Rebecca T. Slifkin, PhD


Completed Projects - (26)

  • Analysis of the Cesarean Section Rates in Rural Hospitals
    This project will describe the practice patterns for deliveries in rural hospitals. Cesarean section rates in rural hospitals will be compared to urban hospitals and the national rate.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Maternal and child health
  • Analytic Capacity to Respond to Changes in Medicare and Medicaid, Data Assistance to Policy Staff at the Federal Office of Rural Health Policy, and Production of Short Policy Briefs
    This project will produce short policy briefs on a variety of topics related to proposed and enacted changes in Medicare and Medicaid, as requested by policy staff at the federal Office of Rural Health Policy.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health policy, Legislation and regulation, Medicaid and S-CHIP, Medicare
  • Assessing the Impact of Transfer of Pharmacy Services for Dual Eligible Beneficiaries to Medicare Part D
    This project will focus on the implementation of the new Part D benefit for those dually eligible for Medicare and Medicaid. The study will examine the impact on rural dual eligibles and their local pharmacies of the transfer to Part D coverage. The project is a joint undertaking with the RUPRI Center, taking advantage of unique data sets held at each center, the analytical and programming resources of both centers, and the ability to conduct qualitative analysis in multiple states efficiently.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Medicaid and S-CHIP, Medicare Part D, Pharmacy and prescription drugs
  • Background Paper on Skilled Nursing Facilities in Rural Areas
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Long term care
  • Community Impact Assessment
    This project will evaluate the impact of the Flex program on local communities. Activities will focus on identifying the ways in which the program could have a measurable effect, as well as the ways in which Flex program coordinators intended to affect community health. A briefing paper that integrates information on scope of services, networking, and quality will be produced. Additionally, case studies will be conducted in six CAH communities.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Networking and collaboration
  • Critical Access Hospital Conversion Tracking
    Information regarding new CAH conversions will be gathered from Flex coordinators and CMS, and added to the CAH management information dataset that is housed at UNC. Flex coordinators will also be queried regarding topics of interest to the coordinators, the monitoring team, and the federal Office of Rural Health Policy.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • Describing Geographic Access to Physicians in Rural America Using Statistical Applications in GIS
    This study will use a geographically weighted regression to assess the influence of distance and travel time on the distribution of physicians in rural America. The ultimate goal of the study will be to improve our measures of access by identifying the extent to which border resources can be considered in indices of access.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health services, Physicians
  • Describing the Health Care Infrastructure in Rural Towns
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Federally Qualified Health Centers (FQHCs), Hospitals and clinics, Physician assistants, Physicians, Rural Health Clinics (RHCs), Rural statistics and demographics
  • Developing a Financial Performance Measurement System for Critical Access Hospitals
    This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Healthcare financing
  • Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion
    Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Healthcare financing, Medicare Prospective Payment System (PPS)
  • Impact of The Medicaid Budget Crisis on Rural Communities: A 50-State Survey
    The impact of the Medicaid budgetary crisis on rural communities across the US will be assessed through a 50-state survey of state Medicaid agencies, state Offices of Rural Health and state rural health associations.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health policy, Medicaid and S-CHIP
  • Medicaid and SCHIP Participation in Rural and Urban Areas
    This project examines state-level Medicaid and SCHIP participation rates for children in rural and urban areas. It also updates the State Profiles of Medicaid and SCHIP in Rural and Urban Areas web site and documents changes in program characteristics relevant to rural areas over the past few years.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Medicaid and S-CHIP
  • Occupational Mix Differences Across PPS Hospitals: Analysis of Hospital Occupation Mix Survey Data and Implications for Rural Hospital Payments
    This study addresses the occupation-mix adjustment that has recently been added to the computation of the area wage index used to adjust Medicare prospective rates for all institutional health care providers. The study will review the policy objectives as well as the mechanics of the adjustment, and then analyze the data from the most recent occupation-mix survey to obtain a better understanding of occupation mix differences across labor markets and hospital types.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare Prospective Payment System (PPS), Workforce
  • Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
    Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Topic: Pharmacy and prescription drugs
  • Premium Assistance Programs: Exploring Public-Private Partnerships as a Vehicle for Expanding Health Insurance to Rural Uninsured
    This project examines the experience of states that have implemented premium assistance programs in rural areas to determine whether there are certain design features or certain types of rural communities where these programs may be more feasible.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Health insurance and the uninsured
