Hospitals and clinics

Current Projects

  • A Closer Examination of Rural Hospital Bypass
    This project will estimate the rural hospital bypass rate using all-payer claims data for a set of states and compare patients based on the inpatient treatments and procedures received relative to those routinely provided by rural facilities.
    Research center: Rural Health Equity Research Center
    Topics: Critical Access Hospitals, Health reform, Health services, Healthcare access, Hospitals and clinics, Medicaid and CHIP, Medicare, Medicare Advantage (MA), Minority health, Private health insurance, Uninsured and underinsured
  • Changes in Hospital Services Offered After Mergers, Acquisition and Affiliations
    Hospitals have affiliated with systems in increasing numbers since 2007, as of 2016 reaching 56.1 percent of nonmetropolitan prospective payment system hospitals and 42.8 percent of critical access hospitals. This project will examine resulting changes in services offered by rural hospitals, hypothesizing shifts of some services to regional hospitals and growth in some service lines.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals, Hospitals and clinics, Networking and collaboration
  • Changes in Medicare Fee-for-Services Health Care Expenditures in Rural and Urban Communities after Passage of the Affordable Care Act
    This project will assess changes in Medicare per-beneficiary spending across rural and urban counties from 2007 to 2020. It will examine differences in rural versus urban per-beneficiary spending on hospital inpatient, hospital outpatient, physician, and post-acute care after the Affordable Care Act (ACA).
    Research center: Rural and Minority Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health services, Hospitals and clinics, Public health
  • Clinical-Community Linkages in Non-Metropolitan and Metropolitan Hospitals: COVID-19 Impacts and Trends
    This study will examine trends in partnerships between hospitals and public health departments and other community linkages in both non-metropolitan and metropolitan hospitals with a particular focus on the impact of the COVID-19 pandemic.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals, Health services, Hospitals and clinics, Networking and collaboration, Public health, Social determinants of health
  • Estimation of the Fixed and Variable Costs of a Rural Emergency Hospital
    This project will: 1) inform the design of CMS Rural Emergency Hospital (REH) payment methods, particularly the Medicare monthly additional facility payment; 2) estimate patient break-even volumes for the long-run financial sustainability of REHs; and; 3) provide a tool that rural hospitals can use to estimate the cost of operating a REH.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Legislation and regulation, Medicare
  • Examining Rural-Urban Differences in Availability of Hospital Cardiac Testing Services Between 2010-2020
    This project will examine whether the availability of hospital-based cardiac testing services has changed over the past ten years in rural and urban counties and identify the characteristics of counties where service availability has changed.
    Research center: Rural and Minority Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health services, Hospitals and clinics, Public health
  • Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
    This project will update our 2014 brief: Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where? In addition to examining health conditions of patients discharged from rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs), the current project will also look to see what has changed over time and whether race and ethnicity, sex, or age explain differences.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Long-term care, Medicare
  • How Does Participation in Medicare Accountable Care Organizations Affect Rural Hospital Financial Outcomes?
    This project will examine the impact of Medicare Accountable Care Organizations' (ACOs') participation on rural hospitals' financial outcomes. Findings from this project will provide policy-relevant information on how ACO participation affects rural hospitals' financial bottom lines, contributing to further program design.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Care management, Health reform, Health services, Hospitals and clinics, Medicare
  • Improving Racial Equity for Rural Mothers and Infants
    The purpose of this project is to assess differences in maternal and infant health outcomes and access to perinatal care, among urban and rural counties. We will also compare health outcomes and availability of services, including evidence-based services and supports, between rural counties that are majority Black, Indigenous, and People of Color with those that are majority white.
    Research center: University of Minnesota Rural Health Research Center
    Topics: American Indians and Alaska Natives, Critical Access Hospitals, Health disparities and health equity, Healthcare access, Hospitals and clinics, Maternal health, Minority health, Rural statistics and demographics, Social determinants of health, Women
  • Palliative Care in the Rural U.S.
    This project will describe the availability of palliative care services in rural hospitals and community settings using data from the American Hospital Association Annual Survey, interviews with palliative care providers, and a survey of rural hospitals without palliative care services.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospice and palliative care, Hospitals and clinics
  • Psychiatric Bed Closures in Rural Hospitals: An Assessment of Trends, Impact, and Policy Strategies
    This study will examine trends in the closure of psychiatric beds by rural hospitals using the Substance Abuse and Mental Health Services Administration Treatment Services Locator; the American Hospital Association Annual Survey of Hospitals (2010-2017); and the Area Health Resources File.
