NORC Walsh Center for Rural Health Analysis

Products

Listed by publication date. You can also view these publications alphabetically.

For a complete list of publications from the Center, which may include older publications and publications funded by other sources, please see the Center's website.

2010

  • The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Final Report)
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2010
    Discusses the impact of rurality on office-based physicians' participation in the 2007 Physician Quality Reporting Initiative (PQRI), a voluntary pay-for-reporting program in Medicare. PQRI offers a financial incentive to physicians and other eligible professionals who successfully report quality measures related to services provided under the Medicare Physician Fee Schedule.
  • The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Policy Brief)
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2010
    Rural practices may be at a disadvantage with respect to participating in the Physician Quality Reporting Initiative (PQRI), not necessarily because of their geographic location, but because they tend to be smaller, and have fewer resources and a less developed quality measurement infrastructure.
  • Use of Emergency Departments for Conditions Related to Poor Oral Health Care
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2010
    Persistent and worsening shortages of oral healthcare providers in rural areas, combined with limited acceptance of Medicaid and the Children's Health Insurance Program (CHIP), have left many patients without adequate access to dental care.
  • Alternatives to the Outpatient Prospective Payment System: Assessing the Impact on Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2010
    In 2000, CMS implemented a new congressionally mandated hospital outpatient prospective system (OPPS). The new system changed payments for hospital outpatient services from a retrospective cost basis to a prospective amount based on the median resource cost of groups of services expected to be provided. Because of the magnitude of the potential impact of this payment change on both rural hospitals and rural residents, small rural hospitals were granted protection from payment reductions in the transition to OPPS-referred to as "hold harmless" provisions. Given changes in rural hospital reimbursement for outpatient services, particularly as the hold-harmless protection is expected to phase out in December 2009, the purpose of this policy brief is to explore alternatives to the OPPS and how these options would affect rural hospitals.

2009

  • Satisfaction with Practice and Decision to Relocate: An Examination of Rural Physicians
    NORC Walsh Center for Rural Health Analysis
    Date: 05/2009
    The goal of this project was to improve our understanding of the dynamics of physician practice location decision making. The inability of rural areas to attract and retain physicians has been of concern to health services researchers and policymakers for many years. This project tracked practice locations of a cohort of physicians using information on physicians who were identified during the early stages of their medical careers as part of the National Survey of Rural Physicians (NSRP), conducted in 1993-1994 with funding from the Robert Wood Johnson Foundation. These data were supplemented with information on the current practice locations of physicians in the cohort, and with data from a follow-up survey that also asked a battery of satisfaction questions. For the subset of sampled physicians who responded to the NSRP, we identified factors correlated with the decision to maintain a rural practice. Contingency tables were used to test a variety of hypotheses concerning factors affecting the physician's decision to continue practice in a rural community, along with statistical analyses to examine relationships between these factors.
  • Achieving Success in QIO and Rural Hospital Partnerships (Final Report)
    NORC Walsh Center for Rural Health Analysis
    Date: 02/2009
    This report describes four case studies that highlight the strategies employed by QIOs to help small rural hospitals implement successful quality improvement initiatives. These case studies are presented with the goal of describing successful QIO-hospital relationships, where success is measured in terms of quality improvement. These relationships are spotlighted to emphasize the value that rural hospitals derive from the technical assistance offered to CAHs and small rural providers. This study was conducted by staff at Social and Scientific Systems, Inc., under contract to the NORC Walsh Center for Rural Health Analysis.

