North Carolina Rural Health Research and Policy Analysis Center

Publications

Alphabetical list. You can also view by publication date.

• 340B Drug Pricing Program: Results of a Survey of Eligible but Non-Participating Rural Hospitals
  Date: 01 / 2007
  Author(s): Andrea Radford, Rebecca Slifkin, Claudia Schur, Karen Cheung
  Report Number: Working Paper No. 88 (UNC), Working Paper 2007-01 (Walsh)
  Topics: Hospitals and clinics, Pharmacy and prescription drugs
  Summarizes the results of a 2006 survey of pharmacy directors at rural hospitals that are eligible but currently not participating in the 340B Drug Pricing Program, which enables certain types of safety-net organizations to obtain discounted outpatient medications.
• 340B Drug Pricing Program: Results of a Survey of Participating Hospitals
  Date: 05 / 2007
  Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin, Marianne Baernholdt
  Report Number: Working Paper No. 2007-03 (Walsh), Working Paper No. 90 (NC)
  Topics: Hospitals and clinics, Pharmacy and prescription drugs
  Presents the results of a survey of pharmacy directors at rural hospitals currently buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program in general, the financial impact of the program, and which specific program features presented barriers to its broader implementation.
• Allied Health Job Vacancy Tracking Report
  Date: 08 / 2006
  Author(s): Samir Thaker, Erin Fraher, and Jennifer King
  Topics: Allied health professionals, Workforce
  Quantifies workforce demand for selected allied health professions in North Carolina, tracks job vacancy advertisements in print and online sources, summarizes vacancy advertisements by profession, region, and employer type, and describes the types of sign-on bonuses offered by employers.
• Arguing for Rural Health in Medicare: A Progressive Rhetoric for Rural America
  Date: 09 / 2002
  Author(s): Thomas Ricketts
  Topics: Health policy, Medicare
  Examines how rural health policy is treated in the broader field of public policy, discusses the role of advocacy in developing rural health policy, and suggests ways to make that advocacy more effective. Specifically, the report explores the types of claims that rural advocates make, focusing in the context of Medicare policy, and determines to what extent those claims reflect a central them of fairness and inclusiveness in national polices versus claims that benefit special interests.
• At-Risk Hospitals: The Role of Critical Access Hospital Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
  Date: 02 / 2000
  Author(s): Kathleen Dalton, Rebecca Slifkin, Hilda Howard
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare Prospective Payment System (PPS)
  This report examines not-for-profit hospitals that potentially qualify as Critical Access Hospitals and identifies those facilities that are at risk as a result of Medicare's PPS to non-acute care settings.
• Background on the Wage-related Portion of the Medicare DRG Payments
  Date: 09 / 2000
  Author(s): Kathleen Dalton
  Topics: Health care financing, Medicare
  Discusses how to calculate Medicare diagnostic related group (DRG) payments. Includes examples and a diagram of how to calculate a DRG payment.
• Becoming an Emergency Medical Technician: Urban-Rural Differences in Motivation and Job Satisfaction
  Date: 03 / 2007
  Author(s): P. Daniel Patterson, Victoria A Freeman, Charity G. Moore, Rebecca T. Slifkin
  Report Number: Working Paper No. 89
  Topics: Emergency medical services (EMS), Workforce
  This study uses cross-sectional data from the 2003 national Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) Project to explore urban-rural differences in why EMTs enter the field, what is important in their jobs, and whether they are satisfied with their profession.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Date: 08 / 2007
  Author(s): CAH Financial Indicators Report Team at UNC
  Report Number: Flex Monitoring Team Data Summary Report No. 3
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Presents 20 financial indicators for Critical Access Hospitals (CAHs). Includes state and national medians for indicators addressing profitability, liquidity, capital structure, revenue, cost, and utilization. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Date: 10 / 2005
  Author(s): CAH Financial Indicators Report Team at UNC
  Report Number: Flex Monitoring Team Data Summary Report No. 1
  Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Summarizes Critical Access Hospital (CAH) financial indicators for 2003, providing state and national medians for each indicator. The indicators are grouped by financial dimension: profitability, liquidity, capital structure, revenue, cost, and utilization. The number of CAHs included in the median calculations is also provided. Information about the definition and interpretation of the indicators can be found in the full report, Briefing Paper No. 7, Financial Indicators for Critical Access Hospitals. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Date: 11 / 2006
  Author(s): CAH Financial Indicators Report Team at UNC
  Report Number: Flex Monitoring Team Data Summary Report No. 2
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Presents 20 financial indicators for Critical Access Hospitals (CAHs). Includes state and national medians for indicators addressing profitability, liquidity, capital structure, revenue, cost, and utilization. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Case Study of Rural Health Care in the Economic Downturn
  Date: 07 / 2009
  Topic: Health insurance and the uninsured
  Many rural communities face persistent challenges with health care access and cost. These problems have been amplified by the current economic downturn. This report describes the economic and health care environment in Ashe County, a rural community in the mountains of western North Carolina. The experience in Ashe County exemplifies the health care challenges faced in many rural areas across the country.
• Cesarean Section Patterns In Rural Hospitals
  Date: 11 / 2004
  Author(s): Sandra B. Greene, George M. Holmes, Rebecca Slifkin, Victoria Freeman, Hilda Ann Howard
  Report Number: Working Paper No. 80
  Topics: Hospitals and clinics, Maternal and child health
  Examines childbirth delivery patterns in rural hospitals and compares the cesarean section (c-section) rate in rural hospitals to that in urban hospitals. The c-section rate for rural hospitals was well above the 10-15% rate recommended by the World Health Organization, and was higher (but not statistically significant) in rural hospitals than in urban hospitals. A Findings Brief on this topic is also available.
• Cesarean Section Rates in Rural Hospitals
  Date: 03 / 2005
  Author(s): Sandra Greene, George Holmes, Rebecca Slifkin, Victoria Freeman, Hilda Ann Howard
  Report Number: Findings Brief No. 79
  Topics: Hospitals and clinics, Maternal and child health
  Findings Brief examining childbirth delivery patterns in rural hospitals and comparing the C-section rate in rural hospitals to that in urban hospitals using the Nationwide Inpatient Sample (NIS). Working Paper No. 80 on this topic is also available.
• Challenges for Rural Emergency Medical Services: Medical Oversight
  Date: 05 / 2008
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Report Number: Findings Brief 85
  Topics: Emergency medical services (EMS), Workforce
  This Findings Brief examines the challenges faced by local rural EMS agencies in obtaining a medical director and ensuring medical oversight for EMS personnel, and also describes how the challenges faced in rural areas differ from those in urban ones. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
• Characteristics of Rural & Urban Children Who Qualify For Medicaid or CHIP But Are Not Enrolled (Policy Brief)
  Date: 07 / 2009
  Author(s): Jennifer King, Rebecca Slifkin, Mark Holmes
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP
  About three-quarters of children who qualify for Medicaid or CHIP are enrolled, with slightly higher rates in rural areas than in urban areas. This leaves one in four qualified children without insurance coverage.
