Walter Gregg, MA, MPH

Upper Midwest Rural Health Research Center

Phone: 612.627.4411
E-mail: gregg006@umn.edu

University of Minnesota

Current Projects

The Impact of Expansion of Ambulatory Surgery Centers on Rural Hospitals and Communities
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health services
This project will examine the extent of freestanding ambulatory surgery center (ASC) expansion into rural communities between 1998 and 2005, the market factors driving that expansion, and the impact of ASCs on the operational and financial viability of rural hospitals located in the same communities.

Completed Projects

Critical Access Hospital Access To and Use of Capital, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program
This project will describe the capital needs of CAHs and their experiences in accessing and using capital, based on data from an e-mail survey of State Flex Coordinators, the TASC listserve, telephone contacts with Flex Coordinators in key states, and Medicare Cost Reports.

National Rural Hospital Flexibility Program Tracking Project: Analysis of Network Development Strategies and CAH Performance, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program, Networking and collaboration

National Rural Hospital Flexiblity Program Tracking Project: Analysis of Hospital Conversion and Network Development Strategies, Lead researcher
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Networking and collaboration

Role of Rural Hospitals in Community-Centered Systems of Care: Supporting Population Health Improvement for Rural Communities
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health services, Hospitals and clinics
This project will assess the degree to which rural hospitals engage in activities that facilitate community responsiveness and the provision of community-oriented services, using 1996 to 2004 data from the American Hospital Association Annual Survey and the Area Resource File.

Rural Hospitals' Access to Capital
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Capital funding, Hospitals and clinics

Publications

• Availability and Use of Capital by Critical Access Hospitals
  Author(s): Walter Gregg
  Research center: Minnesota Rural Health Research Center
  Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Briefing Paper No. 4
  Date: 03 / 2005
  Examines the experiences of Critical Access Hospitals (CAHs) in meeting their capital needs. It focuses specifically on their efforts to obtain capital, the capital sources tapped through these efforts, how CAHs have used the capital they have been able to obtain over the past few years, and assesses their current capital needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Community Impact of Critical Access Hospitals
  Author(s): John A. Gale, Andrew F. Coburn, Victoria Freeman, Walter R. Gregg, Rebecca Slifkin
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Policy Brief No. 2
  Date: 02 / 2007
  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.
• Current Status of Health Information Technology Use in CAHs
  Author(s): Michelle Casey, Jill Klingner, Walt Gregg, Ira Moscovice, Emily Nicholson, Tami Lichtenberg, Terry Hill
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health information technology
  Report Number: Briefing Paper No. 11
  Date: 05 / 2006
  Both the public and private sectors have focused considerable attention on health information technology (HIT) as a potential means of improving the quality, safety, and efficiency of health care. The purpose of this briefing paper is to assess the current status of HIT use in Critical Access Hospitals (CAHs) nationally. This project is part of the federal Office of Rural Health Policy's initiative to implement national performance measures for the Medicare Rural Hospital Flexibility Program. It was conducted by the Flex Monitoring Team in collaboration with the Technical Assistance and Services Center (TASC) at the Rural Health Resource Center in Duluth, Minnesota. Data for the study came from a national survey of CAHs conducted in March and April 2006. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Exploring the Community Impact of Critical Access Hospitals
  Author(s): John Gale, Andrew Coburn, Walt Gregg, Rebecca Slifkin, Victoria Freeman
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Report Number: Flex Monitoring Team Briefing Paper No. 14
  Date: 01 / 2007
  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.
• Far From the City: Community Orientation and Responsiveness of Rural Hospitals
  Author(s): Walter Gregg, Douglas Wholey
  Research center: Upper Midwest Rural Health Research Center
  Topics: Health services, Hospitals and clinics
  Date: 05 / 2008
  Reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts. Study findings suggest that measures of community orientation and responsiveness differ between urban and rural hospitals, and further research is needed to develop an improved, context specific, model for community benefits.
• Grantee Sustainability in the Rural Health Outreach Grant Program
  Author(s): Walter Gregg, Astrid Knott, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topic: Health services
  Date: 12 / 2003
  Describes a study of the post-grant experiences of 99 Rural Health Outreach Grant recipients. Focuses on the extent to which programs were able to maintain or expand services after their grants ended and characteristics that helped programs succeed in the post-grant period.
• Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Brief)
  Author(s): Walter Gregg, Ira Moscovice, Denise Remus
  Research center: Upper Midwest Rural Health Research Center
  Topics: Health care financing, Hospitals and clinics, Quality
  Report Number: Policy Brief No. 2
  Date: 11 / 2006
  Overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration (HQID) project.
• Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Full Report)
  Author(s): Walter Gregg, Ira Moscovice, Denise Remus
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Working Paper No. 2
  Date: 09 / 2006
  Reports the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
• Review of State Flex Program Plans, 2004-2005
  Author(s): Stephenie Loux, John Gale, Anush Yousefian, Andrew Coburn, Walter Gregg
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Briefing Paper No. 10
  Date: 03 / 2006
  Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. Highlights recent trends in State Flex Program planning, development, and implementation. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Role of Rural Hospitals in Community-Centered Systems of Care
  Author(s): Walter Gregg, D. Wholey
  Research center: Upper Midwest Rural Health Research Center
  Topic: Hospitals and clinics
  Report Number: Working Paper No. 5
  Date: 02 / 2007
  
