Health care financing

Publications

Alphabetical list. You can also view by publication date.

• 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.
• 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.
• Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
  Author(s): Anthony Wellever, Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health care financing, Legislation and regulation, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Date: 08 / 2000
  This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
• 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.
• Background on the Wage-related Portion of the Medicare DRG Payments
  Author(s): Kathleen Dalton
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health care financing, Medicare
  Date: 09 / 2000
  Discusses how to calculate Medicare diagnostic related group (DRG) payments. Includes examples and a diagram of how to calculate a DRG payment.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Author(s): CAH Financial Indicators Report Team at UNC
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Data Summary Report No. 3
  Date: 08 / 2007
  Presents 20 financial indicators for Critical Access Hospitals (CAHs). Includes state and national medians for indicators addressing profitability, liquidity, capital structure, revenue, cost, and utilization. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Author(s): CAH Financial Indicators Report Team at UNC
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Data Summary Report No. 1
  Date: 10 / 2005
  Summarizes Critical Access Hospital (CAH) financial indicators for 2003, providing state and national medians for each indicator. The indicators are grouped by financial dimension: profitability, liquidity, capital structure, revenue, cost, and utilization. The number of CAHs included in the median calculations is also provided. Information about the definition and interpretation of the indicators can be found in the full report, Briefing Paper No. 7, Financial Indicators for Critical Access Hospitals. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Author(s): CAH Financial Indicators Report Team at UNC
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Data Summary Report No. 2
  Date: 11 / 2006
  Presents 20 financial indicators for Critical Access Hospitals (CAHs). Includes state and national medians for indicators addressing profitability, liquidity, capital structure, revenue, cost, and utilization. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• 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.
• Establishing a Fair Medicare Reimbursement for Low-Volume Rural Ambulance Providers
  Author(s): Penny E. Mohr, C. Michael Cheng, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Emergency medical services (EMS), Health care financing, Medicare
  Date: 07 / 2001
  National study of ambulance transport costs looks at the advantages and disadvantages of several options for Medicare to compensate low-volume rural ambulance providers. Among its conclusions: many low-volume rural volunteer EMS providers will benefit from the new Medicare fee schedule; a volume-based premium offers a disincentive for small providers to grow and take advantage of economies of scale; and cost-based reimbursement for a select class of rural providers would not over- or under-pay vulnerable providers. Report available on request.
• 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.
• Financial Benefits of Critical Access Hospital Conversion for FY 1999 and FY 2000 Converters
  Author(s): Jeffrey Stensland, Gestur Davidson, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Date: 01 / 2004
  Discusses the impact of conversion to Critical Access Hospital (CAH) status on the financial condition of rural hospitals one and two years after conversion. CAHs pre- and post-conversion revenues are compared, and CAH revenues are compared to small rural hospitals that did not convert to cost-based Medicare reimbursement.
• Financial Effects of Critical Access Hospital Conversion
  Author(s): Jeffrey Stensland, Gestur Davidson, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Working Paper No. 44
  Date: 01 / 2003
  Describes how the first wave of conversions to Critical Access Hospital (CAH) status affected rural hospitals? financial performance and organizational structure.
• 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 Indicators for Critical Access Hospitals
  Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Briefing Paper No. 7
  Date: 05 / 2005
  The purpose of this study was to develop and disseminate comparative financial indicators specifically for Critical Access Hospitals (CAHs) using Medicare Cost Report data. Results showed that, over the six years since 1998, CAHs generally became more profitable and increased their utilization of beds. However, while on average CAHs with long-term care became more liquid and reduced their use of debt over time, those without long-term care became less liquid and increased their use of debt. In the most recent year for which we have data (2003), CAHs without long-term care generally were more profitable, were more liquid, had less debt, and had higher utilization of beds in comparison to CAHs with long-term care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Financial Indicators for Critical Access Hospitals
  Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Citation: Journal of Rural Health, 22(3), 229-36
  Date: 2006
  There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). The authors, along with a technical advisory group, focused on twenty indicators deemed appropriate for assessment of CAH financial condition and formulas determined. Issues 1 and 2 of the CAH Financial Indicators Report were mailed to the chief executive officers of 853 CAHs in the summer of 2004 and 1,092 CAHs in the summer of 2005, respectively. Each report included indicator values specifically for their CAH, indicator medians for peer groups, and an evaluation form.