• Classification Change, 1999 to 2003: Office of Management and Budget Metropolitan Areas and Core Based Statistical Areas (CBSAs) Map
  Date: 07 / 2003
  Topic: Defining rural
  Map of the Office of Management and Budget's June 2003 Core Based Statistical Areas (CBSAs) Designations for Counties that were Nonmetropolitan in 1999.
• Community Impact of Critical Access Hospitals
  Date: 02 / 2007
  Author(s): John A. Gale, Andrew F. Coburn, Victoria Freeman, Walter R. Gregg, Rebecca Slifkin
  Report Number: Policy Brief No. 2
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Community Involvement of Critical Access Hospitals: Results of the 2004 National CAH Survey
  Date: 03 / 2005
  Author(s): Stephanie Poley, Rebecca Slifkin
  Report Number: Flex Monitoring Team Briefing Paper No. 6
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  The data reported here provide a starting point for understanding Critical Access Hospital (CAH) community involvement. Data were collected and analyzed from a national telephone survey of CAH administrators conducted in 2004. Survey respondents were asked about community involvement activities including community needs assessment, outreach and formal health promotion programs, relationships with other community organizations, free or reduced cost health care, and hospital activities in support of special populations. Most CAHs are engaged in activities that offer benefit to their community beyond hospital-based acute care services. Administrators recognize the importance of being responsive to community needs and seek the financial support necessary to maintain outreach activities. The outreach programs reported by CAH administrators resemble typical community activities for a health care facility, with a particular emphasis on health promotion and management of chronic conditions. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Comparative Performance Data for Critical Access Hospitals
  Date: 2004
  Author(s): George H. Pink, Rebecca T. Slifkin, Andrew F. Coburn, John A. Gale
  Citation: Journal of Rural Health, 20(4), 374-382
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
• Comparison of Rural Hospitals with Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment (Final Report)
  Date: 08 / 2010
  Author(s): G. Mark Holmes, George H. Pink, Sarah A. Friedman, Hilda A. Howard
  Report Number: No.98
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare, Medicare Prospective Payment System (PPS)
  This final report compares the financial performance and condition of rural hospitals with special Medicare payment provisions to urban and rural hospitals paid under prospective payment (UPPS and R-PPS hospitals, respectively). Nine ratios from the three most common categories of ratios used in financial statement analysis (profitability, liquidity, and capital structure) as well as four other ratios that are commonly used to evaluate rural hospital financial performance are assessed.
• Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
  Date: 12 / 2005
  Author(s): Michelle Mason, Roslyn Fraser-Maginn, Keith Mueller, Jennifer King, Andrea Radford, Rebecca Slifkin, Jennifer Lenardson, Lauren Silver, Curt Mueller
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare Advantage (MA)
  Summarizes the experience of Critical Access Hospital (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 administrators have been offered, their experiences negotiating with MA plans, and their advice for others dealing with this issue.
• Core Based Statistical Areas And The Medicare Wage Index
  Date: 02 / 2004
  Report Number: Policy Brief
  Topics: Defining rural, Medicare Wage Index
  Discusses the potential impact of the 2003 Office of Management and Budget (OMB) statistical area standards on the hospital wage index and Medicare payments to rural providers. Additionally, three other possible options for defining labor markets using the 2003 classifications are presented.
• Definition of Rural in the Context of the MMA Access Standards for Prescription Drug Plans
  Date: 09 / 2004
  Author(s): Keith J. Mueller, Rebecca T. Slifkin, Michael D. Shambaugh-Miller, Randy K. Randolph
  Report Number: RUPRI Policy Paper P2004-7, North Carolina Working Paper No. 79
  Topics: Defining rural, Legislation and regulation, Pharmacy and prescription drugs
  Access to local pharmacy services is dependent upon the extent to which prescription drug plans offering the Medicare benefit incorporate local rural pharmacies into their provider networks. This will be based on market considerations and on the requirements for local access contained in the MMA and regulation, which in turn will be shaped by how "rural" is defined. This paper assesses how the definition of rural affects the potential impact of the specific access standards in the Proposed Rule to implement Title I of the MMA, and finds that the congressional objective to achieve convenient access to pharmacies (other than mail order) would be more fully realized if the Proposed Rule definition of rural is changed.
• Design of Enhanced Primary Care Case Management Programs Operating in Rural Communities: Lessons Learned from Three States
  Date: 03 / 2003
  Author(s): Stephanie Poley, Pam Silberman, Rebecca Slifkin
  Topic: Medicaid and S-CHIP
  Discusses state programs that provide enhanced benefits to Medicaid beneficiaries such as enhanced primary care case management (PCCM). Examples from three states: Florida, North Carolina and Oklahoma.
• Effect of Market Reform on Rural Public Health Departments
  Date: 01 / 2000
  Author(s): Rebecca Slifkin, Pam Silberman, Susan Reif
  Topic: Public health
  This study seeks to determine how rural health departments and populations they serve have been affected by recent health system changes, especially Medicaid managed care.
• Effect of Medicare Part D Plan Switching and Formulary Changes on Sole Community Pharmacies and the Patients They Serve
  Date: 03 / 2010
  Author(s): Michelle Lampman, Andrea Radford, Anh Nguyen
  Topic: Pharmacy and prescription drugs
  Presents findings from a 2008 survey of 401 pharmacist-owners of sole community independent pharmacies.
• Effect of Rural Hospital Closures on Community Economic Health
  Date: 2006
  Author(s): George M. Holmes, Rebecca T. Slifkin, Randy K. Randolph, Stephanie Poley
  Citation: Health Services Research, 41(2), 467-485
  Topics: Economic development, Hospitals and clinics
  Describes the effect of hospital closure on the local economy, based on a study of county level economic data for 1990-2000 in rural counties experiencing a hospital closure.
• Effect of Rural Residence On Dental Unmet Need for Children With Special Health Care Needs
  Date: 2006
  Author(s): Asheley Cockrell Skinner, Rebecca T. Slifkin, Michelle L. Mayer
  Citation: Journal of Rural Health, 22(1), 36-42
  Topics: Children, Dental health, Disabilities
  Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need.
• Effect of Swing Bed Use on Medicare Average Daily Cost and Reimbursement in Critical Access Hospitals
  Date: 12 / 2011
  Author(s): Kristin L. Reiter, George M. Holmes, George H. Pink, Victoria A. Freeman
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare
  This analysis estimates the average net cost to Medicare of a SNF swing day by simulating the elimination of all Medicare SNF swing bed days in CAHs in 2009.