    Research center: Maine Rural Health Research Center
    Topics: Healthcare access, Hospitals and clinics, Mental and behavioral health
  • Quality Measures for Skilled Nursing Care in Rural Swing Beds: What Works and What Doesn't?
    This project will provide a systematic review of skilled nursing facility quality measures and how these measures apply to skilled nursing facility-level care provided in rural swing beds in both critical access hospitals and prospective payment system hospitals.
    Research center: Southwest Rural Health Research Center
    Topics: Hospitals and clinics, Long-term care, Medicare Prospective Payment System (PPS)
  • Ransomware Attacks on Rural Hospitals
    The rise in hospital ransomware attacks threatens to harm patients, especially in rural areas. This project will use a novel dataset to analyze rural/urban differences in how ransomware attacks affect patients and hospitals.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Emergency medical services and trauma, Health information technology, Hospitals and clinics
  • Rural-based Accountable Care Organizations Accepting Downside Risk
    The RUPRI Center will update its studies of rural provider participation in accountable care organizations, including differences between those who exit the program, those who remain, and those who enter. In particular, this project will address participation decisions made after a rule change in July 2019 that requires conversion to two-sided risk.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals, Federally Qualified Health Centers (FQHCs), Health reform, Hospitals and clinics, Legislation and regulation, Medicare
  • Rural/Urban Differences in Postpartum Health Insurance, Healthcare Use, and Health Outcomes
    The purpose of this project is to identify rural/urban differences in health insurance, healthcare use, and health outcomes among postpartum individuals, and to describe policy-relevant implications or strategies to improve insurance coverage, receipt of recommended healthcare, and, ultimately, health outcomes among rural residents who give birth. With a lens towards health equity, all analyses will be stratified by race/ethnicity and income.
    Research center: University of Minnesota Rural Health Research Center
    Topics: American Indians and Alaska Natives, Health disparities and health equity, Healthcare access, Healthcare financing, Hispanics, Hospitals and clinics, Legislation and regulation, Maternal health, Medicaid and CHIP, Minority health, Private health insurance, Women
  • Safe Obstetric Care Access for All Rural Residents: Minimum Standards for Clinical, Workforce, and Financial Viability of Rural Obstetric Units
    The goal of this project is to analyze data from rural hospitals to understand the criteria by which hospitals and communities assess their need and capacity for obstetric care access in rural counties and to describe effective ways to operationalize minimum standards for clinical safety and financial viability for rural obstetric units.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals, Health disparities and health equity, Healthcare access, Hospitals and clinics, Maternal health, Women, Workforce
  • Third Party Negotiated Pricing in Rural and Urban Hospitals
    We will use third party negotiated pricing information to compare prices in urban and rural hospitals, across a variety of common services. Because there has been poor compliance with the Centers for Medicare & Medicaid Services (CMS) requirement to publish third party negotiated pricing, we will also examine if the availability of this information differs for rural and urban hospitals.
    Research center: Rural and Underserved Health Research Center
    Topics: Critical Access Hospitals, Federally Qualified Health Centers (FQHCs), Healthcare financing, Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS), Private health insurance
  • Three Models of a Rural Emergency Hospital
    This project will use secondary data about small rural emergency departments and expert opinion to develop three clinical and operational models of a Rural Emergency Hospital (REH). The REH models will be based on case mix, service mix, patient volume, clinical staffing, and technology.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Legislation and regulation, Medicare
  • Understanding Rural Health Clinic Services, Use, and Reimbursement
    This study describes the scope and intensity of services provided to Medicare beneficiaries by independent and provider-based Rural Health Clinics. It will also assess the adequacy of the Centers for Medicare & Medicaid Services' changes to the outpatient evaluation and management codes in 2021 compared to the 2021 per-visit reimbursement cap.
    Research center: Maine Rural Health Research Center
    Topics: Health services, Healthcare financing, Hospitals and clinics, Medicare, Rural Health Clinics (RHCs)
  • Understanding Rural Non-Emergent Emergency Department Use
    Research shows rural residents use emergency departments (ED) at higher rates than urban residents. Other studies suggest rural residents are more likely to visit the ED for a non-emergent reasons. This study uses the 2014-17 Medical Expenditure Panel Survey to analyze factors associated with rural versus urban residents' non-emergent use of EDs.
    Research center: Maine Rural Health Research Center
    Topics: Emergency medical services and trauma, Health services, Healthcare access, Hospitals and clinics