2008

  • Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
    NORC Walsh Center for Rural Health Analysis
    Date: 10/2008
    This brief presents NORC Walsh Center for Rural Health Analysis research conducted to better understand the experiences of CAHs in operating an EMS unit. Using key informant interviews, researchers examined motivations for acquiring EMS services and the effect of these services on the level of emergency care available in the community. The benefits and challenges that CAH providers face in operating EMS services are discussed.
  • Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services (Final Report)
    NORC Walsh Center for Rural Health Analysis
    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.
  • Urban-to-Rural Evacuation: Planning for Rural Population Surge (Final Report)
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2008
    To date, rural emergency planning efforts have focused more on addressing the needs of rural residents and have not accounted for potential population surge from neighboring urban areas in the event of disaster. In many areas, rural infrastructure and capacities are likely to be stretched thin or possibly overwhelmed. This study assessed the likelihood of urban evacuation to rural areas and provides recommendations for rural planning and response.
  • Financing Rural Public Health Activities in Prevention and Health Promotion (Final Report)
    NORC Walsh Center for Rural Health Analysis
    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.
  • Rural Public Health Financing: The Relationship Between Infrastructure and Local Program Funding (Policy Brief)
    NORC Walsh Center for Rural Health Analysis
    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.
  • Critical Access Hospitals' Experience with Medicare Advantage Plans
    NORC Walsh Center for Rural Health Analysis, RUPRI Center for Rural Health Policy Analysis
    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.

2007

2006

  • Roadmap for the Adoption of Health Information Technology in Rural Communities
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2006
    Assists rural providers who are just beginning their investigation of using health IT, and its applicability to their organization.
  • Attention from the Top? Roles of State Offices of Rural Health Policy in Preparing for Bioterrorism and Other Health System Emergencies
    NORC Walsh Center for Rural Health Analysis
    Date: 07/2006
    Presents results from a follow-up survey of directors of state offices of rural health on emergency preparedness in rural communities. A telephone survey was used to identify state office involvement with emergency preparedness (EP) activities. Findings indicate that the nature of involvement varied considerably across states. Among the most pressing needs were for improvements in communication and for additional EP training, especially for EMS and hospital personnel. Most offices were involved in activities related to development of an emergency preparedness response plan encompassing the state (71 percent) or development of a plan for regions within the state (55 percent). Over half of state office directors reported involvement in assessment of training needs of emergency personnel and in assessing EP of rural hospitals. Almost half of state offices participated in assessment of rural public health system preparedness capabilities. Sixty-one percent of offices assisted in development of capabilities for the electronic exchange of information among health care providers and public health officials serving rural areas, and 48 percent of rural offices were engaged in activities in support of development of a system for receipt of urgent reports or information by providers on a 24-hour-7-day basis.
  • Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes
    NORC Walsh Center for Rural Health Analysis
    Date: 05/2006
    This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes, and to ascertain whether there are agency characteristics that are associated with better or worse outcomes. This study found rather small differences in the quality of care provided by home health agencies in rural and urban areas. Findings from the multivariate analyses indicated that rural agencies performed better on measures of improvement in walking, transferring, and dressing, whereas urban agencies performed better on measures of improvement in pain frequency and medication management. Rural or urban location had only a modest effect on functional performance scores. Rural and urban agency differences in rates of unplanned urgent care and hospital admissions were not statistically significant after controlling for other agency characteristics, region of country and characteristics of the health care market.
  • Rural Public Health Infrastructure: Case Studies to Assess the Impact of Structure on Service Delivery
    NORC Walsh Center for Rural Health Analysis
    Date: 01/2006
    The purpose of this study is to contribute to a more thorough understanding of how public health governance affects how states structure and organize the delivery of public health services, and how this, in turn, influences the strategies adopted for meeting community public health needs in rural areas. Using a case study approach, the study examined three themes: 1) lines of reporting and accountability among public health entities, 2) provision of public health services, and 3) public health funding for localities. This work suggests that it would be of value to develop a comprehensive profile of state' public health systems, which would include specific aspects of each state's public health infrastructure, as well as community population and health statistics. Report available on request by contacting the Center.

