Janet Sutton, PhD


Completed Projects - (13)

Achieving Equity in Disproportionate Share Payments to Rural Hospitals: An Examination of MedPAC's Revised Disproportionate Share Formula
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Healthcare financing, Hospitals and clinics, Legislation and regulation
Burdens of HIPAA on Rural Hospitals
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Hospitals and clinics, Legislation and regulation
Determinants of Quality of Care in Rural Communities: How Does The Health Care Infrastructure Affect Quality of Care in Rural America?
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Health services, Quality, Workforce
Effective Strategies for Achieving HIPAA Compliance Among Rural Hospitals
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Hospitals and clinics, Legislation and regulation
Impact of CAH Conversion on Hospital Costs and Mix of 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.
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services, Healthcare financing
Impact of the Home Health PPS on Access in Rural America
This study is designed to help policymakers understand whether patterns of home care use in rural communities have been affected by the PPS. Analyses will provide information on the characteristics of the patients served, the number and mix of services rendered, and quality of care.
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Home health, Medicare Prospective Payment System (PPS)
Medicare Beneficiary Outcomes in Rural and Urban Home Health Agencies
This study will compare the performance of rural and urban home care agencies, and identify agency characteristics that contribute to better patient care outcomes.
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Home health, Medicare Prospective Payment System (PPS), Quality
Options for Structuring Disproportionate Share (DSH) Payments to Account for Uncompensated Care: Impact on Rural Hospitals
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.
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Health policy, Healthcare financing, Hospitals and clinics
Outpatient Payment Policy Under Medicare: Recent Policy Developments from the Rural Perspective
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.
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Healthcare financing, Hospitals and clinics
Post-Acute Care: A Rural and Urban Comparison
This multi-phase analysis examines whether discharge patterns for and use of post-acute care services by rural and urban hospitalized Medicare beneficiaries differ and, if they do, what are the sources of these different patterns.
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Home health, Long term care, Medicare
Quality Improvement Organizations' Contributions to Rural Hospital Performance
This qualitative study is designed to gather information on best-practices in Quality Improvement Organization (QIO)-rural hospital partnerships. Specifically, this study will identify successful and replicable examples in which QIOs have worked with rural and critical access hospitals to improve processes of care, implement health information technology and promote organizational safety culture.
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health information technology, Hospitals and clinics, Quality
Rapid Response: Elimination of Bad Debt Payments to Rural PPS Hospitals
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.
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Healthcare financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
Rural Dimensions of Medicare Payment Policies
Research center: NORC Walsh Center for Rural Health Analysis
Topics: Health policy, Medicare

Publications - (14)

  • Achieving Equity in Medicare Disproportionate Share Payments to Rural Hospitals: An Assessment of the Financial Impact of Recent and Proposed Changes to the Disproportionate Share Hospital Payment Formula
    NORC Walsh Center for Rural Health Analysis
    Date: 09/2002
    Examines how Benefits Improvement and Protection Act revisions to the Medicare disproportionate share hospital (DSH) program are likely to affect rural hospital financial performance. The study shows that paying rural hospitals based on the rules used for urban hospitals could improve access to care in rural communities.
  • 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.
  • 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.
  • 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.
  • How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
    NORC Walsh Center for Rural Health Analysis
    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)
    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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Rural and Urban Patterns of Home Health Use: Implications for Access Under the Interim Payment System
    NORC Walsh Center for Rural Health Analysis
    Date: 03/2000
    This policy analysis brief compares patterns of home health utilization among rural and urban Medicare beneficiaries in order to estimate the potential impact of an interim payment system (IPS) on access to home care in rural areas of the country.
  • 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.
  • Spontaneous Evacuation Following a Dirty Bomb or Pandemic Influenza: Highlights from a National Survey of Urban Residents' Intended Behavior
    NORC Walsh Center for Rural Health Analysis
    Date: 11/2007
    Reports results of a national survey to assess the evacuation intentions of urban citizens following emergency scenarios. Includes information on how likely it would be for evacuees to go to a rural or urban area. Discusses the potential impact of an urban evacuation on rural areas.
  • 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.