Janet Sutton, PhD

Current Projects

Outpatient Payment Policy Under Medicare: Recent Policy Developments from the Rural Perspective
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Hospitals and clinics
This study was designed to examine outpatient payment options for rural hospitals, the advantages and disadvantages of each, and their potential impact on hospital revenue and rural access to health services.

Quality Improvement Organizations' Contributions to Rural Hospital Performance
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health information technology, Hospitals and clinics, Quality
This qualitative study is designed to gather information on best-practices in Quality Improvement Organization (QIO)-rural hospital partnerships. Specifically, this study will identify successful and replicable examples in which QIOs have worked with rural and critical access hospitals to improve processes of care, implement health information technology and promote organizational safety culture.

Completed Projects

Achieving Equity in Disproportionate Share Payments to Rural Hospitals: An Examination of MedPAC's Revised Disproportionate Share Formula, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Hospitals and clinics, Legislation and regulation

Burdens of HIPAA on Rural Hospitals, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Legislation and regulation

Determinants of Quality of Care in Rural Communities: How Does The Health Care Infrastructure Affect Quality of Care in Rural America?, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Quality, Workforce

Effective Strategies for Achieving HIPAA Compliance Among Rural Hospitals, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Hospitals and clinics, Legislation and regulation

Impact of CAH Conversion on Hospital Costs and Mix of Services, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services
This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.

Impact of the Home Health PPS on Access in Rural America, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Home health, Medicare Prospective Payment System (PPS)
This study is designed to help policymakers understand whether patterns of home care use in rural communities have been affected by the PPS. Analyses will provide information on the characteristics of the patients served, the number and mix of services rendered, and quality of care.

Medicare Beneficiary Outcomes in Rural and Urban Home Health Agencies, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Home health, Medicare Prospective Payment System (PPS), Quality
This study will compare the performance of rural and urban home care agencies, and identify agency characteristics that contribute to better patient care outcomes.

Options for Structuring Disproportionate Share (DSH) Payments to Account for Uncompensated Care: Impact on Rural Hospitals, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Hospitals and clinics
This study will identify options for development of an equitable DSH payment adjustment that accounts for hospital uncompensated care costs and determine the financial impact of each of these proposals on rural hospitals, using simulations with data from Washington, West Virginia, Texas, and Iowa.

Post-Acute Care: A Rural and Urban Comparison, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Home health, Long term care, Medicare
This multi-phase analysis examines whether discharge patterns for and use of post-acute care services by rural and urban hospitalized Medicare beneficiaries differ and, if they do, what are the sources of these different patterns.

Rapid Response: Elimination of Bad Debt Payments to Rural PPS Hospitals , Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
The purpose of this project is to examine: (1) the extent to which elimination of Medicare Bad Debt payments will reduce reimbursement to rural PPS hospitals and (2) how rural hospitals would respond to this reduction in reimbursement.

Rural Dimensions of Medicare Payment Policies, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Topics: Health policy, Medicare

Rural Dimensions of Medicare Payment Policies, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Medicare