2005

  • Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 12/2005
    Summarizes the experience of Critical Access Hospital (CAH) administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans.
  • Revisions to Medicare's Disproportionate Share Payment Policy to Incorporate Bad Debt and Charity Care
    NORC Walsh Center for Rural Health Analysis
    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.
  • Utilization of Home Health Services Among Rural Medicare Beneficiaries Before and After the PPS
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2005
    Describes a study conducted to gather information on the rural effects of the PPS, including whether the PPS contributed to changes in: (1) the demographic and clinical characteristics of home care users; (2) the likelihood of using each of six home care disciplines (aide, skilled nursing, physical therapy, occupational therapy, speech therapy and medical social work); and (3) the intensity of services. A total of 99,367 home health episodes were represented in the two years of Medicare data examined. In both study years, urban residents accounted for three-quarters of episodes, while residents of large rural counties and those of remote rural counties accounted for approximately 21 percent and 3 percent of episodes, respectively. Findings suggest that the PPS has had a mixed effect on access to home care in rural counties. Study results indicated an association between implementation of the PPS and admitting home health diagnoses, utilization and intensity of home care episodes and, for the subset of home health users admitted from an acute hospital, readmission rates.
  • Home Health Payment Reform: Trends In The Supply Of Rural Agencies And Availability Of Home-Based Skilled Services
    NORC Walsh Center for Rural Health Analysis
    Date: 03/2005
    Findings from this study suggest that changes in home health reimbursement were associated with dramatic reductions in the supply of home care agencies; however those reductions appear to have occurred primarily during the time in which the Interim Payment System was in place. Although proportionately fewer rural agencies closed between 1998 and 2000, the closure of a rural agency may have a greater impact on access since many communities are experiencing critical shortages of providers. In the post-PPS period, agency supply became more stable, but closure rates were higher among rural agencies.
  • Patterns Of Post-Acute Utilization In Rural And Urban Communities: Home Health, Skilled Nursing, and Inpatient Medical Rehabilitation
    NORC Walsh Center for Rural Health Analysis
    Date: 03/2005
    Describes rural Medicare beneficiaries' patterns of post-acute utilization of home health services, skilled nursing facilities, and inpatient rehabilitation facilities. This study provides baseline data that policymakers, researchers, and others who are interested in rural health care issues may use to monitor how changes in Medicare policies affect access to post-acute care in rural areas.

2004

  • Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
    NORC Walsh Center for Rural Health Analysis, RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    Provides in chart form sections of the MMA which were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policymakers. The particular sections are cited and implications for rural health services are indicated. Most of the sections identified are concerned with access to prescription drug coverage and the impact of the proposed legislation on rural pharmacies. The primary focus is on rules that will affect providers of drug coverage; this policy paper does not focus on rural dimensions of coverage from the insurance providers' perspective.
  • Exploring the Impact of Medicare's Post-Acute Care Transfer Payment Policy on Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
    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.
  • Access To Primary Care And Quality Of Care In Rural America
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2004
    Provides findings from a population-based study addressing the impact of the availability of health care resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services.
  • Rural Implications of Medicare's Post-Acute Care Transfer Payment Policy
    NORC Walsh Center for Rural Health Analysis
    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.
  • Perspectives Of Rural Hospitals On Bioterrorism Preparedness Planning
    NORC Walsh Center for Rural Health Analysis
    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.
  • 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
    NORC Walsh Center for Rural Health Analysis
    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.
  • Rural Hospitals' Strategies for Achieving Compliance with HIPAA Privacy Requirements
    NORC Walsh Center for Rural Health Analysis
    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.
  • Financially Distressed Rural Hospitals In Four States
    NORC Walsh Center for Rural Health Analysis
    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.
  • Medicare Home Health Care in Rural America (Brief)
    NORC Walsh Center for Rural Health Analysis
    Date: 01/2004
    This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies. Findings demonstrate that urban agencies, either directly or through their branch offices, play an important role in providing home healthcare to rural Medicare beneficiaries. A full report is also available.