• Rural Health Networks: Evolving Organizational Forms and Functions
  Author(s): Ira Moscovice, Walt Gregg, Eric Lewerenz
  Research center: Minnesota Rural Health Research Center
  Topic: Networking and collaboration
  Date: 06 / 2003
  Discusses results of a survey of rural health networks. Includes information about the location, membership, relationships, governance and management, process and products of rural health networks.
• Rural Hospital Access to Capital: Issues and Recommendations
  Author(s): Walter Gregg, Astrid Knott, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Capital funding, Hospitals and clinics
  Report Number: Working Paper No. 41
  Date: 07 / 2002
  Identifies federal and state programs that have assisted or could assist rural hospitals in meeting their capital needs; assesses whether rural hospital borrowers have difficulty in meeting their capital needs under existing grant, loan, and mortgage insurance programs; and discusses potential options for improving access to capital for rural hospitals. Offers regulatory, programmatic, and policy recommendations to improve the HUD 242 Program and the USDA Community Facilities Program-two federal programs that have been able to assist some of the less creditworthy hospitals over the last three decades.
• State Flex Program at 10 Years: Strengthening Critical Access Hospitals and Rural Communities
  Author(s): John A. Gale, Jennifer Lenardson, Walter R. Gregg, Michelle Casey, Indira Richardson, Stephen Rutledge
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Policy Brief No. 3
  Date: 04 / 2007
  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
  Author(s): John Gale, Jennifer Lenardson, Walt Gregg, Michelle Casey, Indira Richardson, Stephen Rutledge, Rebecca Slifkin
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Briefing Paper No. 15
  Date: 10 / 2007
  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.
• Sustaining Community Health Services Over Time: Models from the Rural Health Outreach Grant Program
  Author(s): Walter R. Gregg, Astrid Knott, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Health services
  Date: 11 / 2004
  Discusses post-grant sustainability of services provided by recipients of Rural Health Outreach Grant Program projects. Based on site visits to a medical rehabilitation project in Wyoming, a prenatal outreach project in Maryland, and a community health center in Oregon.
• Synthesis of State Flex Program Plans 2003-2004
  Author(s): Rochelle Schultz Spinarski, Walter Gregg
  Research center: Minnesota Rural Health Research Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Briefing Paper No. 1
  Date: 05 / 2004
  Highlights recent trends in the development and implementation of State Flex Programs, whose goal it is to strengthen the rural healthcare infrastructure using CAHs as the hub of organized, local systems of care. A major portion of the FY2003 funding dollars continue to target state program infrastructure development; however, the role of this infrastructure is shifting from supporting conversions to the ongoing availability of appropriate health care services for communities served by CAHs (e.g., CAH performance improvement, EMS integration, systems development, and community engagement). States are pursuing these areas with a variety of strategies including the use of local, interstate, and regional collaborations to share lessons learned and advance their knowledge in key areas for success (e.g., performance and quality improvement, health information technology, and capital planning). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.