• Effects of Rural Residence and Other Social Vulnerabilities on Subjective Measures of Unmet Need
  Date: 2005
  Author(s): Michelle L. Mayer, Rebecca T. Slifkin, Asheley Cockrell Skinner
  Citation: Medical Care Research and Review, 62(5), 617-628
  Topics: Children, Disabilities, Health services, Poverty
  To determine whether self-reports of unmet need are biased measures of access to health care, the authors examined the relationship between rural residence and perceived need for physician services. Logistic regression analyses was performed to examine the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs. Even after controlling for factors known to be associated with evaluated need, parents of rural children were less likely to report a need for routine or specialty services. Poor children, those whose mothers had less education, and those who were uninsured in the previous year were also less likely to perceive a need for physician services. Findings suggest that rural residence and other social vulnerabilities are associated with decreased perception of need, which may bias subjective measurements of unmet need for these populations.
• Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
  Date: 02 / 2006
  Author(s): P. Daniel Patterson, John A. Gale, Stephenie L. Loux, Anush E. Yousefian, Rebecca Slifkin
  Report Number: Flex Monitoring Team Briefing Paper No. 8
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS)
  Describes the EMS related activities that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-2005. Since the first full year of funding, the number and range of EMS improvement activities proposed has increased substantially states' proposals contained 239 documented EMS improvement activities. Of these, 40% focused on the Integration of Health Services attribute, 13% on Human Resource challenges, and 13% on Education Systems. Continued support of activities begun prior to 2004 was common. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
  Date: 2007
  Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
  Citation: Journal of Rural Health, 23(4), 286–293
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Describes first-hand reports from rural pharmacist-owners about their experiences with Medicare Part D plans in the first 7 months of 2006 in order to gain a more thorough understanding of the challenges faced by rural independent pharmacies as a result of program implementation.
• Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
  Date: 11 / 2006
  Author(s): Andrea Radford, Rebecca Slifkin, Roslyn Fraser, Michelle Mason, Keith Mueller
  Report Number: Working Paper No. 87 (NC), Policy Paper P2006-3 (RUPRI)
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Case study describing first-hand reports from 12 rural independent pharmacists in seven states about their experiences with Medicare Part D plans (PDPs) in the first seven months of 2006. The rural independent pharmacists interviewed are experiencing major changes in payment, administrative burden, and interaction with patients as a result of the shift of patients into Medicare Part D plans. Previously, these patients were mostly non-covered cash or Medicaid-covered clients. Two consequences are apparent in the data collected: 1) Payment per prescription is lower from Medicare PDPs than from either non-covered cash or Medicaid, and in some instances payment from PDPs is less than the combined cost of stocking the medications and dispensing them, representing a reduction in revenue; and 2)The number of plans that provide Part D benefits greatly exceeds the two payment sources pharmacists previously dealt with, representing an increase in administrative burden for independent pharmacies. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• Exploring the Community Impact of Critical Access Hospitals
  Date: 01 / 2007
  Author(s): John Gale, Andrew Coburn, Walt Gregg, Rebecca Slifkin, Victoria Freeman
  Report Number: Flex Monitoring Team Briefing Paper No. 14
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Fewer Hospitals Close in the 1990s: Rural Hospitals Mirror This Trend
  Date: 10 / 2001
  Author(s): Stephanie T. Poley, Thomas C. Ricketts
  Topic: Hospitals and clinics
  Summarizes a study of the number and rate of hospital closures in rural areas during the 1990s. Includes graphs and a map.
• Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (Findings Brief)
  Date: 04 / 2010
  Author(s): George H. Pink, Rebecca T. Slifkin, Hilda A. Howard
  Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
  Compares the profitability of hospitals with the four classifications of rural hospitals that can qualify for special payment provisions under Medicare (Critical Access Hospitals, Medicare Dependent Hospitals, Sole Community Hospitals, and Rural Referral Centers) to urban and rural hospitals paid under prospective payment over a recent three-year period.
• Financial Indicators for Critical Access Hospitals
  Date: 2006
  Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca T. Slifkin
  Citation: Journal of Rural Health, 22(3), 229-36
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). The authors, along with a technical advisory group, focused on twenty indicators deemed appropriate for assessment of CAH financial condition and formulas determined. Issues 1 and 2 of the CAH Financial Indicators Report were mailed to the chief executive officers of 853 CAHs in the summer of 2004 and 1,092 CAHs in the summer of 2005, respectively. Each report included indicator values specifically for their CAH, indicator medians for peer groups, and an evaluation form.
• Financial Indicators for Critical Access Hospitals
  Date: 05 / 2005
  Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca Slifkin
  Report Number: Flex Monitoring Team Briefing Paper No. 7
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  The purpose of this study was to develop and disseminate comparative financial indicators specifically for Critical Access Hospitals (CAHs) using Medicare Cost Report data. Results showed that, over the six years since 1998, CAHs generally became more profitable and increased their utilization of beds. However, while on average CAHs with long-term care became more liquid and reduced their use of debt over time, those without long-term care became less liquid and increased their use of debt. In the most recent year for which we have data (2003), CAHs without long-term care generally were more profitable, were more liquid, had less debt, and had higher utilization of beds in comparison to CAHs with long-term care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• How Adults' Access to Outpatient Physician Services Relates to the Local Supply of Primary Care Physicians in the Rural Southeast
  Date: 2006
  Author(s): Donald E. Pathman, Thomas C. Ricketts, Thomas R. Konrad
  Citation: Health Services Research, 41(1), 79-102
  Topics: Health services, Physicians
  For adults as a whole in the rural South and for the elderly there, low local primary care physician densities are associated with travel inconvenience but not convincingly with other aspects of access to outpatient care. Access for those insured under Medicaid and the uninsured, however, is in more ways sensitive to local physician densities.
• How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Pre-Implementation Prescription Volume and Payment Sources in Rural and Urban Areas
  Date: 2005
  Author(s): Erin P. Fraher, Rebecca T. Slifkin, Laura Smith, Randy Randolph, Matthew Rudolf, George M. Holmes
  Citation: Journal of Rural Health, 21(2), 114-121
  Topics: Health care financing, Health policy, Medicare Part D, Pharmacy and prescription drugs
  Presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs. urban areas. Together, these data provide a baseline for evaluating how implementation of the MMA may affect the financial viability of rural independent pharmacies. The authors found that the volume of mail-order prescriptions is small. Rural providers prescribed fewer retail and mail-order prescriptions per person, but more units per person. Rural areas have a higher percentage of prescriptions paid for by cash (18% vs. 13%) and Medicaid (16% vs. 10%) and a lower percentage of third-party payers than urban areas. Significant variation in volume and payer type exists between states. The authors conclude that rural, independent pharmacies may be negatively affected by MMA implementation as business shifts from cash to third-party reimbursement. The high degree of variation between states also has potentially important implications for the implementation of Prescription Drug Plan regions under MMA.
