Rural Health
Research Gateway

Hospitals and clinics

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2024

2023

2022

2021

  • 2021 CMS Hospital Quality Star Ratings of Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 10/2021
    The purpose of this study is to 1) compare the 2021 CMS Hospital Quality Star Rating results for rural and urban hospitals, 2) to compare the 2021 and 2016 CMS Hospital Quality Star Rating results for rural hospitals, and 3) to identify implications for the usefulness of the CMS Hospital Quality Star Ratings for rural hospitals.
  • Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2021
    The purpose of this brief is to describe differences in Medicare Outpatient Prospective Payment System (OPPS) payments between rural and urban hospitals by Medicare payment classification and by number of acute beds.
  • State and Regional Differences in Access to Hospital-Based Obstetric Services for Rural Residents, 2018
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 08/2021
    This policy brief measures state and regional differences in the availability of hospital-based obstetric services among rural hospitals in the U.S. in 2018.
  • Trends in Cancer Treatment Service Availability Across Critical Access Hospitals and Prospective Payment System Hospitals
    Journal Article
    Rural and Minority Health Research Center
    Date: 08/2021
    This study investigated trends in cancer services availability in urban and rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs). Compared with all PPS hospitals, CAHs offered fewer cancer treatment services and experienced a decline in service capability over time.
  • How Many Hospitals Might Convert to a Rural Emergency Hospital?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2021
    In this study, three measures were used to predict the number of rural hospitals with 50 beds or less that are likely to consider conversion to a Rural Emergency Hospital: 1) three years negative total margin; 2) average daily census (acute + swing) less than three; and 3) net patient revenue less than $20 million.
  • Changes in Provision of Selected Services by Rural and Urban Hospitals Between 2009 and 2017
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2021
    The purpose of this study is to gain a better understanding of recent trends in hospital service provision and whether there were disparities between rural and urban hospitals. This brief describes and compares the changes in service provision for rural and urban hospitals between 2009 and 2017.
  • Characteristics of Rural and Urban U.S. Hospitals Based on Obstetric Services
    University of Minnesota Rural Health Research Center
    Date: 04/2021
    This infographic provides an overview of characteristics of rural and urban hospitals in the United States that provide obstetric services, as well as rural hospitals that recently closed their obstetric units.
  • Rural and Urban Hospital Characteristics by Obstetric Service Provision Status, 2010-2018
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2021
    The purpose of this policy brief is to illustrate the differences between urban and rural hospitals that provide obstetric services by their size, capacity, location, and community characteristics, as well as to compare these factors between rural hospitals with obstetric services and those that recently closed their obstetric units.
  • Challenges to Admitting Residents: Perspectives From Rural Nursing Home Administrators and Staff
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 03/2021
    This study uses a survey of rural nursing home administrators (n=209) to assess perceptions of difficulty rural nursing homes encounter in admitting and serving individuals with dementia, obesity, mental and behavioral health conditions, and medically complex conditions.
  • The Effect of Medicare Payment Standardization Methods on the Perceived Cost of Post-Acute Swing Bed Care in Critical Access Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2021
    The purpose of this study is to describe the effects of current Medicare payment standardization methods on the perceived cost of Critical Access Hospital swing bed care as it relates to the Medicare Spending per Beneficiary measure.
  • Alternatives to Hospital Closure: Findings From a National Survey of CAH Executives
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2021
    Despite the many challenges of operating a Critical Access Hospital (CAH), little research examines the perspectives of CAH executives on potential community healthcare options if the CAH closed. This brief provides policymakers with a better understanding of what CAH executives think about the viability of various alternatives to closure.
  • Health System Challenges for Critical Access Hospitals: Findings From a National Survey of CAH Executives
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2021
    Despite the numerous challenges of operating a Critical Access Hospital (CAH), there is little research examining the perspectives of CAH executives on potential community healthcare options if the CAH closed. This brief presents a subset of results from a national survey of CAH executive perspectives on pressing challenges.
  • Opioid-Related Visits to Rural Emergency Departments
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2021
    The purpose of this project was to compare rural and urban opioid-related emergency department visits. Data from the Nationwide Emergency Department Sample were used to examine rural and urban opioid-related visits over time and to compare the outcomes of these visits.

