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 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: Legislation and regulation, Medicaid and 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 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, Networking and collaboration, Rural Hospital Flexibility Program
  • 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
  • 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, Health care 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, Health care financing, Medicare Prospective Payment System (PPS), Rural Hospital Flexibility Program
  • 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
    Topic: Medicaid and 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 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 healthcare 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
    Topics: Private health insurance, Uninsured and underinsured
  • Rapid and Flexible Analysis of Data from Centers for Medicare and Medicaid Services
    Project staff will provide rapid and flexible analysis of Centers for Medicare and Medicaid Services (CMS) data in response to requests from Office of Rural Health Policy (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: 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, 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 and trauma, 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
    Topic: 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 and adolescents, Medicaid and 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 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 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 healthcare needs (CSHCNs) who live in rural areas are less likely to perceive the need for routine and specialty medical care than their metropolitan counterparts, and whether CSHCNs that live in rural areas face a greater risk of having unmet needs for healthcare services than their metropolitan counterparts.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Children and adolescents, Disabilities, Health services, Oral health

Publications - (78)

2010

  • 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. Respondents were encouraged to speculate on the future viability of their local service, describe the challenges they face, and what they need to ensure continuance.
  • 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. Respondents were encouraged to speculate on the future viability of their local service, describe the challenges they face, and what they need to ensure continuance.
  • Pediatric Care in Rural Hospital Emergency Departments (Final Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2010
    This report analyzes data from the Emergency Pediatric Services and Equipment Supplement 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
    This brief analyzes data from the Emergency Pediatric Services and Equipment Supplement to the National Hospital Ambulatory Medical Care Survey. Rural/urban hospitals' responses on pediatric emergency department (ED) care were compared. Rural ED directors also were surveyed to further explore rural pediatric ED care in more detail.
  • 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
    This brief compares the profitability of hospitals in the four classifications of rural hospitals that can qualify for special payment provisions under Medicare (critical access, Medicare-dependent, and sole community hospitals and rural referral centers) to urban and rural hospitals paid under prospective payment during a recent three-year period.

2009

2008

2007

  • 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
    This brief describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their communities one year after implementation of the Medicare Part D prescription drug benefit.
  • 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
    This report explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural healthcare infrastructure and discusses which activities were considered most successful by state Flex coordinators.
  • 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
    This report describes the experiences of 51 rural, independently owned pharmacies that are the sole providers of pharmacy services in their communities one year after implementation of the Medicare Part D prescription drug benefit.
  • Rural Hospitals' Experience with the 340B Drug Pricing Program
    Policy Brief
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2007
    This policy brief describes the results of surveys of rural hospitals participating in the 340B drug-pricing program and of rural eligible but non-participating hospitals. It includes information on factors affecting participation in the program and the benefits and challenges of participation.
  • 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.
  • 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
    This report presents survey results of pharmacy directors at rural hospitals buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program, the program's financial impact, and which program features presented barriers to its broader implementation.
  • 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 Project to explore urban-rural differences in why emergency medical technicians enter the field, what is important in their jobs, and whether they are satisfied with their profession.
  • 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
    This policy brief discusses the findings of a project to understand the community involvement and impact of critical access hospitals and the Medicare Rural Hospital Flexibility Program (Flex Program).
  • 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
    This paper 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.
  • 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
    This paper reports on a series of site visits to six diverse rural communities and critical access hospitals to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs.
  • 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.
  • 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.
  • 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.
  • 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).

2006

2005

  • Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
    Policy Brief
    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
    This policy brief 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.
  • 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
    This study considers rural beneficiaries' perspectives to broaden understanding of whether Medicaid-managed care programs provide acceptable access to healthcare services for children.
  • 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
    This paper examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a time of dramatic change in Medicare payments for acute and post-acute care. It focuses on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment.
  • The Impact of Medicaid Cuts on Rural Communities
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2005
    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.
  • 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 using Medicare Cost Report data.
  • Cesarean Section Rates in Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    This findings brief examines childbirth delivery patterns in rural hospitals and compares the C-section rate in rural hospitals to that in urban hospitals using the Nationwide Inpatient Sample.
  • 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
    This report provides a start for understanding critical access hospital (CAH) community involvement. Data were collected and analyzed from a survey of CAH administrators conducted in 2004. Respondents were asked about community involvement activities, such as community needs assessments and hospital activities supporting special populations.
  • Intensive Care In Critical Access Hospitals (Working Paper)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    This paper describes what officials at critical access hospitals mean when they report that they provide intensive care and the importance of these services to the hospital and the community it serves.
  • 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 and 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.
  • How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Preimplementation 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 Medicare Prescription Drug, Improvement, and Modernization Act may affect the financial viability of rural independent pharmacies.
  • 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.

2004

  • Cesarean Section Patterns In Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2004
    This paper examines childbirth delivery patterns in rural hospitals and compares the cesarean section rate in rural hospitals to that in urban hospitals.
  • 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
    This study assesses how the definition of rural affects the potential impact of the 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.
  • 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
    Hourly wage data from Medicare-participating nursing homes were used to examine urban/rural patterns in average hourly nursing home wages and 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.
  • 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.

2003

2002

2001

2000