• If Fewer International Medical Graduates are Allowed in the U.S., Who Might Replace Them in Rural Underserved Areas?
  Date: 05 / 2001
  Author(s): Leonard D. Baer, Thomas R. Konrad, Rebecca T. Slifkin
  Report Number: Findings Brief
  Topics: International Medical Graduates (IMGs), Workforce
  Describes a study to identify rural communities that would be most affected by a decrease in availability of international medical graduates (IMGs) and perceptions of recruiters on who might replace IMGs in these areas. Includes maps. A full report is also available.
• If Fewer International Medical Graduates Were Allowed in the U.S., Who Might Replace Them in Rural Areas?
  Date: 02 / 2001
  Author(s): Leonard D. Baer, Thomas R. Konrad, Rebecca T. Slifkin
  Report Number: Working Paper No. 71
  Topics: International Medical Graduates (IMGs), Workforce
  Identifies rural communities that would be most affected should restrictions on IMG entry into the United States be tightened, and reports on the perceptions of physician recruiters and health planners about who might replace IMGs currently working in such areas. Findings indicate that given the difficulty of expanding ongoing recruitment and retention efforts, many underserved rural areas would likely remain underserved in the event of a cutback in IMGs, and many rural areas that are currently adequately served could face serious problems as well. A single national solution to replace IMGs would be difficult. Recruiters and planners within states and local areas will need to expand creative and innovative approaches, and even then, many rural communities might have to make do with less.
• Impact of Conversion to Critical Access Hospital Status on Hospital Financial Performance and Condition
  Date: 11 / 2006
  Author(s): Mark Holmes, George H. Pink, Rebecca T. Slifkin
  Report Number: Flex Monitoring Team Findings Brief No. 1
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Policy brief analyzing financial ratios associated with Critical Access Hospitals' profitability, liquidity, and capital structure. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Impact of Medicaid Cuts on Rural Communities
  Date: 08 / 2005
  Author(s): Pam Silberman, Matt Rudolf, Laura Brogan, Stephanie Poley, Rebecca Slifkin, Charity Moore
  Report Number: Working Paper No. 82
  Topics: Medicaid and S-CHIP, Poverty
  Medicaid is a critical program in both urban and rural areas, but it is particularly important in rural areas because of high levels of poverty and less access to employer-sponsored insurance. This study assesses the perception of state Medicaid staff and individuals from State Offices of Rural Health (SORH) and Rural Health Associations (RHA) regarding the impact on rural areas of state Medicaid policy changes that occurred between 2002 and 2004. Despite the importance of this program to rural communities, our study suggests that few people are specifically concerned with the unique challenges Medicaid changes may pose to rural communities. This study presents insight to the potential rural impact of Medicaid policy changes, especially those that could adversely affect the ability of rural residents to access services or that might potentially affect the overall rural health infrastructure.
• Impact Of The Medicaid Budgetary Crisis On Rural Communities
  Date: 08 / 2003
  Author(s): Pam Silberman, Matthew Rudolf, Cammie D'Alpe, Randy Randolph, Rebecca Slifkin
  Report Number: Working Paper No. 77
  Topic: Medicaid and S-CHIP
  Provides an overview of the Medicaid program and options states have to reduce program costs. Steps states have proposed or taken to reduce Medicaid costs and the potential impact of these changes on rural areas are discussed. The potential impact on rural communities of federal proposals to redesign Medicaid is assessed.
• Impacts of Multiple Race Reporting on Rural Health Policy and Data Analysis
  Date: 05 / 2002
  Author(s): Randy Randolph, Rebecca Slifkin, Lynn Whitener, Anna Wulfsberg
  Report Number: Working Paper No. 73
  Topics: Health policy, Minority health
  Examines some of the impacts to rural health analysis of new federal policy that allows people to choose one or more race categories when classifying themselves. Implementation of the new policy in the 2000 Census yields 63 possible combinations of race classification. Report also presents data on the number of persons choosing more than one race, discusses ways that analysts can handle the issues surrounding multiple race data, and compares several methods for bridging the change from the old single-race system to the new multiple-race system. Among its findings: rural Americans were less inclined to identify themselves as more than one race than were urban Americans; rural western residents were the only ones more inclined to choose multiple races than the rural average; and rural residents of Hawaii, Alaska, and Oklahoma were the most likely to identify with multiple races while those of Mississippi, Pennsylvania, and South Carolina were the least likely to do so.
• Innovative Primary Care Case Management Programs Operating in Rural Communities: Case Studies of Three States
  Date: 01 / 2003
  Author(s): Pam Silberman, Stephanie Poley, Rebecca Slifkin
  Report Number: Working Paper No. 76
  Topic: Medicaid and S-CHIP
  Medicaid managed care programs have been continually growing in the past decade, but this system has posed some problems to rural areas. In order to address these problems, some states have developed alternative managed care strategies, including enhanced primary care case management (PCCM). This study examines three states that have implemented PCCM and provides an overview of each program including their strengths and weaknesses. The states studied are Florida, North Carolina, and Oklahoma.
• Intensive Care In Critical Access Hospitals
  Date: 03 / 2005
  Author(s): Victoria Freeman, Joan Walsh, Matthew Rudolf, Rebecca Slifkin
  Report Number: Working Paper No. 81
  Topics: Health services, Hospitals and clinics
  Describes what officials at Critical Access Hospitals (CAHs) mean when they report that they provide intensive care and the importance of these services to the hospital and the community it serves. Semi-structured interviews were conducted with Directors of Nursing at 63 CAHs in 27 states. Respondents described the physical structure of the intensive care area, equipment and staffing available for such care, types of patients who receive intensive care, transfer patterns, the role of intensive care in the decision to convert to CAH status, and the perceived value of this service to the community and hospital.
• Intensive Care in Critical Access Hospitals
  Date: 2007
  Author(s): Victoria A. Freeman, Joan Walsh, Matthew Rudolf, Rebecca T. Slifkin, Asheley Cockrell Skinner
  Citation: Journal of Rural Health, 23(2), 116-123
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.
• Issues in Staffing Emergency Medical Services: A National Survey of Local Rural and Urban EMS Directors
  Date: 05 / 2008
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Report Number: Final Report No. 93
  Topics: Emergency medical services (EMS), Workforce
  This report explores rural-urban differences in medical oversight and the recruitment and retention of emergency medical technicians (EMTs)and paramedics as reported by a survey of 1,425 local EMS directors.
• Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems
  Date: 03 / 2009
  Author(s): Andrea Radford, Indira Richardson, Michelle Mason, Stephen Rutledge
  Topics: Pharmacy and prescription drugs, Workforce
  This findings brief presents findings from a 2008 survey of 401 community pharmacists that are the only retail provider in their community to document their extended relationships with other health care providers and the additional health care services these pharmacists provide to their patients. Pharmacist-owners in independent pharmacies located at least 10 miles from the next closest retail pharmacy were interviewed to determine the presence in their community of other types of health care organizations that require pharmaceutical support(such as hospitals, long-term care facilities, hospice providers, home health agencies and community health centers), their level of involvement with those facilities, and the types of clinical services (other than dispensing and counseling) the pharmacists offered to their own patients.
• Medicaid & CHIP Participation Among Rural & Urban Children (Policy Brief)
  Date: 07 / 2009
  Author(s): Jennifer King, Rebecca Slifkin, Mark Holmes
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP
  Describes the characteristics of rural and urban children who qualify for Medicaid or CHIP but are uninsured.
• Medicare Beneficiaries' Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans
  Date: 01 / 2009
  Author(s): Victoria A Freeman, Indira Richardson, Rebecca T. Slifkin
  Report Number: Final Report No. 95
  Topics: Medicare, Medicare Part D, Pharmacy and prescription drugs
  Describes the contracting patterns of sole rural community pharmacies to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
• Metropolitan and Micropolitan Core Based Statistical Areas (CBSAs) Map
  Date: 07 / 2003
  Topic: Defining rural
  Map of the June 2003 Office of Management and Budget's metropolitan and micropolitan Core Based Statistical Areas (CBSA )Designations by County.
• One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
  Date: 09 / 2007
  Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
  Report Number: Final Report No. 92 (NC), Final Report No. P2007-1 (RUPRI)
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A findings brief is also available. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
  Date: 10 / 2007
  Author(s): Andrea Radford, Michelle Mason, Indira Richardson, Stephan Rutledge, Stephanie Poley, Keith Mueller, Rebecca Slifkin
  Report Number: Findings Brief No. 83
  Topics: Medicare Part D, Pharmacy and prescription drugs
  Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A final report is also available. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
• Pediatric Care in Rural Hospital Emergency Departments (Final Report)
  Date: 05 / 2010
  Author(s): Victoria A. Freeman, Randy K. Randolph, Stephanie Poley, Sarah Friedman, Rebecca T. Slifkin
  Report Number: 97
  Topics: Children, Emergency medical services (EMS), Hospitals and clinics
  Analyzes data from the Emergency Pediatric Services and Equipment Supplement (EPSES) to the National Hospital Ambulatory Medicare Care Survey to compare rural and urban hospitals' responses on various dimensions of pediatric Emergency Department care.
• Pediatric Care in Rural Hospital Emergency Departments (Findings Brief)
  Date: 05 / 2010
  Author(s): Victoria A. Freeman, Randy K. Randolph, Stephanie Poley, Sarah Friedman, Rebecca T. Slifkin
  Topics: Children, Emergency medical services (EMS), Hospitals and clinics
  Analyzes data from the Emergency Pediatric Services and Equipment Supplement(EPSES) to the National Hospital Ambulatory Medical Care Survey (NHAMCS). Rural and urban hospitals' responses were compared on various dimensions of pediatric ED care. We also surveyed 65 ED directors at rural hospitals in a separate process to explore rural pediatric ED care in more detail and to obtain the opinion of rural ED administrators regarding ways to assure quality emergency care for children.
• PPS Inpatient Payment and the Area Wage Index
  Date: 01 / 2001
  Author(s): Kathleen Dalton, Rebecca T. Slifkin
  Topics: Hospitals and clinics, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Discusses how inpatient rates are calculated, the role of the wage index, and issues surrounding the wage index and reimbursement to rural hospitals by Medicare under the Prospective Payment System (PPS).
• Premium Assistance Programs for Low Income Families: How Well Does it Work in Rural Areas?
  Date: 01 / 2006
  Author(s): Pam Silberman, Laura Brogan, Charity Moore, Rebecca Slifkin
  Report Number: Working Paper No. 85
  Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
  Reports results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance (SCHIP) funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals. Because of the characteristics of rural residents and their employment markets, many stand to benefit from premium assistance programs, but there are also reasons to believe that these programs may be less successful in rural communities. Findings form the telephone survey of Medicaid or SCHIP officials in 14 of the 16 states with at least one premium assistance program indicate that premium assistance programs have not lived up to their potential. Enrollment in most of the states' programs has been small, and while positive in concept, these programs have inherent limitations that may preclude more widespread enrollment. Of particular concern is that rural residents are more likely to work for small employers who do not offer health insurance or have higher premiums or less comprehensive benefits. However, with creative program design, premium assistance programs may be a useful tool for states to expand health insurance coverage to the rural uninsured.
• Primer On Interpreting Hospital Margins
  Date: 07 / 2003
  Author(s): Kathleen Dalton, Rebecca Slifkin
  Topics: Health care financing, Hospitals and clinics
  Explains the most commonly used measures of hospital profitability, and how they are used to inform policy changes. Covers measures of overall or payer-specific profitability, total margins and operating margins. Particular emphasis on the different formulas as they impact rural versus urban hospital figures. Addresses the different ways in which these measures are commonly aggregated when they are used in descriptive studies or regulatory impact statements.
• Primer on the Occupational Mix Adjustment to the Medicare Hospital Wage Index
  Date: 09 / 2006
  Author(s): Kristin Reiter, Rebecca Slifkin, Mark Holmes
  Report Number: Working Paper No. 86
  Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index
  Focuses on the occupational mix adjustment (OMA) to the labor-related share in the hospital inpatient prospective payment system. The Primer explains what the OMA is, why it is needed and how it has been calculated. In addition, reasons why the effect of the OMA has been less than some rural advocates anticipated are discussed.
• Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals with Special Medicare Payment Provisions (Findings Brief)
  Date: 09 / 2010
  Author(s): G. Mark Holmes, George H. Pink, Hilda A. Howard
  Report Number: Findings Brief #97
  Topics: Hospitals and clinics, Medicare
  This study compares the profitability of urban and rural hospitals paid under PPS (U-PPS and R-PPS, respectively) to rural hospitals with special Medicare payment provisions between 2007 and 2009. R-PPS hospitals are subdivided by bed size (<26, 26-50 and >50) to assess differences within the group. Financial ratios are used to compare the profitability of hospital groups, and percentages of hospitals with negative total margins are used as a sign of financial distress.
• Proximity of Rural African American and Hispanic/Latino Communities to Physicians and Hospital Services
  Date: 06 / 2001
  Author(s): Donald E. Pathman, Thomas R. Konrad, Robert Schwartz
  Report Number: Working Paper No. 72
  Topics: African Americans, Health services, Hispanics, Minority health, Physicians
  Assesses how local physician concentrations and distances to hospitals differ for rural communities of varying African American and Hispanic/Latino compositions. Uses data at the town-area level for nine southern and six western states to compare town-areas with low, medium, and high proportions of African Americans and Hispanics on their local physician-to-population ratios and distances to nearest hospital offering each of four levels of services. Among the findings are that rural Hispanics, but not African Americans, face longer travel distances to physicians, and both groups face longer distances to some types of hospital services than do non-minority rural individuals.
