Hospitals and clinics

Publications

Alphabetical list. You can also view by publication date.

• 2003 Index of Hospital Quality
  Author(s): Colm O'Muircheartaigh
  Research center: Walsh Center for Rural Health Analysis
  Topics: Hospitals and clinics, Quality
  Date: 2003
  Published annually by U.S. News & World Report. Describes a series of factors regarding ranking of measuring hospital quality.
• 340B Drug Pricing Program: Results of a Survey of Eligible but Non-Participating Rural Hospitals
  Author(s): Andrea Radford, Rebecca Slifkin, Claudia Schur, Karen Cheung
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Walsh Center for Rural Health Analysis
  Topics: Hospitals and clinics, Pharmacy and prescription drugs
  Report Number: Working Paper No. 88 (UNC), Working Paper 2007-01 (Walsh)
  Date: 01 / 2007
  Summarizes the results of a 2006 survey of pharmacy directors at rural hospitals that are eligible but currently not participating in the 340B Drug Pricing Program, which enables certain types of safety-net organizations to obtain discounted outpatient medications.
• 340B Drug Pricing Program: Results of a Survey of Participating Hospitals
  Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin, Marianne Baernholdt
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Walsh Center for Rural Health Analysis
  Topics: Hospitals and clinics, Pharmacy and prescription drugs
  Report Number: Working Paper No. 2007-03 (Walsh), Working Paper No. 90 (NC)
  Date: 05 / 2007
  Presents the results of a survey of pharmacy directors at rural hospitals currently buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program in general, the financial impact of the program, and which specific program features presented barriers to its broader implementation.
• 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.
• Ambulatory Care Sensitive Condition Hospitalizations Among Rural Children
  Author(s): Michelle Casey, Alana Knudson, Michele Burlew, Gestur Davidson
  Research center: Upper Midwest Rural Health Research Center
  Topics: Children, Chronic diseases and conditions, Hospitals and clinics
  Report Number: Working Paper No. 4
  Date: 02 / 2007
  Ambulatory care sensitive conditions (ACSCs) are conditions for which inpatient hospital admissions could potentially be avoided through better outpatient care. Using hospital inpatient discharge data from six states, this study examined the relationships between children’s inpatient hospitalizations for ACSCs, rural residence, poverty, health insurance, and physician supply. Admission rates for five conditions were examined: asthma, diabetes short-term complications, gastroenteritis, urinary tract infection and perforated appendix. Hospitalization rates for four of the five conditions are significantly higher for children living in rural areas than in urban areas. Condition-specific ACSC hospitalization rates for children also vary significantly across states, even after adjusting for rurality, poverty, uninsurance, and physician supply.
• Analysis of the Agreement of Financial Data between the Medicare Cost Report and the Audited Hospital Financial Statement
  Author(s): Li-Wu Chen, Julie Stoner, Catherine Makhanu, Kathy Minikus, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Report Number: Rural Policy Brief Vol. 9, No. 4 (PB2004-4 )
  Date: 05 / 2004
  Very few studies have thoroughly examined the discrepancies between the Medicare Cost Report (MCR) and the audited hospital financial statement (FS), and none have been conducted for rural hospitals. Findings from this study which focused on the MCR and FS for rural hospitals suggest that relying on a single source of financial data such as the MCR to assess the financial performance of rural hospitals may be inappropriate.
• Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results?
  Author(s): Li-Wu Chen, Susan Puumala, Keith J. Mueller, Liyan Xu, Kathy Minikus, Catherine Makhanu
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare
  Report Number: Rural Policy Brief Vol. 10, No. 3 (PB2005-3 )
  Date: 11 / 2005
  Explores how predictions of changes in hospital financial performance as a result of change in Medicare payment differ when comparing results using data from the Medicare Cost Report (MCR) to results using data from the audited hospital financial statement (FS). Results indicate that when policy analysts and policymakers examine the effect of payment policies on hospitals' financial performance (e.g., total margin) using the best available national data (the MCR) rather than FS data, the results are likely to be valid, despite previously reported discrepancies in the financial information between the two data sources Using statistical analysis of MCR data as a basis for decisions is, therefore, valid for hospitals as a whole. However, using MCR data to directly track the financial performance of individual hospitals may not be valid. This analysis does not, therefore, support using only MCR data for particular hospitals when FS data are available. In those situations, the findings would support using both data sources because of the potential disagreements between the financial data in the MCR and the FS.
