Mark Holmes, PhD

Director, North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.966.5541
Fax: 919.966.5764
E-mail: mark_holmes@unc.edu

Rural Health Research and Policy Analysis Center
University of North Carolina - Chapel Hill
725 MLK Jr. Blvd., CB 7590
Chapel Hill, NC 27599-7590

Current Projects (3)

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.

Comprehensive Study of Swing Bed Use in 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 project will comprehensively address questions about how swing beds are used by rural hospitals. Questions to be answered include whether decision about use are driven by patient need, community resources, hospital operational concerns or some combination of these factors; the cost implications of swing bed use in critical access hospitals to the Medicare program; and whether patients served in swing beds differ in meaningful ways from those in skilled nursing facilities.

Patterns of Care in Small Rural Areas: Implications for New Models of Care Provision and Payment such as Bundled Payments and Accountable Care Organizations
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Health services
This study will describe usual patterns of care in rural areas to determine whether rural areas are part of a single service area, or whether smaller communities utilize services from a variety of larger hubs. The results of this analysis will inform a thought piece on how the concepts of bundled payments and Accountable Care Organizations might play out in small rural areas and whether small rural communities can be assigned to a single service area without major disruption of current patterns of care.

Completed Projects (1)

Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion
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, Medicare Prospective Payment System (PPS)
Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion.

Publications (16)