  • Rapid and Flexible Analysis of Data from Centers for Medicare and Medicaid Services
    Project staff will provide rapid and flexible analysis of CMS data in response to requests from ORHP staff. Work will be ongoing throughout the contract year, with the design of individual products determined in response to ORHP staff needs.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health policy, Medicare, Rural statistics and demographics
  • Role of Intensive Care Units in Critical Access Hospitals
    This project will examine the role that intensive care units (ICUs) play in Critical Access Hospitals (CAHs). The number and geographic distribution of CAH with ICUs will be described, and types of services provided in these units discussed.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  • Rural Emergency Medical Services: Workforce and Medical Direction
    This two year study will examine the status of medical direction for rural EMS systems and the nature of the challenges and impediments to obtaining adequate medical direction in rural areas across the country. In addition, the study will address issues surrounding the recruitment and retention of paid and volunteer staff for rural EMS systems.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Emergency medical services (EMS), Workforce
  • Rural Hospital Closures, 1990-2000: Community Profiles and Economic Indicators Before and After the Event
    This study investigated the economic impact of hospital closures in non- metropolitan counties, taking into account the economic characteristics and employment trends that may have preceded the event.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Economic development, Hospitals and clinics
  • Rural Hospital Participation in the 340B Drug Discount Program
    The 340B drug discount program enables certain types of safety net organizations to obtain deeply discounted medications, at prices below the 'best price' typically offered to Medicaid agencies. This study used telephone interviews and mail surveys to explore the experiences that rural hospitals have had in seeking 340B eligibility status.
    Research centers: NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Pharmacy and prescription drugs
  • Rural Medicaid and CHIP Mini-Studies
    Medicaid and the Children's Health Insurance Program (CHIP) are important sources of health insurance coverage in rural communities and it is likely that the importance of Medicaid/CHIP will grow as job-based health insurance coverage continues to erode and policymakers pursue the goal of expanding coverage. This project is composed of three mini-studies that: 1) Update our State Profiles of Medicaid and CHIP in Rural and Urban Areas website, adding information on Medicaid Disproportionate Share Hospital (DSH) payments to rural hospitals; 2) Analyze trends in Medicaid/CHIP enrollment in rural and urban areas over the past two to three years; and 3) Explore the future role of CHIP given increasing levels of childhood poverty.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Children, Medicaid and S-CHIP
  • Rural Population and Providers: Mapping the 2000 Census
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Rural statistics and demographics, Workforce
  • State Facts about Medicaid: Rural Specific Data
    This project will develop state-specific fact sheets which will include information on the groups covered (and income eligibility), structure of the state's SCHIP program, services covered, delivery system, some provider payment information for certain safety net providers, and percentage of the state's rural and urban population that are enrolled in Medicaid. Additional information comparing urban and rural areas of the state will be provided, when available. The rural and urban comparisons will include total numbers of Medicaid recipients, Medicaid expenditures, and enrollment in different types of managed care plans.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Medicaid and S-CHIP, Rural statistics and demographics
  • Tracking the Implementation of Medicaid Managed Care in Rural Areas
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Medicaid and S-CHIP
  • Trends in Swing Bed and Skilled Nursing Facility Use in Rural Hospitals, 1996-2003
    This study will examine trends in the distribution of skilled nursing facility (SNF) services in rural hospitals during a period of dramatic change in Medicare reimbursement, most notably the transition from cost-based reimbursement to SNF prospective payment system (PPS).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Aging, Hospitals and clinics, Long term care, Medicare Prospective Payment System (PPS)
  • Unmet Needs for Health Care Services: An Analysis of Children with Special Health Care Needs in Rural Areas
    This project will study whether parents of children with special health care needs (CSHCN) who live in rural areas are less likely to perceive the need for routine and specialty medical care than their metropolitan counterparts, and whether CSHCN that live in rural areas face a greater risk of having unmet needs for health care services than their metropolitan counterparts.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Children, Dental health, Disabilities, Health services

Publications - (78)

  • 340B Drug Pricing Program: Results of a Survey of Eligible but Non-Participating Rural Hospitals
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2007
    Summarizes the results of a 2006 survey of pharmacy directors at rural hospitals that are eligible but currently not participating in the 340B Drug Pricing Program, which enables certain types of safety-net organizations to obtain discounted outpatient medications.
