Health care financing

Completed Projects

Achieving Equity in Disproportionate Share Payments to Rural Hospitals: An Examination of MedPAC's Revised Disproportionate Share Formula
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

Analysis Related to Health Care Reform Issues
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Health services
The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation.

Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services, Networking and collaboration
This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided.

Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Mental health
This study will use nationally representative data to assess how mental health (MH) services are paid for in rural areas and determine differences in payment sources between rural and urban areas. If payment sources significantly vary in rural vs. urban settings, then policies that are aimed specifically at sources of funding may have a differential impact on subsequent access to and utilization of care and point to the need for policies that are specifically targeted to rural communities.

Cash Flow of Small Rural Hospitals: The Impact of the Medicare Outpatient Prospective Payment System
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)

Characteristics of Low-volume Communities
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Legislation and regulation, Medicare

Cost of Ambulance Transports for Low-Volume Providers in Rural Areas and Its Implications for Medicare Reimbursement Policy
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Health policy, Medicare

Critical Access Hospital Readiness for CMS Value-Based Purchasing
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Quality
The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals.

Developing a Financial Performance Measurement System for Critical Access Hospitals
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs.

Discrepancies of Financial Data between Medicare Cost Report and Hospital Audited Financial Statement and Its Implication for Measuring Financial Impact of Payment Policy on Rural Hospitals
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Hospitals and clinics

Do We Need a Rural Payment Differential Under the Medicare Ambulance Fee Schedule?
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Medicare

Estimating the Medicare+Choice Threshold Payment Rate
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Medicare

Evaluating the Financial Impact of Critical Access Hospital Conversion Over Time
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
Using Medicare cost report data, this project will analyze changes in several key financial and organizational indicators that may be affected by CAH conversion, and produce annual reports describing the financial status of CAHs.

Examining Recent Trends and Variation in Ambulatory Care Sensitive Conditions-related Hospital Expenditures of Rural Americans with Different Health Insurance Coverage and Status
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health care financing, Health insurance and the uninsured, Health services
This study documents the national time-trend and regional variation of rural Ambulatory Care Sensitive Conditions (ACSC)-related hospital expenditures by patient insurance coverage/status. The study will also compare the pattern of difference in the ACSC-related expenditures of rural patients with different insurance coverage/status by patient demographic and economic characteristics as well as hospital characteristics.

Examining the Magnitudes, Geographic Variations, and Determinants Of Expenditures Due to Ambulatory Care Sensitive Conditions in Rural Hospitals
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health care financing, Hospitals and clinics
This project will document the magnitude of and variation in ambulatory care sensitive condition (ACSC) expenditures of rural hospitals and explore the relationships between rural hospital ACSC expenditure and its key determinants in the areas of population demand, health care system supply, and provider practice style.

Exploring the Black Box: Design and Implementation Issues of P4P for Rural Physicians
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Physicians
Information about how pay-for-performance (P4P) payment systems work in ambulatory care settings, and in particular, how rural physicians might be affected, is scarce. This study employs qualitative research methods to explore the design and implementation of P4P systems and to investigate effects of P4P on rural physicians in a variety of settings.

Financial Impact of Mental Health Services on Rural Individuals and Families
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health insurance and the uninsured, Mental health
This project will use the Medical Expenditure Panel Survey (MEPS) to examine the financial burden that rural residents face in seeking mental health services, compared to urban residents. Implications of financial burden for access to needed mental health services for rural residents will be assessed.

Financial Impact of Outpatient Payment Reform on Rural Hospitals
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)

Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Medicare Prospective Payment System (PPS)
Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion.

Financing Rural Public Health Activities in Chronic Disease Prevention and Health Promotion
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health care financing, Health promotion and disease prevention, Public health
This project describes the federal-state funding streams for selected local public health activities in the area of chronic disease prevention and health promotion, and assesses potential barriers to program implementation in less populated, local areas of a state.

Health Panel Project: Providing an Objective Assessment of the Implications of Health Reform for Rural People, Places and Health Care Providers
Research center: Rural Policy Analysis and Applications
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy
The Panel is tracking legislative developments and providing brief assessments about impact on specific rural populations and providers.

Health Reform�Rapid Response
Research center: Maine Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy, Health services, Mental health
This project will include several projects as requested by ORHP and DHHS as those agencies prepare for national health reform. Responses are primarily in the areas of health insurance and behavioral health.

Identifying Stakeholders to Pay for Enhanced Depression Treatment in Rural Populations
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Mental health
The goal of this project is to identify stakeholders who economically benefit when rural patients receive enhanced depression treatment, which will, in turn, encourage health plans to provide enhanced depression treatment to their rural enrollees without raising premiums.

Impact of CAH Conversion on Hospital Costs and Mix of Services
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 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.

Impact of the Proposed Medicare Prospective Payment Reforms on Rural Hospitals in Selected States
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)

Medicare Bonus Payments for Physician Care in Health Professional Shortage Areas
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Medicare, Physicians

Medicare Payment for Post-Acute Care Transfers
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: Analysis of the Financial Impact of Conversion on Critical Access Hospitals (CAHs) and the Medicare Program
Research center: Minnesota Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing

Options for Structuring Disproportionate Share (DSH) Payments to Account for Uncompensated Care: Impact on Rural Hospitals
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.