2003

  • Survey of Critical Access Hospital (CAH)-Affiliated Emergency Medical Service (EMS) Providers
    NORC Walsh Center for Rural Health Analysis
    Date: 09/2003
    To provide a description of EMS providers in rural communities, particularly those with CAHs. Report available by contacting the Center.
  • Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Regulations: Case Studies Of Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
    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 by contacting the Center.
  • Who Receives Inpatient Charity Care in California?
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2003
    Examines the results of a study regarding how California hospitals determine charity care.
  • Medicare Home Health Care in Rural America (Full Report)
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2003
    This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies. Findings demonstrate that urban agencies, either directly or through their branch offices, play an important role in providing home healthcare to rural Medicare beneficiaries. Report available on request. Report available by contacting the Center.
  • Rural Beneficiaries' Projected Drug Coverage Under Three Medicare Prescription Drug Proposals
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2003
    Estimates the expected increase in urban and rural Medicare beneficiaries eligible for drug coverage under three current Medicare prescription drug proposals. Also gives an estimate of the urban and rural per capita federal payments for drug coverage under the three proposals. Finds that total dollar impact of the three proposals is driven by their generosity. The costliest offers the greatest taxpayer-funded benefits. Per dollar of spending, the urban/rural division of federal drug outlays differs across the proposals. The Administration proposal would result in much higher per-capita federal drug spending in rural areas than urban ones. Congressional Republican and Democratic proposals show smaller rural-urban differences. Concludes that higher poverty and lower current drug coverage in rural areas affect projected spending under Medicare drug proposals. Per dollar of spending, the Administration's proposal to focus spending on near-poor without current coverage strongly favors rural areas. Congressional Democratic and Republican proposals subsidize coverage for all, including those currently with and without coverage. The urban-rural split of federal spending under those proposals depends on the extent to which the currently uninsured are willing to take up the newly offered benefit. Report available by contacting the Center.
  • Designing a Medicare Drug Benefit: Balancing Government-Based and Market-Based Approaches, the Implications for Rural Beneficiaries
    NORC Walsh Center for Rural Health Analysis
    Date: 01/2003
    Examines the relationship between a variety of design characteristics of a Medicare prescription drug benefit and their likely impact on rural areas. The research is based on an analysis of three competing legislative proposals, the House passed proposal (HR 4954), the "Tripartisan" proposal (S 2729), and the Graham proposal (S 2625). In addition, there is an analysis of data from the Medicare Current Beneficiary Survey, pharmacy benefit managers, discussions with various state and federal policy makers, and reviews of published literature. The study finds that the different prescription drug proposals will have positive implications for rural areas and address the lack of access to Medicare+Choice drug coverage in rural areas. Rural pharmacies may see a change in revenue, but the actual result of the changes has not been studied. Report available by contacting the Center.
  • 2003 Index of Hospital Quality
    NORC Walsh Center for Rural Health Analysis
    Date: 2003
    Published annually by U.S. News & World Report. Describes a series of factors regarding ranking of measuring hospital quality. Report available by contacting the center.

