Jeffrey Stensland, PhD

Phone: 202.220.3726
Fax: 202.220.3759
Email: jstensland@medpac.gov

MedPAC
601 New Jersey Ave. SE - Suite 9000


Completed Projects - (4)


Publications - (12)

  • 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.
  • 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.
  • The Financial Benefits of Critical Access Hospital Conversion for FY 1999 and FY 2000 Converters
    University of Minnesota Rural Health Research Center
    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.
  • The Financial Effects of Critical Access Hospital Conversion
    University of Minnesota Rural Health Research Center
    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
    University of Minnesota Rural Health Research Center
    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 Viability of Rural Hospitals in a Post-BBA Environment
    University of Minnesota Rural Health Research Center
    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.
  • Rate of Return on Capital Investments at Small Rural Hospitals
    University of Minnesota Rural Health Research Center
    Date: 01/2003
    Examines whether the aging of rural facilities, a major problem among rural hospitals, is due to a lower rate of return on capital investment at these hospitals. This paper also investigates whether membership in a hospital system improves access to capital and results in the updating of buildings and equipment. The study found that hospitals generally do no use system membership to overcome access to capital problems, most likely because investments are not readily available along this pathway. The study also found that hospitals generate 50 cents for every dollar invested in facility improvement. Although this is a way to generate revenue, the small hospitals will typically not be able to recover the costs spent in the improvement. These findings suggest that small hospitals, particularly the smallest and most rural hospitals, would need grants in order to adequately cover the costs of facility improvement.
  • Rural Hospitals' Ability to Finance Inpatient, Skilled Nursing, and Home Health Care
    University of Minnesota Rural Health Research Center
    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.
  • Understanding Rural Hospital Bypass Behavior
    University of Minnesota Rural Health Research Center
    Date: 06/2002
    This study provides a descriptive analysis of rural hospital bypass behavior. Focuses on the extent to which patients admitted from rural areas are bypassing local facilities and whether there are changes in bypass patterns over time.
  • 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.
  • 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.
  • Why do Rural Primary-Care Physicians Sell Their Practices?
    University of Minnesota Rural Health Research Center
    Date: 06/2000
    This study evaluates why rural primary care physicians sell their practices. Examines the factors that led independent physicians to sell their practices to either non- local buyers, local hospitals or local physicians.