Julie A. Schoenman, PhD

Phone: 202.296.4426
Fax: 202.296.4319
E-mail: jschoenman@nihcm.org

National Institutes for Health Care Management
1225 19th St. NW, Suite 710
Washington, DC 20036-2454

Completed Projects

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.

Investments in Health Information Technology by Rural Hospitals, Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health information technology, Hospitals and clinics
This study involved a national survey of rural hospitals conducted in late spring 2006 to gather data about readiness to adopt health IT, current use of different technologies, perceptions about the benefits and barriers to health IT adoption, future implementation plans, use of Federal programs designed to facilitate IT adoption, and interest in various health IT policy options.

Medicare Payment for Post-Acute Care Transfers, 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

National Rural Hospital Flexibility Program Tracking Project: Emergency Medical 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, Emergency medical services (EMS), Networking and collaboration

Roadmap for the Adoption of Health Information Technology in Rural Communities , Lead researcher
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health information technology, Health services
This project developed a resource document intended to help rural health care providers of all types as they think about whether an investment in health information technology makes sense for them and work through various implementation issues. The document was distributed at the September 2006 conference entitled "Health Information Technology: A Rural Provider’s Roadmap to Quality," sponsored by ORHP.

Publications

• Capital Needs of Small Rural Hospitals
  Author(s): Jeffrey Stensland, Julie Schoenman, Curt Mueller, Andrew Singer
  Research center: Walsh Center for Rural Health Analysis
  Topics: Capital funding, Hospitals and clinics
  Date: 05 / 2002
  Examines the capital situation of rural hospitals with fewer than 50 beds to determine the total cost of bringing each facility into compliance with current laws, as well as the facilities' cost of borrowing and ability to borrow. Key results include: 38 percent report having deficiencies that, by law, require renovation or remodeling; the median cost of correcting those deficiencies is $1,000,000; most hospitals will need to, and have the ability to, borrow funds to correct the deficiencies; and the hospitals that report being unable to obtain loans tend to be older, low-volume hospitals with operating losses. Study concludes that due to the poor financial condition of hospitals that lack the ability to borrow, a new federal loan program does not appear to be the answer to their capital needs. Rather, improving access to capital depends on improving hospital profitability. The authors offer three options. 1) Medicare policy could provide hospitals in regions with very few patients an adjustment that would allow low-volume hospitals to earn a profit on Medicare patients. 2) Medicare policy could be adjusted to allow Medicare to directly pay a portion of hospitals' charity care and bad debt burdens. 3) Policy makers could set up a technical assistance program operated at the state level to assist rural hospitals in improving their financial condition.
• Exploring the Impact of Medicare's Post-Acute Care Transfer Payment Policy on Rural Hospitals
  Author(s): Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Report Number: Policy Analysis Brief W Series No. 5
  Date: 07 / 2004
  Describes a change in Medicare post-acute transfer payment policy and its impact on rural and urban hospitals. Includes data on the financial impact and hospital discharge behavior before and after the change. A full report is also available.
• Federal Funding for Emergency Medical Services
  Author(s): Penny E. Mohr, Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topic: Emergency medical services (EMS)
  Date: 07 / 2002
  Includes recent trend data from 1994 to the present on aggregate Federal spending on EMS and funding targeted explicitly to rural areas. Also discusses the role various Federal agencies have played and traces the history of Federal legislation to support EMS programs. Activities funded under Title XII of the Public Health Service Act. Discussion of pending EMS-related legislation and future goals specified by the agencies included in the study. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• 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.
• Potential Supply-Side Implications of the BBA Limits on Reimbursement to Provider-Based Rural Health Clinics
  Author(s): Julie A. Schoenman, C. Michael Cheng, Bonnie B. Blanchfield, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topic: Rural Health Clinics (RHCs)
  Date: 06 / 2000
  This policy analysis brief examines whether provider-based (typically hospital operated) rural health clinics are likely to close due to the reimbursement cap introduced by the Balanced Budget Act of 1997 (BBA). For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• 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.
• Roadmap for the Adoption of Health Information Technology in Rural Communities
  Author(s): Julie A. Schoenman, Joy Keeler, Adil Moiduddin, Benjamin N. Hamlin
  Research center: Walsh Center for Rural Health Analysis
  Topic: Health information technology
  Date: 08 / 2006
  Assists rural providers who are just beginning their investigation of using health IT, and its applicability to their organization.
• Rural Implications of Medicare's Post-Acute Care Transfer Payment Policy
  Author(s): Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Long term care, Medicare
  Date: 06 / 2004
  Beginning in October 1998, Medicare began to pay acute-care hospital cases in 10 DRGs as transfers instead of discharges when the patient is discharged to a targeted post-acute care (PAC) provider after a short inpatient stay. This study examines the behavioral and financial impacts of the initial 10-DRG policy, and projects the likely financial impact of extending the policy to cover additional DRGs or discharges to swing beds. Key findings: 1) Hospitals' discharge behavior did not change significantly in ways that would suggest a strategic response to the PAC transfer payment policy; 2) Based on simulation, less than 5 percent of all cases discharged from the additional DRGs would receive the PAC transfer payment instead of the full DRG payment. Medicare revenue earned by rural hospitals would fall by more than $1,100 for each transfer case.; and 3) Expanding the transfer policy to cover swing beds would result in a relatively small financial impact. A policy brief is also available.
• Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy
  Author(s): Julie A. Schoenman, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Long term care, Medicare
  Citation: Journal of Rural Health, 21(2), 122-130
  Date: 2005
  Examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. The authors conclude that rural hospitals are not disproportionately harmed by the post-acute-care transfer policy. An expanded policy may even benefit rural hospitals by recognizing their lower use of post-acute-care and readjusting DRG weights so that they are paid more appropriately when providing the full course of inpatient care.
• Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals (Full Report)
  Author(s): Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health information technology, Hospitals and clinics
  Date: 02 / 2007
  Reports the full findings from a national survey of rural hospitals designed to investigate how differences among the hospitals affect their implementation of health IT.
• Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals (Policy Brief)
  Author(s): Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health information technology, Hospitals and clinics
  Report Number: Policy Analysis Brief W Series No. 10
  Date: 04 / 2007
  Reports findings from a national survey of rural hospitals designed to investigate how differences among the hospitals affect their implementation of health IT. A full report is also available.