2002

  • Rural Dimensions of Medicare Reimbursement for Inpatient and Outpatient Institutional and Physician Services
    NORC Walsh Center for Rural Health Analysis
    Date: 12/2002
    Examines major Medicare payment policies from the rural perspective and summarizes major payment policies with explicit rural dimensions that directly affect physicians and hospitals. Looks at whether direct rural impacts are consistent with legislative and regulatory intentions.
  • Federal Funding for Emergency Medical Services
    NORC Walsh Center for Rural Health Analysis
    Date: 07/2002
    Includes recent trend data from 1994 to the present on aggregate Federal spending on EMS and funding targeted explicitly to rural areas. Also discusses the role various Federal agencies have played and traces the history of Federal legislation to support EMS programs. Activities funded under Title XII of the Public Health Service Act. Discussion of pending EMS-related legislation and future goals specified by the agencies included in the study. Report available by contacting the Center.
  • Are Fundamental Changes to Medicare's Disproportionate Share Methodology Needed?
    NORC Walsh Center for Rural Health Analysis
    Date: 06/2002
    Examines whether the Medicare disproportionate share percentage (DPP) is a useful predictor of Medicare costs per adjusted discharge and whether it is a good predictor of uncompensated care burdens. Findings indicate that the DPP is not a useful predictor of differences in the cost of treating Medicare patients (and is a statistically significant but weak predictor of uncompensated care burdens); the analysis does not support the contention that treatment of substantial numbers of low-income patients with public insurance directly causes hospitals to incur higher costs per discharge. It finds no support for basing DSH payments on DPP levels. The study concludes that if its results were confirmed in a national study of DSH payments, operating costs, and uncompensated care costs, there would be justification for fundamentally changing DSH payment methodology. Furthermore, since the results indicate that patient needs per adjusted discharge unit are unrelated to the DPP at both rural and urban hospitals, the authors see no rationale for differential treatment between rural and urban providers. Report available by contacting the Center.
  • Capital Needs of Small Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
    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.
  • Variance in the Profitability of Small-Town Rural Hospitals (Policy Brief)
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2002
    This policy brief discusses why some rural small-town hospitals are financially successful and others struggle with persistent financial difficulties. Report available by contacting the Center.
  • Essential Research Issues in Rural Health: The State Rural Health Directors' Perspective
    NORC Walsh Center for Rural Health Analysis
    Date: 03/2002
    Policy brief describes the key issues confronting state rural health directors. Five issues were repeatedly raised by directors from a wide variety of states: workforce, telemedicine, emergency medical services, mental health, and lack of local data.
  • How State Rural Health Directors Obtain Policy-Relevant Research Information
    NORC Walsh Center for Rural Health Analysis
    Date: 03/2002
    Policy brief summarizes how information pertinent to rural health policy activities of the state offices is obtained. The primary sources of policy-relevant information identified by directors are: the Internet, information sharing with others, and strategic partnerships with organizations outside the traditional health policy arena. The study also found that the organizational location of the state's office of rural health may affect the level of resources available for information gathering. The brief identifies steps to ensure that needed information can be accessed in the future: 1) state offices should have and maintain adequate resources to ensure ready access to electronic forms of information; 2) state offices should continue to share information on sources of health policy research; and 3) study further the implications of organizational form of state offices on resources available for getting needed information.
  • Variance in the Profitability of Small-Town Rural Hospitals (Full Report)
    NORC Walsh Center for Rural Health Analysis
    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. Reports on strategies that small-town hospital administrators are using to achieve financial success.

2001

  • Quality of Medicare Outpatient Claims Data and Its Implications for Rural Outpatient Payment Policy
    NORC Walsh Center for Rural Health Analysis
    Date: 12/2001
    Analyzes Medicare outpatient claims to see if relatively poor quality of small rural hospitals' claims data have amplified the negative effects of the new payment system on small hospitals. Compares three indicators of quality across urban, rural, and small rural hospitals: 1) proportion of claims with missing procedure codes, 2) proportion of claims with multiple procedures codes, and 3) proportion of "low-intensity" versus higher intensity evaluation and management or emergency room services. Finds no significant differences among urban, rural, and low-volume rural hospitals with respect to missing codes; urban hospitals were more likely to have multiple codes; and small rural hospitals were substantially more likely to submit low intensity claims. Study does not refute the possibility that undercoding played a role in CMS's forecasts of negative impact of the outpatient PPS for small rural hospitals. Report available on request by contacting the Center.
  • Establishing a Fair Medicare Reimbursement for Low-Volume Rural Ambulance Providers
    NORC Walsh Center for Rural Health Analysis
    Date: 07/2001
    This National study of ambulance transport costs looks at the advantages and disadvantages of several options for Medicare to compensate low-volume rural ambulance providers. Results show that many low-volume rural volunteer EMS providers will benefit from the new Medicare fee schedule.
  • 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
    NORC Walsh Center for Rural Health Analysis
    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 by contacting the Center.
  • Will the Outpatient Prospective Payment System Increase the Number of Distressed Rural Hospitals in Iowa, Texas, Washington, and West Virginia?
    NORC Walsh Center for Rural Health Analysis
    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 by contacting the Center.

2000

1999

1998