between rural and urban hospitals may help state and local officials in their planning for dealing with surge demand. Historically, rural hospitals have reported lower occupancy rates than urban hospitals and more licensed than… Read more »
Rural Health 101: An Overview of Rural Health Research
The PDF is a shorter primer on rural health for researchers in health and health services. It provides information on: a spectrum of rural definitions and the importance of selecting a standardized definition; rural mortality; and some common challenges with rural data analysis.
Risk Factors and Potentially Preventable Deaths in Rural Communities
As the rural-urban mortality gap continues to expand, researchers have been exploring the reasons why the gap exists and how some of the deaths might be prevented. Studies show a higher percentage of rural residents die from preventable causes, specifically heart disease, cancer, unintentional injury, chronic lower respiratory disease,1 and stroke than urban residents.2,3 Researchers… Read more »
A Rural Urban Comparison of the Proposed 2020 Wage Index
On April 23, 2019, the Centers for Medicare & Medicaid Services (CMS) released its annual proposed update for the hospital Inpatient Prospective Payment System for fiscal year 2020 that starts in October 2019. In the proposed update, CMS recognizes that the current wage index system perpetuates and exacerbates the disparities between high and low wage… Read more »
2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals
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 among labor markets,… Read more »
Differences in Community Characteristics of Sole Community Hospitals
In 1983, Congress created the Sole Community Hospital (SCH) program to support small rural hospitals for which “by reason of factors such as isolated location, weather conditions, travel conditions, or absence of other hospitals, is the sole source of inpatient hospital services reasonably available in a geographic area to Medicare beneficiaries.” A SCH is often… Read more »
Rural-Urban Variations in Medicare Live Discharge Patterns from Hospice, 2012-2013
For the last decade-and-a-half, the proportion of patients discharged from the Medicare hospice program prior to death – known as a “live discharge” – has increased across the country with significant hospice-level geographic variations. Despite clear geographic variations in live discharge rates and known rural-urban disparities (e.g., patients of rural hospices have higher satisfaction), previous… Read more »
Regional Differences in Urban and Rural Mortality Trends
Previous research has established both that there is a gap in nationwide urban-rural mortality and that this gap is increasing over time. Existing and ongoing work has found that the urban-rural mortality gap may vary regionally. This brief builds upon previous research and explores the differences in mortality trends between urban and rural locations by… Read more »
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