• 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.
• Financing and Payment Issues in Rural Long Term Care Integration (Brief)
  Research center: Maine Rural Health Research Center
  Topics: Health care financing, Long term care
  Report Number: Research and Policy Brief
  Date: 02 / 2001
  Reviews current research and experience and identifies key policy and program considerations for integrated acute and long term care financing in rural areas.
• Financing and Payment Issues in Rural Long Term Care Integration (Full Report)
  Author(s): Paul Saucier, Julie Fralich
  Research center: Maine Rural Health Research Center
  Topics: Health care financing, Long term care
  Report Number: Working Paper No. 21
  Date: 2000
  Reviews current research and experience and identifies key policy and program considerations for integrated acute and long term care financing in rural areas. Finds that full capitation of acute and long term care payments is an urban financial integration model that is often not applicable in rural areas. Many rural areas do not have adequate infrastructure to support full capitation models, nor are such models necessarily consistent with the common rural area goal of preserving and strengthening existing providers. Other incremental payment approaches that support some integration of services are more feasible for rural areas, including the creation of fee-for-service incentives, partial capitation, and other risk limitation strategies.
• Financing Rural Public Health Activities in Prevention and Health Promotion (Final Report)
  Author(s): Michael Meit, Lorraine Ettaro, Benjamin Hamlin, Bhumika Piya
  Research center: Walsh Center for Rural Health Analysis
  Topics: Chronic diseases and conditions, Health care financing, Health promotion and disease prevention, Public health
  Date: 06 / 2008
  Final Report of a study to determine whether the flow of federal resources, from federal agencies, through states, and to communities, is influenced by state and local level public health infrastructure.
• How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Pre-Implementation Prescription Volume and Payment Sources in Rural and Urban Areas
  Author(s): Erin P. Fraher, Rebecca T. Slifkin, Laura Smith, Randy Randolph, Matthew Rudolf, George M. Holmes
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health care financing, Health policy, Medicare Part D, Pharmacy and prescription drugs
  Citation: Journal of Rural Health, 21(2), 114-121
  Date: 2005
  Presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs. urban areas. Together, these data provide a baseline for evaluating how implementation of the MMA may affect the financial viability of rural independent pharmacies. The authors found that the volume of mail-order prescriptions is small. Rural providers prescribed fewer retail and mail-order prescriptions per person, but more units per person. Rural areas have a higher percentage of prescriptions paid for by cash (18% vs. 13%) and Medicaid (16% vs. 10%) and a lower percentage of third-party payers than urban areas. Significant variation in volume and payer type exists between states. The authors conclude that rural, independent pharmacies may be negatively affected by MMA implementation as business shifts from cash to third-party reimbursement. The high degree of variation between states also has potentially important implications for the implementation of Prescription Drug Plan regions under MMA.
• How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
  Author(s): Janet P. Sutton, Alene Kennedy, Lucia Hammer, Grace Yang
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
  Report Number: Walsh W Series No. 11
  Date: 07 / 2007
  Policy brief examining the financial effect that changes in current Medicare bad debt payment policy, as proposed in the FY2007 budget, might have on rural hospitals.
• Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services (Final Report)
  Author(s): Julie Schoenman and Janet Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services
  Date: 08 / 2008
  This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
• Impact of Conversion to Critical Access Hospital Status on Hospital Financial Performance and Condition
  Author(s): Mark Holmes, George H. Pink, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Findings Brief No. 1
  Date: 11 / 2006
  Policy brief analyzing financial ratios associated with Critical Access Hospitals' profitability, liquidity, and capital structure. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• 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.
• 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.
• 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.
• 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 CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
  Author(s): Kathleen Dalton, Rebecca T. Slifkin, Hilda A. Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Medicare Prospective Payment System (PPS)
  Date: 01 / 2000
  Examines rural hospitals that potentially qualify as Critical Access Hospitals (CAH), and identifies facilities at substantial financial risk as a result of Medicare?s expansion of prospective payment systems (PPS) to non-acute settings.