• 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.
• 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.
• Comparing Patient Safety in Rural Hospitals by Bed Count
  Author(s): Stephenie L. Loux, Susan M. C. Payne, Astrid Knott
  Research centers: Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Citation: Advances in Patient Safety: From Research to Implementation. (Vols. 1-4), (pp. 391-402). Rockville, MD: Agency for Healthcare Research and Quality.
  Date: 2005
  Reports results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals. The authors found that small rural hospitals had rates of potential patient safety events that were significantly lower than those of large rural hospitals for three of the 19 patient safety indicators (PSIs). The types of services offered by rural hospitals varied significantly according to bed numbers, and the likelihood of an offered service increased as bed counts increased. The types of patients treated by rural hospitals, however, did not vary significantly by bed count. The results suggest that rural hospitals differ substantially by offered services and differ somewhat in PSI rates, relative to bed counts. But given the limited information on patient severity using administrative data, future research should look to develop more effective ways to account for patient severity when measuring patient safety rates among hospitals with varying bed counts.
• Critical Access Hospitals' Experience with Medicare Advantage Plans
  Research centers: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Hospitals and clinics, Medicare Advantage (MA)
  Date: 03 / 2008
  This report details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage (MA) plans. Findings from this research identify concerns of CAH administrators that, as the MA program evolves, may be addressed through technical assistance and changes in regulation or legislation.
• Data Sources for Studying Uncompensated Care Provided by Rural Hospitals
  Author(s): Bonnie B. Blanchfield, Emily Randall
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Health insurance and the uninsured, Hospitals and clinics
  Date: 08 / 2000
  This policy analysis brief discusses data sources related to hospitals' provision of charity and uncompensated care. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Policy Brief
  Date: 05 / 2007
  Discusses whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. A full report is also available.
• 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.
• Electronic Health Records Adoption: Rural Providers' Decision-Making Process (Policy Brief)
  Author(s): Li-Wu Chen, Anne Skinner
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health information technology, Hospitals and clinics
  Report Number: 2008-4
  Date: 10 / 2008
  This brief reports findings of a study that examined the decision-making process that small rural physician clinics and hospitals use as they investigate and select an electronic health record (EHR) system. Policy makers can use the study findings to understand the challenges that rural health care providers may face in the process of adopting EHRs and to develop incentives that promote the use of health information technology in rural America.
• Emergency Department Use By Medically Indigent Rural Residents
  Author(s): Kevin Bennett, Janice C. Probst, Charity G. Moore, Judith A. Shinogle
  Research center: South Carolina Rural Health Research Center
  Topics: Emergency medical services (EMS), Federally Qualified Health Centers (FQHCs), Health services, Hospitals and clinics
  Date: 07 / 2003
  Examined emergency department (ED) use, combining national data and South Carolina state data to estimate the uncompensated charges in rural EDs nationally and the ameliorating effects of rural community health centers on ED use by rural residents. Executive summary available online.
• Emergency Department Use by Medically Indigent Rural Residents (Fact Sheet)
  Research center: South Carolina Rural Health Research Center
  Topics: Emergency medical services (EMS), Hospitals and clinics, Minority health
  Date: 2004
  An estimated 211 million emergency department visits were made across the United States during 1999 - 2000, 37 visits per 100 persons per year. Just under a quarter of these, 43 million visits, were made to rural emergency departments.
• Emergency Department Use by the Rural Elderly
  Author(s): Denise M Lishner,Roger A Rosenblatt, Laura-Mae Baldwin, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Aging, Emergency medical services (EMS), Hospitals and clinics
  Citation: Journal of Emergency Medicine, 18(3), 289-297
  Date: 2000
  This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. The U.S. Health Care Financing Administration’s National Claims File was used to identify services provided to Medicare beneficiaries in Washington State in 1994. Patients were classified by urban, adjacent rural, or remote rural residence. We identified ED visits and associated diagnostic codes, assigned severity levels for presenting conditions, and determined the specialties of physicians providing ED services. The rural elderly living in remote areas are 13% less likely to visit the ED than their urban counterparts. Causes of ED use by the elderly do not vary meaningfully by location. Most ED visits by this group are for conditions that seem appropriate for this setting. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.
• 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.
• 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.
• Fewer Hospitals Close in the 1990s: Rural Hospitals Mirror This Trend
  Author(s): Stephanie T. Poley, Thomas C. Ricketts
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Hospitals and clinics
  Date: 10 / 2001
  Summarizes a study of the number and rate of hospital closures in rural areas during the 1990s. Includes graphs and a map.
• Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
  Author(s): Jeffrey Stensland, Michelle Brasure, Ira Moscovice, Tiffany Radcliff
  Research center: Minnesota Rural Health Research Center
  Topics: Health care financing, Health services, Hospitals and clinics
  Report Number: Working Paper No. 40
  Date: 06 / 2002
  This paper examines the financial incentives that rural hospitals have to conduct surgery and treat more complex medical conditions. The objective is to evaluate whether rural hospitals that offer broader services are more profitable than hospitals with very limited inpatient services. A low-volume adjustment considered by the Medicare Payment Advisory Commissions (MedPAC) is discussed.
• Financial Viability of Rural Hospitals in a Post-BBA Environment
  Author(s): Jeffrey Stensland, Ira Moscovice, Jon Christianson
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Hospitals and clinics
  Report Number: Working Paper No. 33
  Date: 10 / 2000
  This paper evaluates the financial viability of rural hospitals under the Balanced Budget Act of 1997 (BBA) and the Balanced Budget Refinement Act of 1999 (BBRA) Medicare payment policies. Estimates the number of hospitals that will become Critical Access Hospitals (CAHs) and estimates the number of beds at each hospital.
• Financially Distressed Rural Hospitals In Four States
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
  Report Number: Policy Analysis Brief W Series No. 2
  Date: 01 / 2004
  The effect of the outpatient prospective payment system (OPPS) on the financial performance of rural hospitals was simulated in four states-Iowa, Texas, Washington, and West Virginia. Findings suggest that the profitability and cash position of small, government-owned, and Medicare-dependent hospitals will be adversely impacted by the OPPS. Results also suggest that the number of financially distressed rural hospitals will increase significantly. The small rural hospitals currently protected by the hold harmless provision are those most likely to be hardest hit by OPPS.
• Hospital Size, Uncertainty and Pay-for-Performance
  Author(s): Gestur Davidson, Ira Moscovice, Denise Remus
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Working Paper No. 3
  Date: 02 / 2007
  Examines whether hospital size impacts the ability to identify hospitals' performance in a pay-for-performance demonstration project based on hospital rankings. Using data from the Premier Hospital Quality Incentive Demonstration and the Centers for Medicare and Medicaid Services' Hospital Compare, the report found that the smallest hospitals would, on average, experience five to seven times more uncertainty than the largest hospitals concerning their true relative performance for heart failure, pneumonia, and acute myocardial infarction. The authors conclude that all estimates of rank need to include adequate measures of uncertainty of those estimates.
• 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.
• 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.
• Implementing Patient Safety Initiatives in Rural Hospitals: An Evaluation of the Tennessee Rural Hospital Patient Safety Demonstration
  Author(s): Jill Klingner, Ira Moscovice, Mary Wakefield, Marlene Miller
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Date: 08 / 2007
  The Tennessee Rural Hospital Patient Safety Demonstration project included: 1) the implementation of three patient safety initiatives in eight rural Tennessee hospitals using a collaborative model and 2) an evaluation of the process and tools used in the implementation to inform future rural patient safety initiatives. Staff from the Tennessee Hospital Association, Q-Source (the state quality improvement organization), BlueCross BlueShield of Tennessee and the University of Southern Maine all provided technical assistance and resources to the hospitals. The Upper Midwest Rural Health Research Center evaluated the project. Executive summary available online. Full report available on request by contacting raasc001@umn.edu.
• Intensive Care In Critical Access Hospitals
  Author(s): Victoria Freeman, Joan Walsh, Matthew Rudolf, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health services, Hospitals and clinics
  Report Number: Working Paper No. 81
  Date: 03 / 2005
  Describes what officials at Critical Access Hospitals (CAHs) mean when they report that they provide intensive care and the importance of these services to the hospital and the community it serves. Semi-structured interviews were conducted with Directors of Nursing at 63 CAHs in 27 states. Respondents described the physical structure of the intensive care area, equipment and staffing available for such care, types of patients who receive intensive care, transfer patterns, the role of intensive care in the decision to convert to CAH status, and the perceived value of this service to the community and hospital.
• 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.