• Proximity of Rural Black and Hispanic/Latino Communities to Physicians and Hospital Services
  Date: 05 / 2001
  Author(s): Donald E. Pathman, Thomas R. Konrad, Robert Schwartz
  Topics: African Americans, Health services, Hispanics, Hospitals and clinics, Minority health, Physicians
  This brief reports the findings of a study of how the African American and Hispanic/ Latino composition of rural communities relates to local physician concentrations, and relates to distances to hospitals offering various levels of services.
• Race and Place: Urban-Rural Differences in Health for Racial and Ethnic Minorities
  Date: 03 / 2000
  Author(s): Rebecca T. Slifkin, Laurie J. Goldsmith, Thomas C. Ricketts,
  Topics: AIDS and HIV, Chronic diseases and conditions, Health disparities, Health promotion and disease prevention, Minority health
  This findings brief investigates urban-rural disparities for racial and ethnic minorities in six health areas: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection, and child and adult immunizations.
• Recent Changes in Health Insurance Coverage in Rural and Urban Areas
  Date: 05 / 2011
  Author(s): Jennifer King, George M. Holmes
  Topics: Children, Health insurance and the uninsured
  This findings brief compares changes in health insurance coverage for non-elderly Americans in rural areas to changes in urban areas during the recent economic recession.
• Reducing Mortality from Motor Vehicle Crashes for Children 0 through 14 Years of Age: Success in New York and North Dakota
  Date: 12 / 2004
  Author(s): Victoria Freeman
  Topic: Children
  Reviews effective interventions to reduce motor vehicle crash mortality among children. Explores what is happening in New York and North Dakota that contributes to their success in being among the best performing states in regard to this measure of child health.
• Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
  Date: 01 / 2000
  Author(s): Kathleen Dalton, Rebecca T. Slifkin, Hilda A. Howard
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Medicare Prospective Payment System (PPS)
  Examines rural hospitals that potentially qualify as Critical Access Hospitals (CAH), and identifies facilities at substantial financial risk as a result of Medicare?s expansion of prospective payment systems (PPS) to non-acute settings.
• Rural and Urban Parents Report on Access to Health Care for their Children with Medicaid Managed Care
  Date: 12 / 2005
  Author(s): Victoria Freeman, Rebecca Slifkin, Asheley Skinner, Robert Schwartz
  Report Number: Working Paper No. 84
  Topics: Children, Medicaid and S-CHIP
  There has been little previous research on rural beneficiaries' perspectives on access to care under Medicaid managed care. The study reported here considers the perspective of the rural beneficiary in four states in order to broaden understanding of whether Medicaid managed care programs provide acceptable access to health care services. The study examines access to health care among rural children ages 0-17 who are enrolled in either fully capitated (New Mexico and Washington) or primary care case management (PCCM) Medicaid managed care plans (North Carolina and North Dakota), and compares this access to that of urban beneficiaries. Overall, this study finds that parents of children living in the rural areas who are enrolled in a Medicaid managed care program are almost always able to get the medical care they need. Rural children who are Medicaid enrollees have primary care providers, their parents know how to access care when needed after hours, and although rural children sometimes use the ER, they do not rely on that source of care more than urban parents do. Where barriers to medical care are reported, they are often consistent with those barriers reported for rural residents generally, and do not appear to be related to restrictions from managed care programs. Access to dental services remains a substantial problem, not just for children in rural areas, but for all Medicaid enrollees. 2004
• Rural Hospital Area Wages and the PPS Wage Index: 1900-1997
  Date: 10 / 2000
  Author(s): Kathleen Dalton, Rebecca Slifkin, Hilda Howard
  Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index
  
• Rural Hospital Support for Emergency Medical Services (Final Report)
  Date: 11 / 2010
  Author(s): Victoria A. Freeman, Hilda A. Howard, Ruth Lavergne
  Report Number: #100
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Hospitals and clinics
  This study uses Medicare Hospital Cost Reports to identify rural hospitals, with and without Emergency Medical Services (EMS) units, to answer the following questions: what proportion of rural hospitals support or operate EMS units; has this changed in last five years; what are the characteristics of rural hospitals that support or operate EMS; what are the financial investments made by these hospitals in EMS; and what describes the communities in which these hospitals are located.
• Rural Hospital Support for Emergency Medical Services (Findings Brief)
  Date: 11 / 2010
  Author(s): Victoria A. Freeman, Hilda A. Howard, Ruth Lavergne
  Report Number: #99
  Topics: Emergency medical services (EMS), Hospitals and clinics
  This study uses Medicare Hospital Cost Reports to identify rural hospitals, with and without Emergency Medical Services (EMS) units, to answer the following questions: what proportion of rural hospitals support or operate EMS units; has this changed in last five years; what are the characteristics of rural hospitals that support or operate EMS; what are the financial investments made by these hospitals in EMS; and what describes the communities in which these hospitals are located.
• Rural Hospital Wages and the Area Wage Index: 1990-1997
  Date: 01 / 2001
  Author(s): Kathleen Dalton, Rebecca T. Slifkin, Hilda A. Howard
  Topics: Hospitals and clinics, Medicare Wage Index
  Examines whether incremental changes to the hospital wage index have made it more equitable across regions and how these changes have impacted rural hospitals.
• Rural Hospitals' Experience with the 340B Drug Pricing Program
  Date: 09 / 2007
  Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin
  Topics: Hospitals and clinics, Pharmacy and prescription drugs
  Policy brief describing the results of surveys of rural hospitals participating in the 340B drug pricing program and of rural eligible but non-participating hospitals. Includes information on factors affecting participation in the program and the benefits and challenges of participation.
• Rural Populations and Health Care Providers: A Map Book
  Date: 09 / 2002
  Author(s): Randy Randolph, Katherine Gaul, Rebecca Slifkin
  Topics: Rural statistics and demographics, Workforce
  Uses 2000 Census data to reassess and provide a visual picture of where rural people live, how the racial and ethnic nature of rural populations is changing, and whether the distribution of health care providers matches the population distribution.
• Rural Volunteer EMS: Reports from the Field (Final Report)
  Date: 08 / 2010
  Author(s): Victoria A. Freeman, Stephen Rutledge, Michael Hamon, Rebecca T. Slifkin
  Report Number: Final Report No. 99
  Topic: Emergency medical services (EMS)
  This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondent agencies were considered to be rural if they were located in a nonmetropolitan county or within a metropolitan county in an area with a Rural Urban Commuting Area (RUCA) code of four or higher. A semi-structured interview format encouraged respondents to speculate on the future viability of their local service, describe the challenges they face and what they need to ensure continuance. The descriptions presented represent the perceptions of those interviewed, but are also likely to resonate with other rural EMS administrators.