Publications

• Achieving Equity in Medicare DSH Payments to Rural Hospitals: An Assessment of the Financial Impact of Recent and Proposed Changes to the DSH Payment Formula
  Author(s): Janet Sutton, Jeffrey Stensland, Lan Zhao, Michael Cheng
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Date: 05 / 2002
  Examines how Benefits Improvement and Protection Act revisions to the qualifying and distribution formulas of the Medicare disproportionate share hospital (DSH) program are likely to affect rural hospital financial performance as measured by hospital operating and total margins. Also considers the effect of establishing a uniform DSH formula. The study shows that paying rural hospitals based on the rules used for urban hospitals would produce financial benefits that could improve access to care in rural communities. Notably, nearly one-fifth of financially distressed rural hospitals could have remained "in the black" and an even greater proportion could have received additional funds to cover costs incurred by treating indigent members of the community if rural hospitals had been paid in 1998 under the same DSH formula. Among the chief economic winners would be the smallest rural hospitals, which generally are in worse financial condition than other hospitals. Findings suggest that elimination of rural and urban disparities in DSH payment could strengthen the rural health care safety net. Report available on request.
• Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
  Author(s): Janet P. Sutton, June Eichner
  Research center: Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS)
  Report Number: W Series No.15
  Date: 10 / 2008
  This brief presents NORC Walsh Center for Rural Health Analysis research conducted to better understand the experiences of CAHs in operating an EMS unit. Using key informant interviews, researchers examined motivations for acquiring EMS services and the effect of these services on the level of emergency care available in the community. The benefits and challenges that CAH providers face in operating EMS services are discussed.
• Home Health Payment Reform: Trends In The Supply Of Rural Agencies And Availability Of Home-Based Skilled Services
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare
  Report Number: Policy Analysis Brief, W Series No. 6
  Date: 03 / 2005
  Findings from this study suggest that changes in home health reimbursement were associated with dramatic reductions in the supply of home care agencies; however those reductions appear to have occurred primarily during the time in which the Interim Payment System was in place. Although proportionately fewer rural agencies closed between 1998 and 2000, the closure of a rural agency may have a greater impact on access since many communities are experiencing critical shortages of providers. In the post-PPS period, agency supply became more stable, but closure rates were higher among rural agencies.
• How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
  Author(s): Janet P. Sutton, Alene Kennedy, Lucia Hammer, Grace Yang
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
  Report Number: Walsh W Series No. 11
  Date: 07 / 2007
  Policy brief examining the financial effect that changes in current Medicare bad debt payment policy, as proposed in the FY2007 budget, might have on rural hospitals.
• Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services (Final Report)
  Author(s): Julie Schoenman and Janet Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services
  Date: 08 / 2008
  This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
• Is the Rural Safety Net at Risk? Analyses of Charity and Uncompensated Care Provided by Rural Hospitals in Washington, West Virginia, Texas, Iowa, and Vermont
  Author(s): Janet Sutton, Bonnie B. Blanchfield, Andrew Singer, Meredith Milet
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health insurance and the uninsured, Hospitals and clinics
  Date: 01 / 2001
  Examines recent trends in the provision of both charity care and uncompensated care by rural hospitals in five states. Also identifies rural communities whose charity and uncompensated care may diminish if their hospitals face more intense financial pressures as a result of the Balanced Budget Act. Two major findings: 1) differences in hospitals' expenditures on charity and uncompensated care vary dramatically across states; and 2) hospital financial health may have a limited effect on charity and uncompensated care expenditures. Concludes that future access to hospital services in many rural communities will depend upon how the uncompensated care burden is shared between hospitals and the state. Report available on request.
• Patterns Of Post-Acute Utilization In Rural And Urban Communities: Home Health, Skilled Nursing, and Inpatient Medical Rehabilitation
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Long term care
  Date: 03 / 2005
  Describes rural Medicare beneficiaries' patterns of post-acute utilization of home health services, skilled nursing facilities, and inpatient rehabilitation facilities. This study provides baseline data that policymakers, researchers, and others who are interested in rural health care issues may use to monitor how changes in Medicare policies affect access to post-acute care in rural areas.
• Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare
  Date: 05 / 2006
  This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes, and to ascertain whether there are agency characteristics that are associated with better or worse outcomes. This study found rather small differences in the quality of care provided by home health agencies in rural and urban areas. Findings from the multivariate analyses indicated that rural agencies performed better on measures of improvement in walking, transferring, and dressing, whereas urban agencies performed better on measures of improvement in pain frequency and medication management. Rural or urban location had only a modest effect on functional performance scores. Rural and urban agency differences in rates of unplanned urgent care and hospital admissions were not statistically significant after controlling for other agency characteristics, region of country and characteristics of the health care market.
• Revisions to Medicare's Disproportionate Share Payment Policy to Incorporate Bad Debt and Charity Care
  Author(s): Julie A. Schoenman, Janet P. Sutton, Lan Zhao
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Date: 09 / 2005
  Investigates the impact of possible changes to the Medicare disproportionate share (DSH) payment policy, designed to incorporate information on the hospital's uncompensated care burden as well as to improve the payment formulae. DSH payments were computed for individual study hospitals under six alternative models, and compared to the payments now made under current law. For each alternative, the authors examined the overall financial impact by type of hospital and the characteristics of hospitals that would experience either large payment increases or decreases relative to the current system. These analyses are intended to help policymakers evaluate the likely impact of revising the DSH payment methodology.
• Rural and Urban Patterns of Home Health Use: Implications for Access Under the Interim Payment System
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare
  Date: 03 / 2000
  This policy analysis brief compares patterns of home health utilization among rural and urban Medicare beneficiaries in order to estimate the potential impact of an interim payment system (IPS) on access to home care in rural areas of the country. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
  Author(s): Curt Mueller, Keith Mueller, Janet Sutton
  Research centers: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Report Number: Walsh W Series No. 6, RUPRI P2004-6
  Date: 08 / 2004
  Provides in chart form sections of the MMA which were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policymakers. The particular sections are cited and implications for rural health services are indicated. Most of the sections identified are concerned with access to prescription drug coverage and the impact of the proposed legislation on rural pharmacies. The primary focus is on rules that will affect providers of drug coverage; this policy paper does not focus on rural dimensions of coverage from the insurance providers' perspective.
• Spontaneous Evacuation Following a Dirty Bomb or Pandemic Influenza: Highlights from a National Survey of Urban Residents’ Intended Behavior
  Author(s): Michael Meit, Thomas Briggs, Alene Kennedy, Janet Sutton, Jacob Feldman
  Research center: Walsh Center for Rural Health Analysis
  Topic: Emergency preparedness
  Report Number: W Series No. 12
  Date: 11 / 2007
  Reports results of a national survey to assess the evacuation intentions of urban citizens following emergency scenarios. Includes information on how likely it would be for evacuees to go to a rural or urban area. Discusses the potential impact of an urban evacuation on rural areas.
• Utilization of Home Health Services Among Rural Medicare Beneficiaries Before and After the PPS
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare Prospective Payment System (PPS), Rural statistics and demographics
  Date: 08 / 2005
  Describes a study conducted to gather information on the rural effects of the PPS, including whether the PPS contributed to changes in: (1) the demographic and clinical characteristics of home care users; (2) the likelihood of using each of six home care disciplines (aide, skilled nursing, physical therapy, occupational therapy, speech therapy and medical social work); and (3) the intensity of services. A total of 99,367 home health episodes were represented in the two years of Medicare data examined. In both study years, urban residents accounted for three-quarters of episodes, while residents of large rural counties and those of remote rural counties accounted for approximately 21 percent and 3 percent of episodes, respectively. Findings suggest that the PPS has had a mixed effect on access to home care in rural counties. Study results indicated an association between implementation of the PPS and admitting home health diagnoses, utilization and intensity of home care episodes and, for the subset of home health users admitted from an acute hospital, readmission rates.