Randy Randolph, MRP

North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.966.7113
Fax: 919.966.5764
Email: randy_randolph@unc.edu

Rural Health Research and Policy Analysis Center
University of North Carolina - Chapel Hill
725 Airport Road CB 7590
Chapel Hill, NC 27599-7290


Completed Projects - (1)

Impacts of Multiple Race Reporting
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Health policy, Minority health

Publications - (20)

  • The 21st Century Rural Hospital: A Chart Book
    Chartbook
    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.

  • Characteristics of Medicaid Beneficiaries Who Use Rural Health Clinics
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2016
    The RHC role varies by state. While we don’t have an understanding of what this looks like for each state, we can see that RHCs are an important provider for Medicaid beneficiaries. One of the most important differences is by age groups. All states tend to cater RHC services toward children, with a minimum of 39% of the RHC population < 18.
  • 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?
  • Definition of Rural in the Context of the MMA Access Standards for Prescription Drug Plans
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 09/2004
    Assesses how the definition of rural affects the potential impact of the specific access standards in the Proposed Rule to implement Title I of the MMA, and finds that the congressional objective to achieve convenient access to pharmacies (other than mail order) would be more fully realized if the Proposed Rule definition of rural is changed.
  • Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2014

    Examines health conditions of patients discharged from rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs).

  • The Effect of Rural Hospital Closures on Community Economic Health
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2006
    Describes the effect of hospital closure on the local economy, based on a study of county level economic data for 1990-2000 in rural counties experiencing a hospital closure.
  • 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.

  • How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Pre-Implementation Prescription Volume and Payment Sources in Rural and Urban Areas
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2005
    Presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs. urban areas. Together, these data provide a baseline for evaluating how implementation of the MMA may affect the financial viability of rural independent pharmacies.
  • Impact Of The Medicaid Budgetary Crisis On Rural Communities
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2003
    Provides an overview of the Medicaid program and options states have to reduce program costs. Steps states have proposed or taken to reduce Medicaid costs and the potential impact of these changes on rural areas are discussed. The potential impact on rural communities of federal proposals to redesign Medicaid is assessed.
  • Impacts of Multiple Race Reporting on Rural Health Policy and Data Analysis
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2002
    Examines some of the impacts to rural health analysis of new federal policy that allows people to choose one or more race categories when classifying themselves. Implementation of the new policy in the 2000 Census yields 63 possible combinations of race classification. Report also presents data on the number of persons choosing more than one race, discusses ways that analysts can handle the issues surrounding multiple race data, and compares several methods for bridging the change from the old single-race system to the new multiple-race system. Among its findings: rural Americans were less inclined to identify themselves as more than one race than were urban Americans; rural western residents were the only ones more inclined to choose multiple races than the rural average; and rural residents of Hawaii, Alaska, and Oklahoma were the most likely to identify with multiple races while those of Mississippi, Pennsylvania, and South Carolina were the least likely to do so.
  • Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close
    Rapid Response to Requests for Rural Data Analysis
    Date: 12/2013
    Reports that changes to Critical Access Hospitals (CAHs) reimbursement may spur some CAHs to close, with the most financially vulnerable more likely to close. The average resident of these communities would experience an 80% increase in distance to the nearest hospital if the CAH were to close. This analysis considers the communities served by the 93 CAHs with the lowest profitability and therefore most likely to close due to a change in Medicare reimbursement.
  • Pediatric Care in Rural Hospital Emergency Departments (Final Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2010
    Analyzes data from the Emergency Pediatric Services and Equipment Supplement (EPSES) to the National Hospital Ambulatory Medicare Care Survey to compare rural and urban hospitals' responses on various dimensions of pediatric Emergency Department care.
  • Pediatric Care in Rural Hospital Emergency Departments (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2010
    Analyzes data from the Emergency Pediatric Services and Equipment Supplement(EPSES) to the National Hospital Ambulatory Medical Care Survey (NHAMCS). Rural and urban hospitals' responses were compared on various dimensions of pediatric ED care. We also surveyed 65 ED directors at rural hospitals in a separate process to explore rural pediatric ED care in more detail and to obtain the opinion of rural ED administrators regarding ways to assure quality emergency care for children.
  • Rural Populations and Health Care Providers: A Map Book
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2002
    Uses 2000 Census data to reassess and provide a visual picture of where rural people live, how the racial and ethnic nature of rural populations is changing, and whether the distribution of healthcare providers matches the population distribution.
  • A Rural-Urban Comparison of Allied Health Average Hourly Wages
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2009
    This report uses data from the Bureau of Labor Statistics to describe the extent to which rural-urban differentials exist in wages for eleven allied health professions, focusing on professions that are both likely to be found in rural communities and have adequate data to support hourly wage estimates.
  • The Financial Importance of the Sole Community Hospital Payment Designation
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2016
    Assesses the financial importance of the Sole Community Hospital (SCH) program by: the proportion of SCHs that was reimbursed at the hospital specific rate between 2006 and 2015; the profitability of providing services to Medicare patients in SCHs between 2006 and 2015, and; the financial consequences if the SCH program had not existed in 2015.
  • 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.
  • Trends in Risk of Financial Distress among Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2016
    From January 2005 to July 2016, 118 rural hospitals have closed permanently, and the rate of rural hospital closures is increasing. Hospital closures impact millions of rural residents. Identifying hospitals at high risk of closure and assessing the trends over time may inform strategies to prevent or mitigate the effects of closures.
  • Urban-Rural Flows of Physicians
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2007
    Reports findings from a study to determine whether there was a significant flow of physicians from urban to rural areas in recent years when the overall supply of physicians has been considered in balance with needs.