• Rural Volunteer EMS: Reports from the Field (Findings Brief)
  Date: 09 / 2010
  Author(s): Victoria A. Freeman, Stephen Rutledge, Michael Hamon, Rebecca T. Slifkin
  Report Number: Findings Brief #98
  Topic: Emergency medical services (EMS)
  This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondent agencies were considered to be rural if they were located in a nonmetropolitan county or within a metropolitan county in an area with a Rural Urban Commuting Area (RUCA) code of four or higher. A semi-structured interview format encouraged respondents to speculate on the future viability of their local service, describe the challenges they face and what they need to ensure continuance. The descriptions presented represent the perceptions of those interviewed, but are also likely to resonate with other rural EMS administrators.
• Rural-Urban Comparison of Allied Health Average Hourly Wages
  Date: 01 / 2009
  Author(s): Indira Richardson, Rebecca Slifkin, Randy Randolph, Mark Holmes
  Report Number: Final Report No. 96
  Topic: Workforce
  This report uses data from the Bureau of Labor Statistics to describe the extent to which rural-urban differentials exist in wages for eleven allied health professions, focusing on professions that are both likely to be found in rural communities and have adequate data to support hourly wage estimates.
• Rural-Urban Differences in Characteristics of Local EMS Agencies
  Date: 05 / 2008
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Report Number: Findings Brief 84
  Topics: Emergency medical services (EMS), Workforce
  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 2006-2007.
• Rural-Urban Differences in Nursing Home and Skilled Nursing Supply
  Date: 02 / 2003
  Author(s): Kathleen Dalton, Courtney Harold VanHoutven, Rebecca Slifkin, Stephanie Poley, Ann Howard
  Report Number: Working Paper No. 74
  Topic: Long term care
  Examines characteristics of nursing facilities and the supply of certified skilled nursing beds as the new PPS is being phased in, with particular reference to differences between urban and rural settings. Finds that rural-urban differences in the supply of long-term care beds and in the characteristics of long-term facilities are less pronounced, in general, than rural-urban differences in acute care capacity. Among the differences between urban and rural nursing facilities are: the most rural counties are the most likely to have no certified nursing homes; as counties become more rural, swing beds account for an increasing percentage of Medicare SNF discharges; and long-term care facilities in the most rural counties are more likely to be hospital based. Overall, the supply of nursing facilities does not appear to be a problem in rural areas, with the possible exception of the most rural counties.
• Rural-Urban Issues In The Wage Index Adjustment For Prospective Payment In Skilled Nursing Facilities (Brief Report)
  Date: 01 / 2004
  Author(s): Kathleen Dalton, Rebecca Slifkin
  Report Number: Findings Brief
  Topics: Long term care, Medicare Prospective Payment System (PPS), Medicare Wage Index
  The hourly wage data collected from Medicare-participating nursing homes were used to examine urban and rural patterns in average hourly nursing home wages and patterns of wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates. Working Paper No. 78 also addresses this topic.
• Rural-Urban Issues In The Wage Index Adjustment For Prospective Payment In Skilled Nursing Facilities (Full Report)
  Date: 11 / 2003
  Author(s): Kathleen Dalton, Rebecca Slifkin
  Report Number: Working Paper No. 78
  Topics: Long term care, Medicare Prospective Payment System (PPS), Medicare Wage Index
  The hourly wage data collected from Medicare-participating nursing homes were used to examine urban and rural patterns in average hourly nursing home wages and patterns of wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates. A findings brief on this topic is also available.
• Rural/Urban Differences in Barriers to and Burden of Care for Children With Special Health Care Needs
  Date: 2007
  Author(s): Asheley Cockrell Skinner, Rebecca T. Slifkin
  Citation: Journal of Rural Health, 23(2), 150-157
  Topics: Children, Disabilities
  Examines the barriers and difficulties experienced by rural families of children with special health care needs in caring for their children. Covers rural-urban differences in types of providers used, reasons for unmet health care needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care.
• Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (Findings Brief)
  Date: 02 / 2009
  Author(s): Victoria Freeman, Indira Richardson, Rebecca Slifkin
  Topics: Medicare Part D, Pharmacy and prescription drugs
  This findings brief describes the contracting rates of sole rural community pharmacies in 16 states to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
• State Flex Program at 10 Years: Strengthening Critical Access Hospitals and Rural Communities
  Date: 04 / 2007
  Author(s): John A. Gale, Jennifer Lenardson, Walter R. Gregg, Michelle Casey, Indira Richardson, Stephen Rutledge
  Report Number: Flex Monitoring Team Policy Brief No. 3
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  To understand the priorities and accomplishments of state Flex Grant Programs, members of the Flex Monitoring Team asked Flex Coordinators to identify and discuss their states' three most successful initiatives in the past two years. Interviews were conducted during February 2007 with Flex Coordinators and State Office of Rural Health staff (SORH) in all 45 states. The listed publication is a policy brief; the full report will be available in the fall of 2007. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
  Date: 10 / 2007
  Author(s): John Gale, Jennifer Lenardson, Walt Gregg, Michelle Casey, Indira Richardson, Stephen Rutledge, Rebecca Slifkin
  Report Number: Flex Monitoring Team Briefing Paper No. 15
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural health care infrastructure and discusses which activities were considered most successful by State Flex Coordinators. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• State Profiles of Medicaid and SCHIP in Rural and Urban Areas
  Date: 08 / 2007
  Author(s): Jennifer King, Leslie Geiger, Pam Silberman, Rebecca Slifkin
  Report Number: Final Report No. 91
  Topics: Medicaid and S-CHIP, Rural statistics and demographics
  This final report is one component of a larger project that includes the development of web-based State Profiles of Medicaid and SCHIP in Rural and Urban Areas. The report provides national data comparing Medicaid enrollment and expenditures in rural and urban counties. A summary of these and other data found in the State Profiles is included.
• States' Use of Cost-Based Reimbursement for Medicaid Services at Critical Access Hospitals
  Date: 04 / 2010
  Author(s): Andrea Radford, Mike Hamon, Caitlin Nelligan
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicaid and S-CHIP, Medicare
  Critical Access Hospitals (CAH) are reimbursed by Medicare at 101% of allowable cost for both inpatient and outpatient services. State Medicaid agencies however are not required to reimburse CAHs on a cost-basis and have flexibility in determining how CAHs are paid for providing services to Medicaid enrollees. This brief documents which states utilize a cost-based reimbursement methodology for Medicaid.
