H. Ann Howard, BA
North Carolina Rural Health Research and Policy Analysis Center
Email: ann_howard@unc.edu
University of North Carolina - Chapel Hill
Cecil G. Sheps Center for Health Services Research
CB# 7590
Chapel Hill, NC 27599
- Publications - (23)
Publications - (23)
2022
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Characteristics of Rural Hospitals Eligible for Conversion to Rural Emergency Hospitals and Three Rural Hospitals Considering Conversion
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 12/2022
This brief presents 2021 data for Rural Emergency Hospital (REH)-eligible hospitals, compares financial and operational measures of three rural hospitals that have expressed interest in REH conversion to all REH-eligible hospitals, and discusses what factors may ultimately determine the number of rural hospitals that convert to REH. -
Types of Rural and Urban Hospitals and Counties Where They Are Located
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 07/2022
The purpose of this brief is to provide a snapshot of the types of rural and urban hospitals and the counties where they are located.
2021
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How Many Hospitals Might Convert to a Rural Emergency Hospital?
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2021
In this study, three measures were used to predict the number of rural hospitals with 50 beds or less that are likely to consider conversion to a Rural Emergency Hospital: 1) three years negative total margin; 2) average daily census (acute + swing) less than three; and 3) net patient revenue less than $20 million.
2020
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2016-18 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2020
This study compares the 2016-18 profitability of urban Prospective Payment System (PPS) hospitals to that of rural hospitals. Rural hospitals are further divided by size of rural PPS hospitals and by the rural Medicare payment classifications. -
Geographic Variation in the 2018 Profitability of Urban and Rural Hospitals
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 04/2020
This study describes the geographic variability in 2018 profitability of Critical Access Hospitals, other rural hospitals, and urban Prospective Payment System hospitals by census region, census division, and state. -
Rural Hospitals With Long-Term Unprofitability
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 04/2020
The purpose of this study is to examine the characteristics of rural hospitals that had negative total margins in 2016, 2017, and 2018. We examined net patient revenue, Medicare payment classification, region, and state for 311 rural hospitals. -
Understanding the Broader Context of Rural Hospitals and Profitability
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 04/2020
The intent of this infographic is to quantify rural hospital profitability in the broader context of all hospitals. This infographic compares the number of rural and urban hospitals and rural and urban operating revenue and operating income.
2019
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Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 05/2019
This brief describes the geographic variation of the 2019 Centers for Medicare & Medicaid Services hospital wage index by rural/urban definition, census region, Frontier and Remote Area codes and state.
2018
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Rural Hospital Mergers From 2005 Through 2016
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2018
This brief describes the number and geographic distribution of rural hospital mergers from 2005-2016. -
Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 06/2018
The purpose of this brief is to compare uncompensated care in rural and urban hospitals and to describe how it varies across regions of the country. -
Geographic Variation in the 2016 Profitability of Urban and Rural Hospitals
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2018
This study describes the geographic variation in 2016 profitability of critical access hospitals (CAHs), other rural hospitals (Medicare Dependent Hospitals, Sole Community Hospitals, and rural Prospective Payment System (PPS) hospitals denoted as "ORH"), and urban PPS hospitals by census region, census division, and state.
2017
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The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2017
This brief describes Medicare post-acute and hospice care provided by hospitals in rural areas by characterizing the variation in the number of rural hospitals that provide PAC and hospice care, the average amount of Medicare revenue rural hospitals receive for these services, and the financial importance of PAC and hospice care to rural hospitals.
2015
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The 21st Century Rural Hospital: A Chart Book
Chartbook
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2015
This chartbook presents a broad profile of rural hospitals and includes information on location, who they serve, services they provide, how they ensure outpatient services for their communities, other community benefits they provide, and financial performance. Each page includes charts comparing rural hospitals to each other and to urban hospitals.
2010
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A Comparison of Rural Hospitals With Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment (Final Report)
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2010
This final report compares the financial performance and condition of rural hospitals with special Medicare payment provisions to urban and rural hospitals paid under prospective payment (UPPS and R-PPS hospitals, respectively). Nine ratios from the three most common categories of ratios used in financial statement analysis (profitability, liquidity, and capital structure) as well as four other ratios that are commonly used to evaluate rural hospital financial performance are assessed.
2006
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Trends Over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2006
This findings brief examines trends in the delivery of skilled nursing facility services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on critical access hospitals.
2005
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Trends in Skilled Nursing and Swing-Bed Use in Rural Areas, 1996-2003
North Carolina Rural Health Research and Policy Analysis Center
Date: 12/2005
This paper examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a time of dramatic change in Medicare payments for acute and post-acute care. It focuses on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment. -
Cesarean Section Rates in Rural Hospitals
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2005
This findings brief examines childbirth delivery patterns in rural hospitals and compares the C-section rate in rural hospitals to that in urban hospitals using the Nationwide Inpatient Sample.
2004
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Cesarean Section Patterns in Rural Hospitals
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2004
This paper examines childbirth delivery patterns in rural hospitals and compares the cesarean section rate in rural hospitals to that in urban hospitals.
2003
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Background Paper: Rural-Urban Differences in Nursing Home and Skilled Nursing Supply
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2003
This paper examines characteristics of nursing facilities and the supply of certified skilled nursing beds as the new PPS is being phased in, with particular reference to differences between urban and rural settings.
2001
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Rural Hospital Wages and the Area Wage Index: 1990-1997
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2001
This findings brief examines whether incremental changes to the hospital wage index have made it more equitable across regions and how these changes have impacted rural hospitals.
2000
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Rural Hospital Area Wages and the PPS Wage Index: 1900-1997
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2000
This paper examines the hospital wage index used by the Health Care Financing Administration and its effects on rural hospitals. -
At-Risk Hospitals: The Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2000
This report examines not-for-profit hospitals that potentially qualify as critical access hospitals and identifies facilities at risk as a result of Medicare's prospective payment systems to non-acute care settings. -
Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2000
This findings brief examines rural hospitals that potentially qualify as critical access hospitals and identifies facilities at substantial financial risk as a result of Medicare's expansion of prospective payment systems to non-acute settings.