Cesarean Section Patterns In Rural Hospitals
Author(s): Sandra B. Greene, George M. Holmes, Rebecca Slifkin, Victoria Freeman, Hilda Ann Howard
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Hospitals and clinics, Maternal and child health
Report Number: Working Paper No. 80
Date: 11 / 2004
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
Author(s): Sandra Greene, George Holmes, Rebecca Slifkin, Victoria Freeman, Hilda Ann Howard
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Hospitals and clinics, Maternal and child health
Report Number: Findings Brief No. 79
Date: 03 / 2005
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.
Characteristics of Rural & Urban Children Who Qualify For Medicaid or CHIP But Are Not Enrolled (Policy Brief)
Author(s): Jennifer King, Rebecca Slifkin, Mark Holmes
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP
Date: 07 / 2009
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.
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 Rural Hospital Closures on Community Economic Health
Author(s): George M. Holmes, Rebecca T. Slifkin, Randy K. Randolph, Stephanie Poley
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Economic development, Hospitals and clinics
Citation: Health Services Research, 41(2), 467-485
Date: 2006
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.
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.
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
Author(s): Erin P. Fraher, Rebecca T. Slifkin, Laura Smith, Randy Randolph, Matthew Rudolf, George M. Holmes
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Health care financing, Health policy, Medicare Part D, Pharmacy and prescription drugs
Citation: Journal of Rural Health, 21(2), 114-121
Date: 2005
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.
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.
Medicaid & CHIP Participation Among Rural & Urban Children (Policy Brief)
Author(s): Jennifer King, Rebecca Slifkin, Mark Holmes
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP
Date: 07 / 2009
Describes the characteristics of rural and urban children who qualify for Medicaid or CHIP but are uninsured.
Primer on the Occupational Mix Adjustment to the Medicare Hospital Wage Index
Author(s): Kristin Reiter, Rebecca Slifkin, Mark Holmes
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index
Report Number: Working Paper No. 86
Date: 09 / 2006
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)
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.
Rural-Urban Comparison of Allied Health Average Hourly Wages
Author(s): Indira Richardson, Rebecca Slifkin, Randy Randolph, Mark Holmes
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topic: Workforce
Report Number: Final Report No. 96
Date: 01 / 2009
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.
Unpredictable Demand and Low-Volume Hospitals
Author(s): Kathleen Dalton, Mark Holmes, Rebecca Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topic: Hospitals and clinics
Report Number: Findings Brief 75
Date: 01 / 2003
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
Author(s): Kathleen Dalton, Mark Holmes, Rebecca Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topic: Hospitals and clinics
Report Number: Findings Brief 76
Date: 01 / 2003
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.
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		Mark Holmes, PhD Director, North Carolina Rural Health Research and Policy Analysis Center Phone: 919.966.5541 Fax: 919.966.5764 E-mail: mark_holmes@unc.edu Rural Health Research and Policy Analysis Center University of North Carolina - Chapel Hill 725 MLK Jr. Blvd., CB 7590 Chapel Hill, NC 27599-7590 Current Projects (3) 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. Comprehensive Study of Swing Bed Use in 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 project will comprehensively address questions about how swing beds are used by rural hospitals. Questions to be answered include whether decision about use are driven by patient need, community resources, hospital operational concerns or some combination of these factors; the cost implications of swing bed use in critical access hospitals to the Medicare program; and whether patients served in swing beds differ in meaningful ways from those in skilled nursing facilities. Patterns of Care in Small Rural Areas: Implications for New Models of Care Provision and Payment such as Bundled Payments and Accountable Care Organizations Research center: North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, Health services This study will describe usual patterns of care in rural areas to determine whether rural areas are part of a single service area, or whether smaller communities utilize services from a variety of larger hubs. The results of this analysis will inform a thought piece on how the concepts of bundled payments and Accountable Care Organizations might play out in small rural areas and whether small rural communities can be assigned to a single service area without major disruption of current patterns of care. Completed Projects (1) Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion 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, Medicare Prospective Payment System (PPS) Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion. Publications (16) Cesarean Section Patterns In Rural Hospitals Author(s): Sandra B. Greene, George M. Holmes, Rebecca Slifkin, Victoria Freeman, Hilda Ann Howard Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Hospitals and clinics, Maternal and child health Report Number: Working Paper No. 80 Date: 11 / 2004 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 Author(s): Sandra Greene, George Holmes, Rebecca Slifkin, Victoria Freeman, Hilda Ann Howard Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Hospitals and clinics, Maternal and child health Report Number: Findings Brief No. 79 Date: 03 / 2005 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. Characteristics of Rural & Urban Children Who Qualify For Medicaid or CHIP But Are Not Enrolled (Policy Brief) Author(s): Jennifer King, Rebecca Slifkin, Mark Holmes Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP Date: 07 / 2009 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. 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 Rural Hospital Closures on Community Economic Health Author(s): George M. Holmes, Rebecca T. Slifkin, Randy K. Randolph, Stephanie Poley Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Economic development, Hospitals and clinics Citation: Health Services Research, 41(2), 467-485 Date: 2006 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. 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. 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 Author(s): Erin P. Fraher, Rebecca T. Slifkin, Laura Smith, Randy Randolph, Matthew Rudolf, George M. Holmes Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Health care financing, Health policy, Medicare Part D, Pharmacy and prescription drugs Citation: Journal of Rural Health, 21(2), 114-121 Date: 2005 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. 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. Medicaid & CHIP Participation Among Rural & Urban Children (Policy Brief) Author(s): Jennifer King, Rebecca Slifkin, Mark Holmes Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP Date: 07 / 2009 Describes the characteristics of rural and urban children who qualify for Medicaid or CHIP but are uninsured. Primer on the Occupational Mix Adjustment to the Medicare Hospital Wage Index Author(s): Kristin Reiter, Rebecca Slifkin, Mark Holmes Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index Report Number: Working Paper No. 86 Date: 09 / 2006 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) 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. Rural-Urban Comparison of Allied Health Average Hourly Wages Author(s): Indira Richardson, Rebecca Slifkin, Randy Randolph, Mark Holmes Research center: North Carolina Rural Health Research and Policy Analysis Center Topic: Workforce Report Number: Final Report No. 96 Date: 01 / 2009 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. Unpredictable Demand and Low-Volume Hospitals Author(s): Kathleen Dalton, Mark Holmes, Rebecca Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topic: Hospitals and clinics Report Number: Findings Brief 75 Date: 01 / 2003 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 Author(s): Kathleen Dalton, Mark Holmes, Rebecca Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topic: Hospitals and clinics Report Number: Findings Brief 76 Date: 01 / 2003 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. 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.