Walter Gregg, MA, MPH

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


Completed Projects - (7)

Critical Access Hospital Access To and Use of Capital
This project will describe the capital needs of CAHs and their experiences in accessing and using capital, based on data from an e-mail survey of State Flex Coordinators, the TASC listserve, telephone contacts with Flex Coordinators in key states, and Medicare Cost Reports.
Research center: University of Minnesota Rural Health Research Center
Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program
Impact of Expansion of Ambulatory Surgery Centers on Rural Hospitals and Communities
This project will examine the extent of freestanding ambulatory surgery center (ASC) expansion into rural communities between 1998 and 2005, the market factors driving that expansion, and the impact of ASCs on the operational and financial viability of rural hospitals located in the same communities.
Research center: Upper Midwest Rural Health Research Center
Topics: Health services, Healthcare financing
National Rural Hospital Flexibility Program Tracking Project: Analysis of Hospital Conversion and Network Development Strategies
Research center: University of Minnesota Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Networking and collaboration
National Rural Hospital Flexibility Program Tracking Project: Analysis of Network Development Strategies and CAH Performance
Research center: University of Minnesota Rural Health Research Center
Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program, Networking and collaboration
Observation Care Services in Rural Hospitals: Reimbursement and Quality Implications
This project will describe the nature and scope of observation care services provided by rural hospitals and discuss policy relevant issues for Medicare beneficiaries and providers. Study findings will provide the first assessment of rural observation care services and identify policy options to minimize the potential for unintended consequences of Medicare policies related to observation care services.
Research center: University of Minnesota Rural Health Research Center
Topics: Health policy, Hospitals and clinics, Medicare, Quality
Role of Rural Hospitals in Community-Centered Systems of Care: Supporting Population Health Improvement for Rural Communities
This project will assess the degree to which rural hospitals engage in activities that facilitate community responsiveness and the provision of community-oriented services, using 1996 to 2004 data from the American Hospital Association Annual Survey and the Area Resource File.
Research center: Upper Midwest Rural Health Research Center
Topics: Health services, Hospitals and clinics
Rural Hospitals' Access to Capital
Research center: University of Minnesota Rural Health Research Center
Topics: Capital funding, Hospitals and clinics

Publications - (23)

  • Availability and Use of Capital by Critical Access Hospitals
    University of Minnesota Rural Health Research Center
    Date: 03/2005
    Examines the experiences of Critical Access Hospitals (CAHs) in meeting their capital needs. It focuses specifically on their efforts to obtain capital, the capital sources tapped through these efforts, how CAHs have used the capital they have been able to obtain over the past few years, and assesses their current capital needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • 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.
  • The Current Status of Health Information Technology Use in CAHs
    University of Minnesota Rural Health Research Center
    Date: 05/2006
    Both the public and private sectors have focused considerable attention on health information technology (HIT) as a potential means of improving the quality, safety, and efficiency of health care. The purpose of this briefing paper is to assess the current status of HIT use in Critical Access Hospitals (CAHs) nationally. This project is part of the federal Office of Rural Health Policy's initiative to implement national performance measures for the Medicare Rural Hospital Flexibility Program. It was conducted by the Flex Monitoring Team in collaboration with the Technical Assistance and Services Center (TASC) at the Rural Health Resource Center in Duluth, Minnesota. Data for the study came from a national survey of CAHs conducted in March and April 2006. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Does Rurality Affect Observation Care Services Use in CAHs for Medicare Beneficiaries?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2014

    Describes the use of observation services across levels of rurality by Medicare beneficiaries in CAHs, the demographics and health status of patients receiving these services, and the characteristics of their observation stays.

  • 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.
  • Far From the City: Community Orientation and Responsiveness of Rural Hospitals
    Upper Midwest Rural Health Research Center
    Date: 05/2008
    Reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts. Study findings suggest that measures of community orientation and responsiveness differ between urban and rural hospitals, and further research is needed to develop an improved, context specific, model for community benefits.
  • Grantee Sustainability in the Rural Health Outreach Grant Program
    University of Minnesota Rural Health Research Center
    Date: 12/2003
    Describes a study of the post-grant experiences of 99 Rural Health Outreach Grant recipients. Focuses on the extent to which programs were able to maintain or expand services after their grants ended and characteristics that helped programs succeed in the post-grant period.
  • The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 10/2010

    Uses a retrospective analysis of data on rural hospital, ambulatory surgery center (ASC), and market characteristics for the years 1997 through 2006 to assess the impact of freestanding ASCs on rural hospital performance.