  • 340B Drug Pricing Program: Results of a Survey of Participating Hospitals
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2007
    Presents the results of a survey of pharmacy directors at rural hospitals currently buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program in general, the financial impact of the program, and which specific program features presented barriers to its broader implementation.
  • Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
  • Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2003
    This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
  • 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.
  • Becoming an Emergency Medical Technician: Urban-Rural Differences in Motivation and Job Satisfaction
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2007
    This study uses cross-sectional data from the 2003 national Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) Project to explore urban-rural differences in why EMTs enter the field, what is important in their jobs, and whether they are satisfied with their profession.
  • Cesarean Section Patterns In Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2004
    Examines childbirth delivery patterns in rural hospitals and compares the cesarean section (c-section) rate in rural hospitals to that in urban hospitals. The c-section rate for rural hospitals was well above the 10-15% rate recommended by the World Health Organization, and was higher (but not statistically significant) in rural hospitals than in urban hospitals. A Findings Brief on this topic is also available.
  • Cesarean Section Rates in Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    Findings Brief examining childbirth delivery patterns in rural hospitals and comparing the C-section rate in rural hospitals to that in urban hospitals using the Nationwide Inpatient Sample (NIS). Working Paper No. 80 on this topic is also available.
  • Challenges for Rural Emergency Medical Services: Medical Oversight
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2008
    This Findings Brief examines the challenges faced by local rural EMS agencies in obtaining a medical director and ensuring medical oversight for EMS personnel, and also describes how the challenges faced in rural areas differ from those in urban ones. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
  • Characteristics of Rural & Urban Children Who Qualify For Medicaid or CHIP But Are Not Enrolled (Policy Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2009
    About three-quarters of children who qualify for Medicaid or CHIP are enrolled, with slightly higher rates in rural areas than in urban areas. This leaves one in four qualified children without insurance coverage.
  • Comments on the June 2001 Report of the Medicare Payment Advisory Commission: Medicare in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2001
    Comments on and critiques the findings in MedPAC's Medicare in Rural America. The authors believe that while the MedPAC report helps set a framework for analysis, it is not a definitive treatise on the role of Medicare in rural health. Among its findings: most of MedPAC's recommendations would have positive impacts on health care for rural beneficiaries, others would do no harm, others could be strengthened, and a few, particularly those relating to access to services, "suffer from disparities and weaknesses." Report produced by the RUPRI Rural Health Panel.
  • The Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 02/2007
    Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Community Involvement of Critical Access Hospitals: Results of the 2004 National CAH Survey
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    The data reported here provide a starting point for understanding Critical Access Hospital (CAH) community involvement. Data were collected and analyzed from a national telephone survey of CAH administrators conducted in 2004. Survey respondents were asked about community involvement activities including community needs assessment, outreach and formal health promotion programs, relationships with other community organizations, free or reduced cost health care, and hospital activities in support of special populations. Most CAHs are engaged in activities that offer benefit to their community beyond hospital-based acute care services. Administrators recognize the importance of being responsive to community needs and seek the financial support necessary to maintain outreach activities. The outreach programs reported by CAH administrators resemble typical community activities for a health care facility, with a particular emphasis on health promotion and management of chronic conditions. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Comparative Performance Data for Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Date: 2004
    Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
  • Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 12/2005
    Summarizes the experience of Critical Access Hospital (CAH) administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans.
  • 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.
  • Design of Enhanced Primary Care Case Management Programs Operating in Rural Communities: Lessons Learned from Three States
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2003
    Discusses state programs that provide enhanced benefits to Medicaid beneficiaries such as enhanced primary care case management (PCCM). Examples from three states: Florida, North Carolina and Oklahoma.
  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Effect of Market Reform on Rural Public Health Departments
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2000
    This study seeks to determine how rural health departments and populations they serve have been affected by recent health system changes, especially Medicaid managed care.
  • 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.
  • The Effect of Rural Residence On Dental Unmet Need for Children With Special Health Care Needs
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2006
    Unmet need for dental care is the most prevalent unmet healthcare need among children with special healthcare needs (CSHCN). The combination of rural residence and special healthcare needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs.
  • The Effects of Rural Residence and Other Social Vulnerabilities on Subjective Measures of Unmet Need
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2005
    Are self-reports of unmet need a biased measure of access to healthcare? We examined the relationship between rural residence and perceived need for physician services. Examined the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs.
  • Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2006
    Describes the EMS related activities that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-2005. Since the first full year of funding, the number and range of EMS improvement activities proposed has increased substantially states' proposals contained 239 documented EMS improvement activities. Of these, 40% focused on the Integration of Health Services attribute, 13% on Human Resource challenges, and 13% on Education Systems. Continued support of activities begun prior to 2004 was common. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • The Experience of Rural Independent Pharmacies With Medicare Part D: Reports From the Field
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 2007
    Describes first-hand reports from rural pharmacist-owners about their experiences with Medicare Part D plans in the first 7 months of 2006 in order to gain a more thorough understanding of the challenges faced by rural independent pharmacies as a result of program implementation.
  • The Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 11/2006
    Case study describing first-hand reports from 12 rural independent pharmacists in seven states about their experiences with Medicare Part D plans (PDPs) in the first seven months of 2006. The rural independent pharmacists interviewed are experiencing major changes in payment, administrative burden, and interaction with patients as a result of the shift of patients into Medicare Part D plans. Previously, these patients were mostly non-covered cash or Medicaid-covered clients. Two consequences are apparent in the data collected: 1) Payment per prescription is lower from Medicare PDPs than from either non-covered cash or Medicaid, and in some instances payment from PDPs is less than the combined cost of stocking the medications and dispensing them, representing a reduction in revenue; and 2)The number of plans that provide Part D benefits greatly exceeds the two payment sources pharmacists previously dealt with, representing an increase in administrative burden for independent pharmacies. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
  • Exploring the Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 01/2007
    Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • A Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2010
    Compares the profitability of hospitals with the four classifications of rural hospitals that can qualify for special payment provisions under Medicare (Critical Access Hospitals, Medicare Dependent Hospitals, Sole Community Hospitals, and Rural Referral Centers) to urban and rural hospitals paid under prospective payment over a recent three-year period.
  • Financial Indicators for Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2005
    The purpose of this study was to develop and disseminate comparative financial indicators specifically for Critical Access Hospitals (CAHs) using Medicare Cost Report data. Results showed that, over the six years since 1998, CAHs generally became more profitable and increased their utilization of beds. However, while on average CAHs with long-term care became more liquid and reduced their use of debt over time, those without long-term care became less liquid and increased their use of debt. In the most recent year for which we have data (2003), CAHs without long-term care generally were more profitable, were more liquid, had less debt, and had higher utilization of beds in comparison to CAHs with long-term care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • 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.
  • If Fewer International Medical Graduates are Allowed in the U.S., Who Might Replace Them in Rural Underserved Areas?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2001
    Describes a study to identify rural communities that would be most affected by a decrease in availability of international medical graduates (IMGs) and perceptions of recruiters on who might replace IMGs in these areas. Includes maps. A full report is also available.
  • If Fewer International Medical Graduates Were Allowed in the U.S., Who Might Replace Them in Rural Areas?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2001
    Identifies rural communities that would be most affected should restrictions on IMG entry into the United States be tightened, and reports on the perceptions of physician recruiters and health planners about who might replace IMGs currently working in such areas. Findings indicate that given the difficulty of expanding ongoing recruitment and retention efforts, many underserved rural areas would likely remain underserved in the event of a cutback in IMGs, and many rural areas that are currently adequately served could face serious problems as well. A single national solution to replace IMGs would be difficult. Recruiters and planners within states and local areas will need to expand creative and innovative approaches, and even then, many rural communities might have to make do with less.
  • Impact of Conversion to Critical Access Hospital Status on Hospital Financial Performance and Condition
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2006
    Policy brief analyzing financial ratios associated with Critical Access Hospitals' profitability, liquidity, and capital structure. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • The Impact of Medicaid Cuts on Rural Communities
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2005
    Medicaid is a critical program in both urban and rural areas, but it is particularly important in rural areas because of high levels of poverty and less access to employer-sponsored insurance. This study assesses the perception of state Medicaid staff and individuals from State Offices of Rural Health (SORH) and Rural Health Associations (RHA) regarding the impact on rural areas of state Medicaid policy changes that occurred between 2002 and 2004. Despite the importance of this program to rural communities, our study suggests that few people are specifically concerned with the unique challenges Medicaid changes may pose to rural communities. This study presents insight to the potential rural impact of Medicaid policy changes, especially those that could adversely affect the ability of rural residents to access services or that might potentially affect the overall rural health infrastructure.
  • 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.