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.

Pay-for-Performance and Quality Improvement in Rural Hospitals
Research center: Upper Midwest Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Hospitals and clinics, Quality
This project will estimate the impact on rural hospitals in the U.S. of a pay-for-performance (PFP) program similar to the CMS-sponsored Premier, Inc. Hospital Quality Incentive Demonstration; synthesize the major factors that will influence the inclusion of rural hospitals in PFP programs; and make recommendations for the design of PFP programs that will appropriately reward rural hospitals for improving quality.

Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
Research centers: Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Quality
The purpose of this project is to continue to investigate the relationship between CAH financial performance and quality of care. UMN and UNC will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses.

Rapid Research Response on Health Care Reform Issues
Research center: South Carolina Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Health policy
The focus of the SC Rural Health Research Center is on investigating persistent inequities in health status within the population of the rural US, with an emphasis on inequities stemming from socioeconomic status, race and ethnicity, and access to healthcare services. Building on existing expertise, the SC Rural Health Research Center will create an internal process that allows for rapid turnaround of analysis on race/ethnicity and rural-based health disparity inquiries from policymakers.

Rapid Response: Elimination of Bad Debt Payments to Rural PPS Hospitals
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.

Recent History of Federal Funding for EMS in the United States
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Health services

Rural-Urban Comparison of Mental Health Care Treatment and Costs
Research center: South Carolina Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Mental health

Volunteerism in Rural EMS
Research center: North Carolina Rural Health Research and Policy Analysis Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Health care financing, Workforce
Semi-structured telephone interviews will be used to examine issues facing rural EMS services that have converted or are considering converting from volunteer services to paid services. Respondents will be queried regarding their conversion or consideration of conversion and the effect on their ability to recruit and retain personnel, their relationship with other agencies such as fire departments and hospitals, and the overall availability of EMS services.

What is Causing the Increase in Rural Hospital Costs?
Research center: Walsh Center for Rural Health Analysis
Funder: Office of Rural Health Policy (ORHP)
Topics: Health care financing, Hospitals and clinics

