Healthcare financing

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2019

  • The Rural MACRA Experience
    The Rural MACRA Experience project will study rural effects of the new Medicare Quality Payment Program (QPP) implementation and operation. Rural QPP effects may include provider eligibility, program preparation and data collection challenges, data analysis bias, and differential fiscal impact.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Medicare, Physicians

2017

  • Characteristics of Rural Hospitals at High Risk of Financial Distress
    Updates the Financial Distress Index Model with current hospital and market data. Evaluates changes in risk status and geographic distribution over time. Conducts an in-depth analysis of high risk hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics

2016

  • Analyzing the Variation in the Performance of Accountable Care Organizations Serving Rural Medicare Beneficiaries
    The goals of this project are to characterize ACOs that operate in rural areas, describe the models being used to organize those ACOs, and to test relationships of those characteristics to performance measures related to financial success and quality. The study will identify potential changes in legislative and regulatory policies that could strengthen the utility of the ACO model to achieve high performing rural healthcare delivery organizations.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Healthcare financing, Legislation and regulation, Medicare, Quality
  • How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals? (Year 2)
    The second year of this two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); and (4) financial performance.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health reform, Healthcare financing, Medicaid and S-CHIP, Medicare, Private health insurance, Uninsured and underinsured

2015

  • Identifying Limitations of PPS Reimbursement for Rural Hospitals
    This project will investigate the potential financial and access consequences of returning rural hospitals to PPS payment. Characteristics of the hospitals and communities at highest risk of adverse consequences will be identified.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics
  • What Does it Cost to Operate a Rural Free-Standing Emergency Department (RFED)?
    In recent months, there have been numerous media reports of rural hospital closures and the adverse effect on communities. In the face of hospital closure, one alternative for maintaining access to healthcare is a rural free-standing emergency department (RFED).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals, Healthcare financing, Medicare

2014

  • Rural Hospital Mergers and Acquisitions - Who is Being Acquired and What Happens Afterwards?
    This study compares the financial and market characteristics of recently acquired rural hospitals to other rural hospitals and investigates the post-acquisition change in services and financial performance of these hospitals. This study will inform rural advocates, federal and state agencies, and regulators as to how mergers and acquisitions (M&As) of small rural hospitals affect access to care for Medicare beneficiaries, and the potential financial consequences of M&As to small rural hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Healthcare financing, Hospitals and clinics, Medicare

2012

2011

2010

  • Analysis Related to Health Care Reform Issues
    The RUPRI Center is prepared to provide analysis of elements and/or effects of proposed or enacted health reform legislation and/or regulations to implement changes mandated by legislation.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Health services, Healthcare financing
  • Exploring the Black Box: Design and Implementation Issues of P4P for Rural Physicians
    Information about how pay-for-performance (P4P) payment systems work in ambulatory care settings, and in particular, how rural physicians might be affected, is scarce. This study employs qualitative research methods to explore the design and implementation of P4P systems and to investigate effects of P4P on rural physicians in a variety of settings.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Emergency medical services and trauma, Healthcare financing, Physicians
  • Health Reform-Rapid Response
    This project will include several projects as requested by ORHP and DHHS as those agencies prepare for national health reform. Responses are primarily in the areas of health insurance and behavioral health.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Healthcare financing, Mental and behavioral health
  • Outpatient Payment Policy Under Medicare: Recent Policy Developments from the Rural Perspective
    This study was designed to examine outpatient payment options for rural hospitals, the advantages and disadvantages of each, and their potential impact on hospital revenue and rural access to health services.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Healthcare financing, Hospitals and clinics
  • Volunteerism in Rural EMS
    Semi-structured telephone interviews will be used to examine issues facing rural EMS services that have converted or are considering converting from volunteer services to paid services. Respondents will be queried regarding their conversion or consideration of conversion and the effect on their ability to recruit and retain personnel, their relationship with other agencies such as fire departments and hospitals, and the overall availability of EMS services.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Emergency medical services and trauma, Healthcare financing, Workforce

2009

  • Critical Access Hospital Readiness for CMS Value-Based Purchasing
    The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Critical Access Hospitals, Healthcare financing, Quality
  • 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