• Measuring Rural Hospital Quality
  Author(s): Ira Moscovice, Douglas R. Wholey, Jill Klingner, Astrid Knott
  Research center: Minnesota Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Report Number: Working Paper No. 53
  Date: 04 / 2004
  This paper seeks to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive to the rural hospital context. A conceptual model is developed for measuring rural hospital quality. Hospital quality measures from national and rural organizations are reviewed for their fit to rural hospitals, with a recommendation for an initial core set of quality measures relevant for rural hospitals with less than 50 beds. Finally, avenues for future quality measure development are suggested.
• Medicare Payment Policies
  Author(s): Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Hospitals and clinics, Medicare, Physicians
  Date: 08 / 2003
  Overview of the policy issues related to Medicare payment to physicians and hospitals. Presented at the All Programs Meeting, Federal Office of Rural Health Policy, 8/21/03.
• National Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
  Author(s): Li-Wu Chen, Wanqing Zhang, Junfeng Sun, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Chronic diseases and conditions, Health care financing, Health policy, Hospitals and clinics
  Report Number: Policy Brief No. PB2007-4
  Date: 12 / 2007
  Documents the national magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals.
• Perspectives Of Rural Hospitals On Bioterrorism Preparedness Planning
  Author(s): Claudia L. Schur, Marc L. Berk, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Emergency preparedness, Hospitals and clinics
  Report Number: Policy Analysis Brief W Series No. 4
  Date: 04 / 2004
  Representatives from several rural hospitals met to discuss various aspects of bioterrorist preparedness in terms of workforce and training, physical capacity and supplies, communication, and coordination with other entities. Three main themes emerged from the discussion: 1) Bioterrorism resources have the potential to improve the rural health care delivery system, 2) A "cookie-cutter" model does not work for rural hospitals, and 3) Strategies for coping with a bioterrorist event need to be practical and have dual use.
• Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Brief)
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
  Report Number: Policy Brief No. 1
  Date: 01 / 2006
  To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. A full report is also available.
• Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
  Author(s): Michelle M. Casey, Ira Moscovice, Gestur Davidson
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
  Report Number: Working Paper No. 1
  Date: 12 / 2005
  To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
• Pharmacist Staffing, Technology Use and Implementation of Medication Safety Practices in Rural Hospitals
  Author(s): Michelle Casey, Ira Moscovice, Gestur Davidson
  Research center: Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality, Technology
  Citation: Journal of Rural Health, 22(4), 321-330
  Date: 2006
  Reports the results of a study that assessed the capacity of small rural hospitals to implement medication safety practices, with a focus on pharmacist staffing and the availability of technology.
• PPS Inpatient Payment and the Area Wage Index
  Author(s): Kathleen Dalton, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Date: 01 / 2001
  Discusses how inpatient rates are calculated, the role of the wage index, and issues surrounding the wage index and reimbursement to rural hospitals by Medicare under the Prospective Payment System (PPS).
• Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
  Author(s): Gary Cochran, PharmD, SM, Katherine Jones, PhD, PT, Liyan Xu, MS, Keith Mueller, PhD
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Hospitals and clinics, Pharmacy and prescription drugs, Quality
  Citation: This issue brief presents the findings of a national survey whose purpose was to describe the prevalence of evidence-based safe medication practices, including the use of voluntary medication error reporting, in the nations smallest hospitals. A key finding is that hospitals with an average daily census of six or more patients were more likely to report having adopted safe medication practices than were hospitals with an average daily census of five or fewer patients. Findings from this research reveal considerable opportunity for improvement in hospitals with 49 or fewer beds to achieve evidence-based standards of medication safety.
  Report Number: Issue Brief 2008-1
  Date: 04 / 2008
  
• Primer On Interpreting Hospital Margins
  Author(s): Kathleen Dalton, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health care financing, Hospitals and clinics
  Date: 07 / 2003
  Explains the most commonly used measures of hospital profitability, and how they are used to inform policy changes. Covers measures of overall or payer-specific profitability, total margins and operating margins. Particular emphasis on the different formulas as they impact rural versus urban hospital figures. Addresses the different ways in which these measures are commonly aggregated when they are used in descriptive studies or regulatory impact statements.
