Kathleen Dalton, PhD

Contact information for this researcher is no longer available, but you can still access their previous work.


Completed Projects - (4)


Publications - (14)

  • At-Risk Hospitals: The Role of Critical Access Hospital 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 those facilities that are at risk as a result of Medicare's PPS to non-acute care settings.
  • Background on the Wage-related Portion of the Medicare DRG Payments
    North Carolina Rural Health Research and Policy Analysis Center
    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.
  • PPS Inpatient Payment and the Area Wage Index
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2001
    Discusses how inpatient rates are calculated, the role of the wage index, and issues surrounding the wage index and reimbursement to rural hospitals by Medicare under the Prospective Payment System (PPS).
  • Primer On Interpreting Hospital Margins
    North Carolina Rural Health Research and Policy Analysis Center
    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.
  • 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
    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 Hospital Area Wages and the PPS Wage Index: 1900-1997
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2000
  • Rural Hospital Wages and the Area Wage Index: 1990-1997
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2001
    Examines whether incremental changes to the hospital wage index have made it more equitable across regions and how these changes have impacted rural hospitals.
  • Rural-Urban Differences in Nursing Home and Skilled Nursing Supply
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2003
    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. Finds that rural-urban differences in the supply of long-term care beds and in the characteristics of long-term facilities are less pronounced, in general, than rural-urban differences in acute care capacity. Among the differences between urban and rural nursing facilities are: the most rural counties are the most likely to have no certified nursing homes; as counties become more rural, swing beds account for an increasing percentage of Medicare SNF discharges; and long-term care facilities in the most rural counties are more likely to be hospital based. Overall, the supply of nursing facilities does not appear to be a problem in rural areas, with the possible exception of the most rural counties.
  • Rural-Urban Issues In The Wage Index Adjustment For Prospective Payment In Skilled Nursing Facilities (Brief Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2004
    The hourly wage data collected from Medicare-participating nursing homes were used to examine urban and rural patterns in average hourly nursing home wages and patterns of wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates. Working Paper No. 78 also addresses this topic.
  • Rural-Urban Issues In The Wage Index Adjustment For Prospective Payment In Skilled Nursing Facilities (Full Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2003
    The hourly wage data collected from Medicare-participating nursing homes were used to examine urban and rural patterns in average hourly nursing home wages and patterns of wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates. A findings brief on this topic is also available.
  • 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
    Examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a period of dramatic change in Medicare payments for both acute and post-acute care, focusing on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment. The authors examined changes in the number and types of facilities providing this level of care, and computed comparative statistics on Medicare utilization, case mix, ancillary service use and per diem costs across the three different institutional settings where inpatient skilled nursing services can be provided-freestanding SNFs, hospital-based units, and swing beds in acute care hospitals.
  • 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
    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 (CAHs).
  • Unpredictable Demand and Low-Volume Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2003
    This Findings Brief assesses the degree to which the annual number of patient discharges varies from year to year for low volume hospitals. The study finds that low volume hospitals face more instability from year to year in demand for inpatient services than larger hospitals. Also, the average variability over time for the smallest hospitals, defined as less than 500 or fewer discharges a year, is nearly 60% higher than the average for all hospitals. Finally, the study concluded that even though low volume, rather than rurality, is the important factor, hospitals in extremely rural counties must contend with more fluctuation than other hospitals, primarily because they tend to be smaller.
  • Unstable Demand and Cost per Case in Low-Volume Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2003
    This Findings Brief looks at the effects of year-to-year changes in annual inpatient discharges on costs per Medicare discharge. The analysis finds that small hospital costs are more vulnerable to change than larger hospital costs. As a result, average costs per discharge are less stable, making it difficult for these facilities to predict and manage profitability under fixed payment schemes. The study finds that among the lowest volume hospitals, there is a 10% decrease in discharges with every 3% increase in the cost per Medicare case. In addition, the study found that hospitals allowed to use swing-beds for long-term care patients are not less sensitive to volume fluctuations.