2008

  • Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings
    This study will use nationally representative data to assess how mental health (MH) services are paid for in rural areas and determine differences in payment sources between rural and urban areas. If payment sources significantly vary in rural vs. urban settings, then policies that are aimed specifically at sources of funding may have a differential impact on subsequent access to and utilization of care and point to the need for policies that are specifically targeted to rural communities.
    Research center: WICHE Center for Rural Mental Health Research
    Topics: Healthcare financing, Mental and behavioral health
  • 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, Healthcare financing
  • Examining the Magnitudes, Geographic Variations, and Determinants Of Expenditures Due to Ambulatory Care Sensitive Conditions in Rural Hospitals
    This project will document the magnitude of and variation in ambulatory care sensitive condition (ACSC) expenditures of rural hospitals and explore the relationships between rural hospital ACSC expenditure and its key determinants in the areas of population demand, health care system supply, and provider practice style.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Chronic diseases and conditions, Healthcare financing, Hospitals and clinics
  • Financial Impact of Mental Health Services on Rural Individuals and Families
    This project will use the Medical Expenditure Panel Survey (MEPS) to examine the financial burden that rural residents face in seeking mental health services, compared to urban residents. Implications of financial burden for access to needed mental health services for rural residents will be assessed.
    Research center: Maine Rural Health Research Center
    Topics: Healthcare financing, Mental and behavioral health, Private health insurance
  • Financing Rural Public Health Activities in Chronic Disease Prevention and Health Promotion
    This project describes the federal-state funding streams for selected local public health activities in the area of chronic disease prevention and health promotion, and assesses potential barriers to program implementation in less populated, local areas of a state.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Chronic diseases and conditions, Health promotion and disease prevention, Healthcare financing, Public health
  • Impact of CAH Conversion on Hospital Costs and Mix of Services
    This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals, Health services, Healthcare financing
  • Quality and Financial Status of Critical Access Hospitals: A Preliminary Analysis
    The purpose of this project is to continue to investigate the relationship between CAH financial performance and quality of care. The University of Minnesota (UMN) and the University of North Carolina (UNC) will jointly develop hypotheses related to the finance-quality link and statistical models suitable for testing hypotheses.
    Research centers: North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Healthcare financing, Quality, Rural Hospital Flexibility Program

2007

  • Pay-for-Performance and Quality Improvement in Rural Hospitals
    This project will estimate the impact on rural hospitals in the U.S. of a pay-for-performance (PFP) program similar to the CMS-sponsored Premier, Inc. Hospital Quality Incentive Demonstration; synthesize the major factors that will influence the inclusion of rural hospitals in PFP programs; and make recommendations for the design of PFP programs that will appropriately reward rural hospitals for improving quality.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Healthcare financing, Hospitals and clinics, Quality
  • Rapid Response: Elimination of Bad Debt Payments to Rural PPS Hospitals
    The purpose of this project is to examine: (1) the extent to which elimination of Medicare Bad Debt payments will reduce reimbursement to rural prospective payment system (PPS) hospitals and (2) how rural hospitals would respond to this reduction in reimbursement.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Healthcare financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)

2006

  • Analyzing the Relationship Among Critical Access Hospital Financial Status, Organizational Linkages, and Scope of Services
    This project will systematically analyze the relationships among pre- and post-conversion Critical Access Hospital (CAH) financial performance, the organizational linkages in which the hospital participates (e.g., health care systems and/or networks), and the scope of services (i.e., the number and type of services) provided.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Health services, Healthcare financing, Networking and collaboration
  • 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, Healthcare financing, Medicare Prospective Payment System (PPS), Rural Hospital Flexibility Program
  • Identifying Stakeholders to Pay for Enhanced Depression Treatment in Rural Populations
    The goal of this project is to identify stakeholders who economically benefit when rural patients receive enhanced depression treatment, which will, in turn, encourage health plans to provide enhanced depression treatment to their rural enrollees without raising premiums.
    Research center: WICHE Center for Rural Mental Health Research
    Topics: Healthcare financing, Mental and behavioral health

2005

2004

2003

2002

2001