Kristie Thompson, MA

North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.966.9484
Fax: 919.966.3811

Cecil G. Sheps Center for Health Services Research
University of North Carolina - Chapel Hill
CB# 7590
Chapel Hill, NC 27599-7590

Completed Projects - (1)

What Does it Cost to Operate a Rural Free Standing Emergency Department (FED)?
In recent months, there have been numerous media reports of rural hospital closures and the adverse effect on communities. In the face of hospital closure, one alternative for maintaining access to health care is rural free-standing emergency department (RFEDs).
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health policy, Healthcare financing, Medicare

Publications - (6)

  • The 21st Century Rural Hospital: A Chart Book
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2015

    Hospitals have changed over recent decades. Hospital stays are shorter. Procedures once requiring hospitalization are now done in an outpatient setting. Hospitals have moved beyond providing mainly inpatient and emergency department care. They have become vertically integrated systems with “one-stop shopping” for all of one’s health care needs.

    The transformation of hospitals has also occurred in rural areas where the presence of a hospital with traditional inpatient and emergency department services may also ensure that other healthcare is available. Even with a cursory scan of rural hospital websites, one can see that rural hospitals offer a variety of services that range from traditional inpatient medical, surgical and obstetric care to advanced imaging, laboratory, and rehabilitation services. Outpatient primary and specialty care are available, and hospitals provide important health promotion and wellness services for the community. Hospitals vary, however, based on their resources and the needs of the populations they serve. As is often said about many things, “if you’ve seen one hospital, you’ve seen one hospital.”

    This Chart Book uses available data to present a broad profile of the 21st century rural hospital and includes such descriptors as: Where are they located? Whom do they serve? What traditional hospital services do they provide? How do they ensure outpatient services for their community? What other community benefits do they provide or enable for citizens in their area? How are they doing financially? How are they supported by federal programs?

    The pages of The 21st Century Rural Hospital: A Chart Book are each designed as a pull-out document and describe many aspects of today’s rural hospital. Each page includes charts comparing rural hospitals to each other and to urban hospitals across different dimensions such as levels of rurality, US Census region, and hospital size. Important data points are emphasized and an illustrative rural hospital is highlighted. Those who are unfamiliar with today’s rural hospital may be surprised by many data points shown here; others may use this document to research a particular data point.

  • CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars is the Problem
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 06/2017
    The purpose of this brief is to look more closely at the characteristics of rural hospitals with and without CMS Hospital Quality Star Ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.
  • A Comparison of Closed Rural Hospitals and Perceived Impact
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2015

    From 2010 through 2014, 47 rural hospitals ceased providing inpatient services in 23 states across the country (“closed”). Among the 47 closed hospitals, 26 hospitals no longer provide any healthcare services (“abandoned”), and 21 continue to provide a mix of health services but no inpatient care (“converted”).

    These closures have affected approximately 800,000 people in the markets with abandoned hospitals and 700,000 people in the markets with converted hospitals. Loss of a rural hospital could impact access to certain necessary health services and is concerning as residents of rural communities are typically older and poorer, more dependent on public insurance programs, and have poorer health status than urban residents.

    Policy-makers, researchers, and rural residents are concerned and interested in determining why these hospitals are closing, whether the rate will continue to climb, and what effects there could be on local health care providers and the communities they serve.

    This policy brief compares selected characteristics of abandoned rural hospitals and their markets to those of converted rural hospitals.

    More specifically:
    • How do abandoned rural hospitals compare to converted rural hospitals?
    • What has been the perceived impact of rural hospital closures?
  • Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2016
    Views on how the implementation of the ACA’s expanded insurance coverage is affecting the financial performance of rural hospitals. The study found that while respondents believe the expanded insurance coverage was the right thing to do for patients, they worried coverage may not be adequate to ensure access to care.
  • Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2014

    Combines the recently released data on plan selection in the Federally Facilitated Marketplaces with estimates of the population likely to qualify for the marketplace (i.e. “eligibles”) to calculate the percent of potential eligible individuals who chose a health insurance plan (the “uptake rate”). Contains a heat map that shows variation in uptake rates across the country.

  • The Rising Rate of Rural Hospital Closures
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2015
    Discusses the increase in rural hospital closure rates, including the causes of closures and its impact on rural communities.