George Pink, PhD

North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.966.1457
E-mail: gpink@email.unc.edu

University of North Carolina - Chapel Hill

Current Projects (1)

Community and Financial Experience of Medicare Dependent Hospitals in Comparison to Other Rural Hospitals
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
This research will investigate the community and financial experience of Medicare Dependent Hospitals in comparison with other rural hospitals. Analysis of the financial experience will include comparison of the long-term profitability of MDHs to other rural hospitals, estimation of the potential profitability consequences of eliminating the payment classification, and estimation of the potential consequences of maintaining the payment classification but failing to update the base year from which costs are trended forward.

Completed Projects (3)

Developing a Financial Performance Measurement System for Critical Access Hospitals
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs.

Importance of Surgery to Rural Hospital Financial Condition and Market Share
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Hospitals and clinics
This study explores the provision of surgical services in rural hospitals and its relationship to financial performance. The percentage of rural hospitals that offer surgical services and the number that have discontinued surgical services over the last decade will be described, and, for those that have discontinued services, the impact on financial condition will be explored.

Rural-urban Comparison of Hospital Financial Performance by Medicare Payment Classification, Lead researcher
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Medicare
This project will compare the financial performance of rural and urban short term general hospitals by Medicare payment classifications (PPS only, Medicare dependent hospitals, sole community hospitals, rural referral centers, and critical access hospitals).

Publications (10)

Comparative Performance Data for Critical Access Hospitals
Author(s): George H. Pink, Rebecca T. Slifkin, Andrew F. Coburn, John A. Gale
Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
Citation: Journal of Rural Health, 20(4), 374-382
Date: 2004
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)
Author(s): G. Mark Holmes, George H. Pink, Sarah A. Friedman, Hilda A. Howard
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare, Medicare Prospective Payment System (PPS)
Report Number: No.98
Date: 08 / 2010
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.
Effect of Swing Bed Use on Medicare Average Daily Cost and Reimbursement in Critical Access Hospitals
Author(s): Kristin L. Reiter, George M. Holmes, George H. Pink, Victoria A. Freeman
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare
Date: 12 / 2011
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.
Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (Findings Brief)
Author(s): George H. Pink, Rebecca T. Slifkin, Hilda A. Howard
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
Date: 04 / 2010
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
Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
Report Number: Flex Monitoring Team Briefing Paper No. 7
Date: 05 / 2005
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.
Financial Indicators for Critical Access Hospitals
Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca T. Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
Citation: Journal of Rural Health, 22(3), 229-36
Date: 2006
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.
Impact of Conversion to Critical Access Hospital Status on Hospital Financial Performance and Condition
Author(s): Mark Holmes, George H. Pink, Rebecca T. Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
Report Number: Flex Monitoring Team Findings Brief No. 1
Date: 11 / 2006
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.
Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals with Special Medicare Payment Provisions (Findings Brief)
Author(s): G. Mark Holmes, George H. Pink, Hilda A. Howard
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Hospitals and clinics, Medicare
Report Number: Findings Brief #97
Date: 09 / 2010
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.
Trends in the Provision of Surgery by Rural Hospitals
Author(s): George M. Holmes, Saleema A. Karim, George H. Pink
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topic: Hospitals and clinics
Date: 07 / 2011
Describes trends in the provision of surgery by rural hospitals.
Variations in Financial Performance Among Peer Groups of Critical Access Hospitals
Author(s): George H. Pink, George M. Holmes, Roger E. Thompson, Rebecca T. Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
Citation: Journal of Rural Health, 23(4), 299�305
Date: 2007
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.

Topics Centers Researchers Other Resources Search		George Pink, PhD North Carolina Rural Health Research and Policy Analysis Center Phone: 919.966.1457 E-mail: gpink@email.unc.edu University of North Carolina - Chapel Hill Current Projects (1) Community and Financial Experience of Medicare Dependent Hospitals in Comparison to Other Rural Hospitals Research center: North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS) This research will investigate the community and financial experience of Medicare Dependent Hospitals in comparison with other rural hospitals. Analysis of the financial experience will include comparison of the long-term profitability of MDHs to other rural hospitals, estimation of the potential profitability consequences of eliminating the payment classification, and estimation of the potential consequences of maintaining the payment classification but failing to update the base year from which costs are trended forward. Completed Projects (3) Developing a Financial Performance Measurement System for Critical Access Hospitals Research center: North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs. Importance of Surgery to Rural Hospital Financial Condition and Market Share Research center: North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topic: Hospitals and clinics This study explores the provision of surgical services in rural hospitals and its relationship to financial performance. The percentage of rural hospitals that offer surgical services and the number that have discontinued surgical services over the last decade will be described, and, for those that have discontinued services, the impact on financial condition will be explored. Rural-urban Comparison of Hospital Financial Performance by Medicare Payment Classification, Lead researcher Research center: North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topics: Hospitals and clinics, Medicare This project will compare the financial performance of rural and urban short term general hospitals by Medicare payment classifications (PPS only, Medicare dependent hospitals, sole community hospitals, rural referral centers, and critical access hospitals). Publications (10) Comparative Performance Data for Critical Access Hospitals Author(s): George H. Pink, Rebecca T. Slifkin, Andrew F. Coburn, John A. Gale Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality Citation: Journal of Rural Health, 20(4), 374-382 Date: 2004 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) Author(s): G. Mark Holmes, George H. Pink, Sarah A. Friedman, Hilda A. Howard Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare, Medicare Prospective Payment System (PPS) Report Number: No.98 Date: 08 / 2010 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. Effect of Swing Bed Use on Medicare Average Daily Cost and Reimbursement in Critical Access Hospitals Author(s): Kristin L. Reiter, George M. Holmes, George H. Pink, Victoria A. Freeman Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare Date: 12 / 2011 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. Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (Findings Brief) Author(s): George H. Pink, Rebecca T. Slifkin, Hilda A. Howard Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS) Date: 04 / 2010 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 Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing Report Number: Flex Monitoring Team Briefing Paper No. 7 Date: 05 / 2005 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. Financial Indicators for Critical Access Hospitals Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca T. Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing Citation: Journal of Rural Health, 22(3), 229-36 Date: 2006 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. Impact of Conversion to Critical Access Hospital Status on Hospital Financial Performance and Condition Author(s): Mark Holmes, George H. Pink, Rebecca T. Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing Report Number: Flex Monitoring Team Findings Brief No. 1 Date: 11 / 2006 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. Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals with Special Medicare Payment Provisions (Findings Brief) Author(s): G. Mark Holmes, George H. Pink, Hilda A. Howard Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Hospitals and clinics, Medicare Report Number: Findings Brief #97 Date: 09 / 2010 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. Trends in the Provision of Surgery by Rural Hospitals Author(s): George M. Holmes, Saleema A. Karim, George H. Pink Research center: North Carolina Rural Health Research and Policy Analysis Center Topic: Hospitals and clinics Date: 07 / 2011 Describes trends in the provision of surgery by rural hospitals. Variations in Financial Performance Among Peer Groups of Critical Access Hospitals Author(s): George H. Pink, George M. Holmes, Roger E. Thompson, Rebecca T. Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing Citation: Journal of Rural Health, 23(4), 299�305 Date: 2007 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.