• Prioritizing Patient Safety Interventions in Small Rural Hospitals
  Author(s): Michelle Casey, Mary Wakefield, Andrew F. Coburn, Ira Moscovice, Stephanie Loux
  Research centers: Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Citation: Joint Commission Journal on Quality and Patient Safety, 32(12), 693-702
  Date: 12 / 2006
  Reports the results of a study seeking to determine if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers in small rural facilities in Maine, Minnesota, Montana, North Dakota, Pennsylvania, and Tennessee. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
• Proximity of Rural Black and Hispanic/Latino Communities to Physicians and Hospital Services
  Author(s): Donald E. Pathman, Thomas R. Konrad, Robert Schwartz
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: African Americans, Health services, Hispanics, Hospitals and clinics, Minority health, Physicians
  Date: 05 / 2001
  This brief reports the findings of a study of how the African American and Hispanic/ Latino composition of rural communities relates to local physician concentrations, and relates to distances to hospitals offering various levels of services.
• Quality of Care for Acute Myocardial Infarction in Rural and Urban U.S. Hospitals
  Author(s): Laura-Mae Baldwin, Richard F MacLehose, Shelli K Beaver, N Every, Leighton Chan
  Research center: WWAMI Rural Health Research Center
  Topics: Hospitals and clinics, Quality
  Citation: Journal of Rural Health, 20(2), 99-108
  Date: 2004
  Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care.
  Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality.
  Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]).
  Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI.
• Rate of Return on Capital Investments at Small Rural Hospitals
  Author(s): Jeffrey Stensland, Astrid Knott, Ira Moscovice, Gestur Davidson
  Research center: Minnesota Rural Health Research Center
  Topics: Capital funding, Hospitals and clinics
  Report Number: Working Paper No. 45
  Date: 01 / 2003
  Examines whether the aging of rural facilities, a major problem among rural hospitals, is due to a lower rate of return on capital investment at these hospitals. This paper also investigates whether membership in a hospital system improves access to capital and results in the updating of buildings and equipment. The study found that hospitals generally do no use system membership to overcome access to capital problems, most likely because investments are not readily available along this pathway. The study also found that hospitals generate 50 cents for every dollar invested in facility improvement. Although this is a way to generate revenue, the small hospitals will typically not be able to recover the costs spent in the improvement. These findings suggest that small hospitals, particularly the smallest and most rural hospitals, would need grants in order to adequately cover the costs of facility improvement.
• Regional Variation in Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
  Author(s): Li-Wu Chen, Wanqing Zhang, Junfeng Sun, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Chronic diseases and conditions, Health care financing, Health policy, Hospitals and clinics
  Report Number: Policy Brief No. PB2007-5
  Date: 12 / 2007
  Estimates and documents the regional magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals.
• 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.
• 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 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.
• Rural Hospital HIPAA Readiness and Resource Needs
  Author(s): J. Patrick Hart, Wanqing Zhang, Jane L. Meza, Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Hospitals and clinics
  Report Number: Rural Policy Brief Vol. 8, No. 6 (PB2003-6)
  Date: 05 / 2003
  Presents survey of rural hospitals regarding the extent of their preparation for HIPAA requirements and their need for resources to implement HIPAA requirements. Results shown by hospital size. Also includes information on financial and staff commitment levels.
• Rural Hospital Wages and the Area Wage Index: 1990-1997
  Author(s): Kathleen Dalton, Rebecca T. Slifkin, Hilda A. Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare Wage Index
  Date: 01 / 2001
  Examines whether incremental changes to the hospital wage index have made it more equitable across regions and how these changes have impacted rural hospitals.
• Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
  Author(s): Andrew F. Coburn, Stephanie Loux, E.J. Bolda
  Research center: Maine Rural Health Research Center
  Topics: Hospitals and clinics, Long term care
  Citation: In R. T. Goins, & J. A. Krout (Eds.), Service delivery to rural older adults: Research, policy, and practice. (pp. 103-122). New York, NY: Springer Publishing Co.
  Date: 2006
  
• Rural Hospitals' Ability to Finance Inpatient, Skilled Nursing, and Home Health Care
  Author(s): Jeffrey Stensland, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Health care financing, Home health, Hospitals and clinics, Long term care, Medicare
  Report Number: Working Paper No. 37
  Date: 10 / 2001
  Surveys 448 rural hospitals to see how they are restructuring in light of the Balanced Budget Act of 1997. Among its findings: the most popular strategy for small rural hospitals is to convert to Critical Access Hospital status-35 percent of those surveyed have done so; despite the closing of some facilities, the vast majority of rural patients still have access to one or more skilled nursing facilities and one or more home health agencies; and to help preserve access to care, policy makers should consider paying a portion of the bad debt and charity care expenses that Critical Access Hospitals incur when treating non-Medicare patients.