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Innovative Primary Care Case Management Programs Operating in Rural Communities: Case Studies of Three States
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2003
    Medicaid managed care programs have been continually growing in the past decade, but this system has posed some problems to rural areas. In order to address these problems, some states have developed alternative managed care strategies, including enhanced primary care case management (PCCM). This study examines three states that have implemented PCCM and provides an overview of each program including their strengths and weaknesses. The states studied are Florida, North Carolina, and Oklahoma.
  • Intensive Care In Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    Describes what officials at Critical Access Hospitals (CAHs) mean when they report that they provide intensive care and the importance of these services to the hospital and the community it serves. Semi-structured interviews were conducted with Directors of Nursing at 63 CAHs in 27 states. Respondents described the physical structure of the intensive care area, equipment and staffing available for such care, types of patients who receive intensive care, transfer patterns, the role of intensive care in the decision to convert to CAH status, and the perceived value of this service to the community and hospital.
  • Intensive Care in Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2007
    Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.
  • Issues in Staffing Emergency Medical Services: A National Survey of Local Rural and Urban EMS Directors
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2008
    This report explores rural-urban differences in medical oversight and the recruitment and retention of emergency medical technicians (EMTs)and paramedics as reported by a survey of 1,425 local EMS directors.
  • Medicaid & CHIP Participation Among Rural & Urban Children (Policy Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2009
    Describes the characteristics of rural and urban children who qualify for Medicaid or CHIP but are uninsured.
  • Medicare Beneficiaries' Access to Pharmacy Services in Small Rural Towns: Implications of Contracting Patterns of Sole Community Pharmacies with Part D Plans
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2009
    Describes the contracting patterns of sole rural community pharmacies to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
  • One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Final Report)
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 09/2007
    Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A findings brief is also available. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
  • One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 10/2007
    Describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community one year after implementation of the Medicare Part D prescription drug benefit. A final report is also available. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research
  • 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.
  • 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).
  • Premium Assistance Programs for Low Income Families: How Well Does it Work in Rural Areas?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2006
    Reports results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance (SCHIP) funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals. Because of the characteristics of rural residents and their employment markets, many stand to benefit from premium assistance programs, but there are also reasons to believe that these programs may be less successful in rural communities. Findings form the telephone survey of Medicaid or SCHIP officials in 14 of the 16 states with at least one premium assistance program indicate that premium assistance programs have not lived up to their potential. Enrollment in most of the states' programs has been small, and while positive in concept, these programs have inherent limitations that may preclude more widespread enrollment. Of particular concern is that rural residents are more likely to work for small employers who do not offer health insurance or have higher premiums or less comprehensive benefits. However, with creative program design, premium assistance programs may be a useful tool for states to expand health insurance coverage to the rural uninsured.
  • 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.
  • A Primer on the Occupational Mix Adjustment to the Medicare Hospital Wage Index
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2006
    Focuses on the occupational mix adjustment (OMA) to the labor-related share in the hospital inpatient prospective payment system. The Primer explains what the OMA is, why it is needed and how it has been calculated. In addition, reasons why the effect of the OMA has been less than some rural advocates anticipated are discussed.
  • Race and Place: Urban-Rural Differences in Health for Racial and Ethnic Minorities
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2000
    This findings brief investigates urban-rural disparities for racial and ethnic minorities in six health areas: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection, and child and adult immunizations.
  • Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2001
    Provides a framework to help shape proposals to redesign Medicare to the benefit of rural beneficiaries and providers. Chapters focus on equity, quality, choice, access, and cost. Each chapter outlines the current situation, analyzes the implications of various approaches to changing the program, and makes recommendations for developing a Medicare program of greatest benefit to rural residents. Report produced by the RUPRI Rural Health Panel.
  • Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    With this paper, the RUPRI Rural Health Panel is presenting a well-defined framework for what should be included in any discussion of Medicare policies.