• Rural Government Role in Medicaid Managed Care: The Development of County-Based Purchasing in Minnesota
  Author(s): Astrid Knott, Jon B. Christianson
  Research center: Minnesota Rural Health Research Center
  Topics: Health care financing, Medicaid and S-CHIP
  Report Number: Working Paper No. 35
  Date: 01 / 2001
  Describes the development and implementation in Minnesota of a model for rural county government participation in Medicaid managed care initiatives. The model-called County-Based Purchasing-allows county governments the option of functioning as direct purchasers of health care for the Medicaid beneficiaries in their area, accepting financial risk for service delivery. Concludes that if the model is to be used nationally, several issues must be addressed including, the federal approval process for similar initiatives, the relationship between state and county agencies, and sources of funding.
• 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 Implications of Medicare's Post-Acute Care Transfer Payment Policy
  Author(s): Julie A. Schoenman
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Long term care, Medicare
  Date: 06 / 2004
  Beginning in October 1998, Medicare began to pay acute-care hospital cases in 10 DRGs as transfers instead of discharges when the patient is discharged to a targeted post-acute care (PAC) provider after a short inpatient stay. This study examines the behavioral and financial impacts of the initial 10-DRG policy, and projects the likely financial impact of extending the policy to cover additional DRGs or discharges to swing beds. Key findings: 1) Hospitals' discharge behavior did not change significantly in ways that would suggest a strategic response to the PAC transfer payment policy; 2) Based on simulation, less than 5 percent of all cases discharged from the additional DRGs would receive the PAC transfer payment instead of the full DRG payment. Medicare revenue earned by rural hospitals would fall by more than $1,100 for each transfer case.; and 3) Expanding the transfer policy to cover swing beds would result in a relatively small financial impact. A policy brief is also available.
• Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy
  Author(s): Julie A. Schoenman, Curt D. Mueller
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Long term care, Medicare
  Citation: Journal of Rural Health, 21(2), 122-130
  Date: 2005
  Examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. The authors conclude that rural hospitals are not disproportionately harmed by the post-acute-care transfer policy. An expanded policy may even benefit rural hospitals by recognizing their lower use of post-acute-care and readjusting DRG weights so that they are paid more appropriately when providing the full course of inpatient care.
• Rural Public Health Financing: The Relationship Between Infrastructure and Local Program Funding (Policy Brief)
  Author(s): Michael Meit, Lorraine Ettaro, Benjamin Hamlin, Bhumika Piya
  Research center: Walsh Center for Rural Health Analysis
  Topics: Chronic diseases and conditions, Health care financing, Health promotion and disease prevention, Public health
  Report Number: W Series No. 14
  Date: 06 / 2008
  The purpose of this study was to describe how federal funds for selected chronic disease prevention and health promotion activities are distributed to local health departments and non-governmental organizations at the local level and to identify infrastructure-related barriers that rural agencies may face in securing and using funds for such purposes. A central hypothesis was that the availability of federal funding for chronic disease prevention and health promotion activities may vary based on state and local public health infrastructural differences.
• 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.
• Variations in Financial Performance Among Peer Groups of Critical Access Hospitals
  Author(s): George H. Pink, George M. Holmes, Roger E. Thompson, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Citation: Journal of Rural Health, 23(4), 299–305
  Date: 2007
  Reports findings from a study that investigated whether indicators of financial performance and condition systematically vary among peer groups of Critical Access Hospitals (CAHs). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Why are Health Care Expenditures Increasing and Is There a Rural Differential?
  Author(s): Timothy D. McBride
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topic: Health care financing
  Report Number: Rural Policy Brief Vol. 10, No. 7 (PB2005-7 )
  Date: 11 / 2005
  Rising health care expenditures have in recent years been a burden for rural persons, rural employers, and taxpayers. Several factors have contributed to rising health care expenditures, including changes in the health care needs of the population, rising income of the population, insurance-induced demand, provider price changes, and technological change. Some of these factors have disproportionately affected rural areas, and rural areas have in recent years seen higher increases in some expenditure categories such as physician office-based visits and prescription drugs. Those differences suggest strategies to contain health expenditure increases may be different in rural areas and may be best determined on a local basis.
• 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.