  • The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997-2006 (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 10/2010
    Describes the impact of Ambulatory Surgery Centers (ASCs) on rural hospital markets.
  • Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Brief)
    Upper Midwest Rural Health Research Center
    Date: 11/2006
    Overview of findings of a national study to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration (HQID) project.
  • Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 09/2006
    Reports the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety (Final Report)
    Upper Midwest Rural Health Research Center
    Date: 12/2008
    Findings from this report describe successful telepharmacy activities being implemented in rural hospitals and analyze policy issues related to the implementation of telepharmacy projects in rural hospitals.
  • Observation Care Services for Medicare Beneficiaries in Rural Hospitals: Policy Issues and Stakeholder Perspectives
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2014

    Describes the findings of a qualitative study aimed to gain a greater understanding of the rural policy context surrounding the use of observation care services by Medicare beneficiaries from 2010 to 2013.

  • A Review of State Flex Program Plans, 2004-2005
    Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Date: 03/2006
    Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. Highlights recent trends in State Flex Program planning, development, and implementation. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Rural Health Networks: Evolving Organizational Forms and Functions
    University of Minnesota Rural Health Research Center
    Date: 06/2003
    Discusses results of a survey of rural health networks. Includes information about the location, membership, relationships, governance and management, process and products of rural health networks.
  • Rural Hospital Access to Capital: Issues and Recommendations
    University of Minnesota Rural Health Research Center
    Date: 07/2002
    Identifies federal and state programs that have assisted or could assist rural hospitals in meeting their capital needs; assesses whether rural hospital borrowers have difficulty in meeting their capital needs under existing grant, loan, and mortgage insurance programs; and discusses potential options for improving access to capital for rural hospitals. Offers regulatory, programmatic, and policy recommendations to improve the HUD 242 Program and the USDA Community Facilities Program-two federal programs that have been able to assist some of the less creditworthy hospitals over the last three decades.
  • Rural Issues Related to Bundled Payments for Acute Care Episodes
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009

    Bundling Medicare payments, i.e., providing a fixed payment for a set of acute and post-acute services, has been proposed as a way of encouraging providers to find innovative, cost reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address these challenges.

  • The State Flex Program at 10 Years: Strengthening Critical Access Hospitals and Rural Communities
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2007
    To understand the priorities and accomplishments of state Flex Grant Programs, members of the Flex Monitoring Team asked Flex Coordinators to identify and discuss their states' three most successful initiatives in the past two years. Interviews were conducted during February 2007 with Flex Coordinators and State Office of Rural Health staff (SORH) in all 45 states. The listed publication is a policy brief; the full report will be available in the fall of 2007. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • 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.
  • Successful Health Insurance Outreach, Education, and Enrollment Strategies for Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014

    Provides best practices for hospitals to use in health insurance outreach and enrollment efforts based on interviews with administrators, staff and community representatives at eleven small rural hospitals. Also discusses certified application counselors who help individuals enroll in health insurance and the importance of collaborative partnerships in the community to conduct insurance enrollment outreach and education.

    Based on their experiences during the first Affordable Care Act (ACA) open enrollment period, five of 11 surveyed rural hospitals reported positive outcomes likely related to their enrollment success: decreases in proportions of self-pay / uninsured patients, charity care, and/or bad debt. Of the remaining six hospitals, one reported no significant changes and five had not yet begun to assess the consequences of their efforts Key strategies and approaches highlighted by the 11 hospitals included the following:

    • Designate a project manager to handle open enrollment who can dedicate time to it.
    • Leverage partnerships with local organizations to boost enrollment, resources, and referrals.
    • Get involved with planning groups and committees at state and regional levels to see what is and is not working at other facilities.
    • Pursue a multi-faceted, targeted approach in outreach and marketing efforts.
    • Employ Certified Application Counselors (CACs) and make them as accessible as possible.
    • Use names of state marketplaces or generic terms rather than “Obamacare.”
  • Sustaining Community Health Services Over Time: Models from the Rural Health Outreach Grant Program
    University of Minnesota Rural Health Research Center
    Date: 11/2004
    Discusses post-grant sustainability of services provided by recipients of Rural Health Outreach Grant Program projects. Based on site visits to a medical rehabilitation project in Wyoming, a prenatal outreach project in Maryland, and a community health center in Oregon.
  • A Synthesis of State Flex Program Plans 2003-2004
    University of Minnesota Rural Health Research Center
    Date: 05/2004
    Highlights recent trends in the development and implementation of State Flex Programs, whose goal it is to strengthen the rural healthcare infrastructure using CAHs as the hub of organized, local systems of care. A major portion of the FY2003 funding dollars continue to target state program infrastructure development; however, the role of this infrastructure is shifting from supporting conversions to the ongoing availability of appropriate health care services for communities served by CAHs (e.g., CAH performance improvement, EMS integration, systems development, and community engagement). States are pursuing these areas with a variety of strategies including the use of local, interstate, and regional collaborations to share lessons learned and advance their knowledge in key areas for success (e.g., performance and quality improvement, health information technology, and capital planning). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 09/2011

    This report and policy brief will (1) assess the financial and quality challenges and potential unintended consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; (2) explore the possible impact on quality of care delivered under a facility-physician bundled payment system; and (3) describe potential modifications to current bundling proposals and additional steps CMS could take that will help address rural-specific issues. Report available by contacting the Center.