  • 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 and Urban Parents Report on Access to Health Care for their Children with Medicaid Managed Care
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2005
    There has been little previous research on rural beneficiaries' perspectives on access to care under Medicaid managed care. The study reported here considers the perspective of the rural beneficiary in four states in order to broaden understanding of whether Medicaid managed care programs provide acceptable access to healthcare services. The study examines access to healthcare among rural children ages 0-17 who are enrolled in either fully capitated (New Mexico and Washington) or primary care case management (PCCM) Medicaid managed care plans (North Carolina and North Dakota), and compares this access to that of urban beneficiaries. Overall, this study finds that parents of children living in the rural areas who are enrolled in a Medicaid managed care program are almost always able to get the medical care they need. Rural children who are Medicaid enrollees have primary care providers, their parents know how to access care when needed after hours, and although rural children sometimes use the ER, they do not rely on that source of care more than urban parents do. Where barriers to medical care are reported, they are often consistent with those barriers reported for rural residents generally, and do not appear to be related to restrictions from managed care programs. Access to dental services remains a substantial problem, not just for children in rural areas, but for all Medicaid enrollees. 2004
  • Rural Assessment of Leading Proposals to Redesign the Medicare Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2000
    This Policy Paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" (S. 1895, introduced by Senator Breaux and others) and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed, specifically how they affect rural Medicare beneficiaries and rural providers of health care services. Report produced by the RUPRI Rural Health Panel.
  • 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 Hospitals' Experience with the 340B Drug Pricing Program
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2007
    Policy brief describing the results of surveys of rural hospitals participating in the 340B drug pricing program and of rural eligible but non-participating hospitals. Includes information on factors affecting participation in the program and the benefits and challenges of participation.
  • 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.
  • Rural Volunteer EMS: Reports from the Field (Final Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2010
    This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondent agencies were considered to be rural if they were located in a nonmetropolitan county or within a metropolitan county in an area with a Rural Urban Commuting Area (RUCA) code of four or higher. A semi-structured interview format encouraged respondents to speculate on the future viability of their local service, describe the challenges they face and what they need to ensure continuance. The descriptions presented represent the perceptions of those interviewed, but are also likely to resonate with other rural EMS administrators.
  • Rural Volunteer EMS: Reports from the Field (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2010
    This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondent agencies were considered to be rural if they were located in a nonmetropolitan county or within a metropolitan county in an area with a Rural Urban Commuting Area (RUCA) code of four or higher. A semi-structured interview format encouraged respondents to speculate on the future viability of their local service, describe the challenges they face and what they need to ensure continuance. The descriptions presented represent the perceptions of those interviewed, but are also likely to resonate with other rural EMS administrators.
  • 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.
  • Rural-Urban Differences in Characteristics of Local EMS Agencies
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2008
    This Findings Brief describes the general characteristics of local rural EMS agencies and important ways that they differ from the characteristics of agencies located in urban areas. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
  • 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.
  • Rural/Urban Differences in Barriers to and Burden of Care for Children With Special Health Care Needs
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2007
    Examines the barriers and difficulties experienced by rural families of children with special healthcare needs in caring for their children. Covers rural-urban differences in types of providers used, reasons for unmet healthcare needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care.
  • Sole Community Pharmacies and Part D Participation: Implications for Rural Residents (Findings Brief)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2009
    This findings brief describes the contracting rates of sole rural community pharmacies in 16 states to assess the extent to which each pharmacy contracts with the most commonly used PDPs available in their state.
  • State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 10/2007
    Explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural health care infrastructure and discusses which activities were considered most successful by State Flex Coordinators. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • State Profiles of Medicaid and SCHIP in Rural and Urban Areas
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2007
    This final report is one component of a larger project that includes the development of web-based State Profiles of Medicaid and SCHIP in Rural and Urban Areas. The report provides national data comparing Medicaid enrollment and expenditures in rural and urban counties. A summary of these and other data found in the State Profiles is included.
  • Tracking Medicaid Managed Care in Rural Communities: A Fifty-State Follow-Up
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2002
    Updates a 1997 study examining implementation of rural Medicaid managed care programs. Among its findings are that there have been significant state-level changes in the types of programs offered; there has been an overall increase in the percentage of urban and rural counties with Medicaid managed care programs; and SCHIP expansion has had little impact on the operation of fully capitated Medicaid managed care programs in rural areas because the increased number of children covered has not been large enough to affect health plans' participation. Concludes that looking only at the increase in rural Medicaid managed care since 1997 could lead to a false impression. While the number of rural counties with fully capitated programs has increased, states' more recent experiences suggest that health plans are pulling out of rural areas just as they are pulling out of urban ones. States may find it difficult to find commercial HMOs willing to participate in Medicaid managed care at prices that states can afford.
  • 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).
  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
    Date: 2005
    The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in 2004 to identify a set of researchable questions concerning rural healthcare.
  • 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.
  • Variations in Financial Performance Among Peer Groups of Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2007
    Reports findings from a study that investigated whether indicators of financial performance and condition systematically vary among peer groups of Critical Access Hospitals (CAHs).