• Rural Hospitals' Experience with the 340B Drug Pricing Program
  Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Walsh Center for Rural Health Analysis
  Topics: Hospitals and clinics, Pharmacy and prescription drugs
  Date: 09 / 2007
  Policy brief describing the results of surveys of rural hospitals participating in the 340B drug pricing program and of rural eligible but non-participating hospitals. Includes information on factors affecting participation in the program and the benefits and challenges of participation.
• Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Regulations: Case Studies Of Rural Hospitals
  Research center: Walsh Center for Rural Health Analysis
  Topics: Hospitals and clinics, Technology
  Date: 08 / 2003
  Rural hospitals in this study recognized the importance of ensuring the confidentiality of patient health information, and have made substantial progress in achieving compliance with HIPAA privacy standards. Although these rural hospitals were using the flexibility afforded to them under HIPAA to develop common-sense approaches, each recognized that additional work will be required to effectively secure patient privacy, particularly as technology and the need for information advance. A policy brief is also available. Report available on request.
• Rural Hospitals' Strategies for Achieving Compliance with HIPAA Privacy Requirements
  Research center: Walsh Center for Rural Health Analysis
  Topics: Hospitals and clinics, Technology
  Report Number: Policy Analysis Brief W Series No. 3
  Date: 03 / 2004
  Rural hospitals in this study recognized the importance of ensuring the confidentiality of patient health information, and have made substantial progress in achieving compliance with HIPAA privacy standards. Although these rural hospitals were using the flexibility afforded to them under HIPAA to develop common-sense approaches, each recognized that additional work will be required to effectively secure patient privacy, particularly as technology and the need for information advance. A full report is also available.
• Rural Hospitals: New Millennium and New Challenges
  Author(s): Ira Moscovice, Gestur Davidson
  Research center: Minnesota Rural Health Research Center
  Topic: Hospitals and clinics
  Date: 02 / 2003
  Discusses the changes in rural hospitals that took place in the decade of the 1990?s and discusses some of the challenges that face rural hospitals in 2003. Includes discussion of rural hospitals' organizational structure, health service provision, payment/reimbursement, and financial performance.
• Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
  Author(s): Stephenie Loux, David Hartley, David Lambert
  Research center: Maine Rural Health Research Center
  Topics: Health services, Hospitals and clinics, Mental health
  Date: 08 / 2007
  Inpatient Psychiatric Units (IPUs) may not only be an important source of care for rural residents, but may also assist in the development of community-based services and the recruitment of mental health professionals. This study investigates the typical characteristics and admission processes of IPUs in rural hospitals with less than 50 beds, as well as the community-based services available to them when discharging patients. Reasons for developing these IPUs as well as the barriers to opening and operating a rural IPU and factors that have led some to close are also explored.
• 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.
• Smallest Rural Hospitals Treat Mental Health Emergencies
  Author(s): David Hartley, Stephenie Loux
  Research center: Maine Rural Health Research Center
  Topics: Hospitals and clinics, Mental health
  Report Number: Research and Policy Brief
  Date: 2006
  Discusses the extent to which rural emergency rooms encounter and treat mental health patients.
• State of Rural Hospital Nursing and Allied Health Professional Shortages
  Research center: Southwest Rural Health Research Center
  Topics: Allied health professionals, Hospitals and clinics, Nurses, Workforce
  Date: 12 / 2005
  This study estimated shortages of nurses and allied health personnel among rural hospitals in order to gauge the difficulty experienced by rural hospitals in recruiting such personnel. Additionally, the study examined strategies these hospitals employ in recruitment and retention of nurses, and addressed strategies that might effectively address such shortages. Report available on request.
• Trends in Skilled Nursing and Swing-bed Use in Rural Areas, 1996-2003
  Author(s): Kathleen Dalton, Jeongyoung Park, Ann Howard, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health services, Hospitals and clinics, Medicare
  Report Number: Working Paper No. 83
  Date: 12 / 2005
  Examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a period of dramatic change in Medicare payments for both acute and post-acute care, focusing on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment. The authors examined changes in the number and types of facilities providing this level of care, and computed comparative statistics on Medicare utilization, case mix, ancillary service use and per diem costs across the three different institutional settings where inpatient skilled nursing services can be provided-freestanding SNFs, hospital-based units, and swing beds in acute care hospitals.