Topics Centers Researchers Other Resources Search		Health care financing Completed Projects Achieving Equity in Disproportionate Share Payments to Rural Hospitals: An Examination of MedPAC's Revised Disproportionate Share Formula 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 Analysis Related to Health Care Reform Issues Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health policy, Health services The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation. Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services Research center: Minnesota Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services, Networking and collaboration This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided. Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings Research center: WICHE Center for Rural Mental Health Research Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Mental health This study will use nationally representative data to assess how mental health (MH) services are paid for in rural areas and determine differences in payment sources between rural and urban areas. If payment sources significantly vary in rural vs. urban settings, then policies that are aimed specifically at sources of funding may have a differential impact on subsequent access to and utilization of care and point to the need for policies that are specifically targeted to rural communities. Cash Flow of Small Rural Hospitals: The Impact of the Medicare Outpatient Prospective Payment System 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) Characteristics of Low-volume Communities Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Legislation and regulation, Medicare Cost of Ambulance Transports for Low-Volume Providers in Rural Areas and Its Implications for Medicare Reimbursement Policy Research center: Walsh Center for Rural Health Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Emergency medical services (EMS), Health care financing, Health policy, Medicare Critical Access Hospital Readiness for CMS Value-Based Purchasing Research center: Upper Midwest Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Quality The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals. Developing a Financial Performance Measurement System for Critical Access Hospitals Research center: North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs. Discrepancies of Financial Data between Medicare Cost Report and Hospital Audited Financial Statement and Its Implication for Measuring Financial Impact of Payment Policy on Rural Hospitals Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health policy, Hospitals and clinics Do We Need a Rural Payment Differential Under the Medicare Ambulance Fee Schedule? Research center: Walsh Center for Rural Health Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Emergency medical services (EMS), Health care financing, Medicare Estimating the Medicare+Choice Threshold Payment Rate Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Medicare Evaluating the Financial Impact of Critical Access Hospital Conversion Over Time Research center: Minnesota Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing Using Medicare cost report data, this project will analyze changes in several key financial and organizational indicators that may be affected by CAH conversion, and produce annual reports describing the financial status of CAHs. Examining Recent Trends and Variation in Ambulatory Care Sensitive Conditions-related Hospital Expenditures of Rural Americans with Different Health Insurance Coverage and Status Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Chronic diseases and conditions, Health care financing, Health insurance and the uninsured, Health services This study documents the national time-trend and regional variation of rural Ambulatory Care Sensitive Conditions (ACSC)-related hospital expenditures by patient insurance coverage/status. The study will also compare the pattern of difference in the ACSC-related expenditures of rural patients with different insurance coverage/status by patient demographic and economic characteristics as well as hospital characteristics. Examining the Magnitudes, Geographic Variations, and Determinants Of Expenditures Due to Ambulatory Care Sensitive Conditions in Rural Hospitals Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Chronic diseases and conditions, Health care financing, Hospitals and clinics This project will document the magnitude of and variation in ambulatory care sensitive condition (ACSC) expenditures of rural hospitals and explore the relationships between rural hospital ACSC expenditure and its key determinants in the areas of population demand, health care system supply, and provider practice style. Exploring the Black Box: Design and Implementation Issues of P4P for Rural Physicians Research center: Walsh Center for Rural Health Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Emergency medical services (EMS), Health care financing, Physicians Information about how pay-for-performance (P4P) payment systems work in ambulatory care settings, and in particular, how rural physicians might be affected, is scarce. This study employs qualitative research methods to explore the design and implementation of P4P systems and to investigate effects of P4P on rural physicians in a variety of settings. Financial Impact of Mental Health Services on Rural Individuals and Families Research center: Maine Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health insurance and the uninsured, Mental health This project will use the Medical Expenditure Panel Survey (MEPS) to examine the financial burden that rural residents face in seeking mental health services, compared to urban residents. Implications of financial burden for access to needed mental health services for rural residents will be assessed. Financial Impact of Outpatient Payment Reform on Rural Hospitals 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) Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion Research center: North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Medicare Prospective Payment System (PPS) Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion. Financing Rural Public Health Activities in Chronic Disease Prevention and Health Promotion Research center: Walsh Center for Rural Health Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Chronic diseases and conditions, Health care financing, Health promotion and disease prevention, Public health This project describes the federal-state funding streams for selected local public health activities in the area of chronic disease prevention and health promotion, and assesses potential barriers to program implementation in less populated, local areas of a state. Health Panel Project: Providing an Objective Assessment of the Implications of Health Reform for Rural People, Places and Health Care Providers Research center: Rural Policy Analysis and Applications Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health policy The Panel is tracking legislative developments and providing brief assessments about impact on specific rural populations and providers. Health Reform�Rapid Response Research center: Maine Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health policy, Health services, Mental health This project will include several projects as requested by ORHP and DHHS as those agencies prepare for national health reform. Responses are primarily in the areas of health insurance and behavioral health. Identifying Stakeholders to Pay for Enhanced Depression Treatment in Rural Populations Research center: WICHE Center for Rural Mental Health Research Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Mental health The goal of this project is to identify stakeholders who economically benefit when rural patients receive enhanced depression treatment, which will, in turn, encourage health plans to provide enhanced depression treatment to their rural enrollees without raising premiums. Impact of CAH Conversion on Hospital Costs and Mix of Services 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 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. Impact of the Proposed Medicare Prospective Payment Reforms on Rural Hospitals in Selected States 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) Medicare Bonus Payments for Physician Care in Health Professional Shortage Areas Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Medicare, Physicians Medicare Payment for Post-Acute Care Transfers 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: Analysis of the Financial Impact of Conversion on Critical Access Hospitals (CAHs) and the Medicare Program Research center: Minnesota Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing Options for Structuring Disproportionate Share (DSH) Payments to Account for Uncompensated Care: Impact on Rural Hospitals 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. 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. Pay-for-Performance and Quality Improvement in Rural Hospitals Research center: Upper Midwest Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Hospitals and clinics, Quality This project will estimate the impact on rural hospitals in the U.S. of a pay-for-performance (PFP) program similar to the CMS-sponsored Premier, Inc. Hospital Quality Incentive Demonstration; synthesize the major factors that will influence the inclusion of rural hospitals in PFP programs; and make recommendations for the design of PFP programs that will appropriately reward rural hospitals for improving quality. Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis Research centers: Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Quality The purpose of this project is to continue to investigate the relationship between CAH financial performance and quality of care. UMN and UNC will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses. Rapid Research Response on Health Care Reform Issues Research center: South Carolina Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Health policy The focus of the SC Rural Health Research Center is on investigating persistent inequities in health status within the population of the rural US, with an emphasis on inequities stemming from socioeconomic status, race and ethnicity, and access to healthcare services. Building on existing expertise, the SC Rural Health Research Center will create an internal process that allows for rapid turnaround of analysis on race/ethnicity and rural-based health disparity inquiries from policymakers. Rapid Response: Elimination of Bad Debt Payments to Rural PPS Hospitals 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. Recent History of Federal Funding for EMS in the United States Research center: Walsh Center for Rural Health Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Emergency medical services (EMS), Health care financing, Health services Rural-Urban Comparison of Mental Health Care Treatment and Costs Research center: South Carolina Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Mental health Volunteerism in Rural EMS Research center: North Carolina Rural Health Research and Policy Analysis Center Funder: Office of Rural Health Policy (ORHP) Topics: Emergency medical services (EMS), Health care financing, Workforce Semi-structured telephone interviews will be used to examine issues facing rural EMS services that have converted or are considering converting from volunteer services to paid services. Respondents will be queried regarding their conversion or consideration of conversion and the effect on their ability to recruit and retain personnel, their relationship with other agencies such as fire departments and hospitals, and the overall availability of EMS services. What is Causing the Increase in Rural Hospital Costs? Research center: Walsh Center for Rural Health Analysis Funder: Office of Rural Health Policy (ORHP) Topics: Health care financing, Hospitals and clinics