• Tracking Medicaid Managed Care in Rural Communities: A Fifty-State Follow-Up
  Date: 08 / 2002
  Author(s): Pam Silberman, Stephanle Poley, Kerry James, Rebecca Slifkin
  Citation: Health Affairs, 21(4), 255-263
  Topic: Medicaid and S-CHIP
  Updates a 1997 study examining implementation of rural Medicaid managed care programs. Among its findings are that there have been significant state-level changes in the types of programs offered; there has been an overall increase in the percentage of urban and rural counties with Medicaid managed care programs; and SCHIP expansion has had little impact on the operation of fully capitated Medicaid managed care programs in rural areas because the increased number of children covered has not been large enough to affect health plans' participation. Concludes that looking only at the increase in rural Medicaid managed care since 1997 could lead to a false impression. While the number of rural counties with fully capitated programs has increased, states' more recent experiences suggest that health plans are pulling out of rural areas just as they are pulling out of urban ones. States may find it difficult to find commercial HMOs willing to participate in Medicaid managed care at prices that states can afford.
• Trend Toward the Clinical Doctorate in Allied Health: Implications for Rural Communities (Final Report)
  Date: 08 / 2008
  Author(s): Janet Freburger, Jennifer King, Rebecca Slifkin
  Report Number: No.94
  Topic: Workforce
  This final report examines how the transition to the Doctor of Physical Therapy (DPT) degree has affected the supply and quality of rural physical therapy care.
• Trends in Skilled Nursing and Swing-bed Use in Rural Areas, 1996-2003
  Date: 12 / 2005
  Author(s): Kathleen Dalton, Jeongyoung Park, Ann Howard, Rebecca Slifkin
  Report Number: Working Paper No. 83
  Topics: Health services, Hospitals and clinics, Medicare
  Examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a period of dramatic change in Medicare payments for both acute and post-acute care, focusing on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment. The authors examined changes in the number and types of facilities providing this level of care, and computed comparative statistics on Medicare utilization, case mix, ancillary service use and per diem costs across the three different institutional settings where inpatient skilled nursing services can be provided-freestanding SNFs, hospital-based units, and swing beds in acute care hospitals.
• Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 (Findings Brief)
  Date: 08 / 2011
  Author(s): Kristin L. Reiter, Victoria A. Freeman
  Topics: Hospitals and clinics, Medicare
  This findings brief looks at if the the availability of post-acute skilled care stabilized, and how and where is it being provided today now that the reimbursement policy changes begun in the late 1990s have been fully implemented.
• Trends in the Provision of Surgery by Rural Hospitals
  Date: 07 / 2011
  Author(s): George M. Holmes, Saleema A. Karim, George H. Pink
  Topic: Hospitals and clinics
  Describes trends in the provision of surgery by rural hospitals.
• Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
  Date: 02 / 2006
  Author(s): Kathleen Dalton, Rebecca Slifkin, Jeongyoung Park, and Hilda Ann Howard
  Report Number: Findings Brief No. 81
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Examines trends in the delivery of skilled nursing facility 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).
• Unpredictable Demand and Low-Volume Hospitals
  Date: 01 / 2003
  Author(s): Kathleen Dalton, Mark Holmes, Rebecca Slifkin
  Report Number: Findings Brief 75
  Topic: Hospitals and clinics
  This Findings Brief assesses the degree to which the annual number of patient discharges varies from year to year for low volume hospitals. The study finds that low volume hospitals face more instability from year to year in demand for inpatient services than larger hospitals. Also, the average variability over time for the smallest hospitals, defined as less than 500 or fewer discharges a year, is nearly 60% higher than the average for all hospitals. Finally, the study concluded that even though low volume, rather than rurality, is the important factor, hospitals in extremely rural counties must contend with more fluctuation than other hospitals, primarily because they tend to be smaller.
• Unstable Demand and Cost per Case in Low-Volume Hospitals
  Date: 01 / 2003
  Author(s): Kathleen Dalton, Mark Holmes, Rebecca Slifkin
  Report Number: Findings Brief 76
  Topic: Hospitals and clinics
  This Findings Brief looks at the effects of year-to-year changes in annual inpatient discharges on costs per Medicare discharge. The analysis finds that small hospital costs are more vulnerable to change than larger hospital costs. As a result, average costs per discharge are less stable, making it difficult for these facilities to predict and manage profitability under fixed payment schemes. The study finds that among the lowest volume hospitals, there is a 10% decrease in discharges with every 3% increase in the cost per Medicare case. In addition, the study found that hospitals allowed to use swing-beds for long-term care patients are not less sensitive to volume fluctuations.
• Urban-Rural Flows of Physicians
  Date: 2007
  Author(s): Thomas C. Ricketts, Randy Randolph
  Citation: Journal of Rural Health, 23(4), 277–285
  Topics: Physicians, Workforce
  Reports findings from a study to determine whether there was a significant flow of physicians from urban to rural areas in recent years when the overall supply of physicians has been considered in balance with needs.
• Variations in Financial Performance Among Peer Groups of Critical Access Hospitals
  Date: 2007
  Author(s): George H. Pink, George M. Holmes, Roger E. Thompson, Rebecca T. Slifkin
  Citation: Journal of Rural Health, 23(4), 299–305
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Reports findings from a study that investigated whether indicators of financial performance and condition systematically vary among peer groups of Critical Access Hospitals (CAHs). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• What Does the Allied Health Clinical Doctorate Mean for Rural Areas (Findings Brief)
  Date: 12 / 2008
  Author(s): Janet Freburger, Jennifer King, Rebecca Slifkin
  Topic: Workforce
  This findings brief examines how the transition to the Doctor of Physical Therapy (DPT) degree has affected the supply and quality of rural physical therapy care.
• Workforce Issues Among Sole Community Pharmacies
  Date: 07 / 2009
  Author(s): Donald Klepser, Michelle Lampman, Andrea Radford, Indira Richardson, Stephen Rutledge
  Topics: Pharmacy and prescription drugs, Workforce
  Pharmacy services are delivered through a sole community pharmacy in over 1000 small rural communities nationwide. This brief presents the findings from 401 telephone interviews of sole community pharmacist-owners nationwide about their current staffing and future plans. Thirty-three percent of those interviewed have one or fewer pharmacist FTEs on staff. Thirty percent of those interviewed would like to retire in five years or fewer, and most would like to sell their pharmacies upon retirement. This brief explores the shared experiences of sole community pharmacist-owners regarding the challenges facing the pharmacy workforce in their communities and their concerns about their pharmacy's future.
• Workforce Issues in Rural Areas: A Focus on Policy Equity
  Date: 01 / 2005
  Author(s): Thomas C. Ricketts
  Citation: American Journal of Public Health, 95(1), 42-48
  Topics: Health policy, Nurses, Pharmacy and prescription drugs, Physicians, Workforce
  Reviews the geographic distribution of 6 classes of health professionals: physicians, nurses, dentists, pharmacists, mental health professionals, and public health professionals. Describes the government and private policies and programs intended to affect the geographic distribution of these health professionals.