• Understanding Rural Hospital Bypass Behavior
  Author(s): Tiffany A. Radcliff, Michelle Brasure, Ira Moscovice, Jeffrey Stensland
  Research center: Minnesota Rural Health Research Center
  Topic: Hospitals and clinics
  Report Number: Working Paper No. 39
  Date: 06 / 2002
  This study provides a descriptive analysis of rural hospital bypass behavior. Focuses on the extent to which patients admitted from rural areas are bypassing local facilities and whether there are changes in bypass patterns over time.
• Understanding The Role Of The Rural Hospital Emergency Department In Responding To Bioterrorist Attacks And Other Emergencies: A Review Of The Literature And Guide To The Issues
  Author(s): Claudia L. Schur
  Research center: Walsh Center for Rural Health Analysis
  Topics: Emergency medical services (EMS), Emergency preparedness, Hospitals and clinics
  Date: 04 / 2004
  Reviews issues affecting rural hospitals' level of readiness for bioterrorist attack. Issues examined include physical capacity, sufficiency of health personnel, preparedness plans, disease surveillance systems, and communication/coordination. Concerns about funding cut across all the issues of preparedness.
• 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.
• Variance in the Profitability of Small-Town Rural Hospitals (Full Report)
  Author(s): Jeffrey Stensland, Meredith Milet
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics
  Date: 02 / 2002
  Documents the variance in profitability among small-town rural hospitals and evaluates the characteristics that distinguish highly profitable small-town hospitals from struggling ones. It also reports on strategies that small-town hospital administrators are using to achieve financial success and discusses public policy priorities for assisting small-town hospitals in rural America. Among the findings are that patient volumes appear to explain a significant portion of the difference in small-town hospital profitability. No small-town hospital with fewer than 300 admissions was able to generate significant profits and no small-town hospital with more than 2,500 admissions generated significant losses. Among the hospitals with between 300 and 2,500 admissions, there is a wide variance in profitability. The case studies suggest that lower staffing levels and higher levels of visiting specialists can improve profitability. They also suggest that bad debt burdens can create significant financial strain. Report available on request.
• Variance in the Profitability of Small-Town Rural Hospitals (Policy Brief)
  Author(s): Jeffrey Stensland, Meredith Milet
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics
  Date: 04 / 2002
  This policy brief discusses why some rural small-town hospitals are financially successful and others struggle with persistent financial difficulties.
• Washington State Hospitals: Results of the 2005 Workforce Survey
  Author(s): Susan M. Skillman, C. Holly A. Andrilla, Ed Phippen, Troy Hutson, Elise Bowditch, Tina Praseuth
  Research center: WWAMI Rural Health Research Center
  Topics: Hospitals and clinics, Workforce
  Report Number: Working Paper No. 104
  Date: 10 / 2005
  The University of Washington Center for Health Workforce Studies and the Washington State Hospital Association's Health Work Force Institute collaborated in a staffing survey of Washington's nonfederal acute care hospitals. Eighty-one percent of the 88 hospitals responded to this mailed survey. Growth in Washington's hospital sector appears to be keeping the demand for health care occupations high, even when vacancy rates for some jobs appear to be lower than in past years. This growth, and the shift away from contracting employees, needs to be considered in projections of future workforce supply and demand.
• Who Receives Inpatient Charity Care in California?
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health services, Hospitals and clinics
  Date: 08 / 2003
  Results of a study regarding how California hospitals determine charity care. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Why Are Fewer Hospitals in the Delivery Business?
  Author(s): Lan Zhao
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health services, Hospitals and clinics, Maternal and child health
  Date: 06 / 2007
  Examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. Examines potential causes for this trend and explores the effects of medical malpractice reforms. Report available on request.
• Will the Outpatient Prospective Payment System Increase the Number of Distressed Rural Hospitals in Iowa, Texas, Washington, and West Virginia?
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
  Date: 01 / 2001
  Simulates the financial impact of the outpatient prospective payment system rates and estimates the number and type of rural hospitals in the five states likely to become financially distressed as a result of its implementation. Results clearly suggest that the outpatient PPS will have a significant negative impact on the profitability and cash position of many rural hospitals, especially those that are small, government owned, and classified as Medicare dependent. The results also suggest that this negative impact may lead to a significant increase in the number of financially distressed rural hospitals. Given these findings, a permanent exemption to outpatient prospective payment to small hospitals may be a policy alternative that would benefit rural communities and cost the Medicare program relatively little. Report available on request.

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