2020

  • Association of CMS‐HCC Risk Scores With Health Care Utilization Among Rural and Urban Medicare Beneficiaries
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2020
    The study examines the relationship between Centers for Medicare & Medicaid Services Hierarchical Condition Categories risk scores and future healthcare utilization among rural and urban Medicare beneficiaries.
  • CMS Hierarchical Condition Category 2014 Risk Scores Are Lower for Rural Medicare Beneficiaries Than for Urban Beneficiaries
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2020
    The study investigates potential differences in rural and urban Centers for Medicare & Medicaid Services Hierarchical Condition Category risk scores by rurality, census region, and beneficiary race or ethnicity.
  • Decline in Inpatient Volume at Rural Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2020
    This study examined inpatient volume in rural hospitals between 2011 and 2017. Patient population and the organizational and geographic characteristics of hospitals that were significant predictors of inpatient volume included census region, Medicare payment type, ownership type, total margin, and percent of the population in poverty.
  • Rural Hospitalizations for COVID-19: Snapshot on December 10, 2020
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 12/2020
    U.S. Department of Health and Human Services data were analyzed to compare rural and urban hospitals on two metrics: 1) the percentage of hospitalized patients with COVID-19, and 2) the percentage of hospital beds occupied by patients that have COVID-19.
  • Rural Hospitals Have Higher Percentages of Patients With COVID-19
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 12/2020
    U.S. Department of Health and Human Services data were analyzed to compare the percentage of hospitalized patients with COVID-19 in rural versus urban hospitals.
  • Emergency Obstetric Training Needed in Rural Hospitals Without Obstetric Units
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    This policy brief discusses the types of training identified by respondents and how those trainings may or may not meet the needs of those managing emergency obstetric situations in rural communities.
  • Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    As increasing numbers of rural hospitals stop offering maternity care, limited information is available about local preparedness to address obstetric emergencies. This paper explores the capacity to treat obstetric emergencies encountered among rural hospitals without obstetric units.
  • Making It Work: Models of Success in Rural Maternity Care
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    The goal of this case series is to describe key factors that underlie three successful models of rural maternity care and to inform communities, clinicians, and hospitals that wish to keep obstetric services available locally.
  • A Comparison of Rural and Urban Specialty Hospitals
    Policy Brief
    Rapid Response to Requests for Rural Data Analysis
    Date: 09/2020
    This brief describes key differences between specialty hospitals located in rural versus urban areas.
  • Obstetric Emergencies in Rural Hospitals: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 09/2020
    The purpose of this policy brief is to describe the challenges rural hospitals face in providing emergency obstetric care and to highlight resources that could help rural hospitals more safely respond to obstetric emergencies.
  • Urban Hospitals With a High Percentage of Inpatient Days for Rural Patients
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 09/2020
    The purpose of this brief is to describe characteristics of urban hospitals with a high percentage of inpatient days for rural patients and to compare how they differ from urban hospitals with lower percentages of rural inpatient days.
  • Characteristics of U.S. Rural Hospitals by Obstetric Service Availability, 2017
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This study described characteristics of rural U.S. hospitals by whether they provide labor and delivery care for pregnant patients. Researchers used the 2017 American Hospital Association Annual Survey to identify rural hospitals and detail their characteristics based on whether they provide obstetric services.
  • Providing Maternity Care in a Rural Northern Iowa Community
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This case study highlights how one rural hospital in northern Iowa has successfully sustained a maternity care practice and identifies opportunities for other rural hospitals and communities seeking to ensure local access to care for pregnancy and childbirth.
  • Changes in Care-Seeking After Rural Hospitals Merge
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2020
    Rural hospital mergers have increased significantly since 2010. Enhanced financial performance and improved quality are often cited as benefits, but hospital mergers can also lead to changes in the services provided by acquired hospitals. This brief estimates the use of inpatient services delivered by acquired rural hospitals following a merger.
  • Changes in Hospital-Based Obstetric Services in Rural U.S. Counties, 2014-2018
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    In 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decrease during the previous decade. Loss of rural maternity care is tied to adverse maternal and infant health outcomes. This study shares hospital-based obstetric service losses in rural U.S. counties from 2014 to 2018.
  • Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2004-2018
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    The purpose of this infographic is to show the loss of hospital-based obstetric services from 2004-2018 and how this differs by county type (micropolitan vs. noncore).
  • Post-Acute Skilled Nursing Care Availability in Rural United States
    Policy Brief
    Southwest Rural Health Research Center
    Date: 07/2020
    This policy brief explores factors related to variations in the availability of post-acute skilled nursing care in rural areas in the U.S. The focus of this analysis is on swing bed program hospitals and skilled nursing facility post-acute skilled nursing care.
  • Major Depression, Treatment Receipt, and Treatment Sources Among Non-Metropolitan and Metropolitan Adults
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 06/2020
    This study estimates and compares the prevalence of past year depression, receipt of treatment for depression, and sources of treatment for depression between non-metropolitan and metropolitan adults.
  • Estimated Reduction in CAH Profitability From Loss of Cost‐Based Reimbursement for Swing Beds
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2020
    The purpose of this study was to estimate the impact of potential loss of cost-based reimbursement for swing beds on Critical Access Hospital (CAH) profitability and to examine the characteristics of CAHs that would be most affected by such a change in reimbursement.
  • Most Rural Hospitals Have Little Cash Going Into COVID
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2020
    This infographic uses Medicare Cost Report data to illustrate the type of rural hospitals most likely to struggle financially during the pandemic as measured by lower median days cash on hand.
  • 2016-18 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2020
    This study compares the 2016-18 profitability of urban Prospective Payment System (PPS) hospitals to that of rural hospitals. Rural hospitals are further divided by size of rural PPS hospitals and by the rural Medicare payment classifications.
  • Patterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2020
    Hospital bypass, the tendency of local rural residents to not seek care at their closest hospital, is thought to be a contributing factor for rural hospital closure. The purpose of this brief is to update the knowledge base of determinants of bypass behavior by analyzing state inpatient data from 2014-2016.
  • Rural and Urban Differences in Primary Care Pain Treatment by Clinician Type
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2020
    In this brief, we compare 2017 opioid prescribing rates among physicians and nurse practitioners within primary care practices and how these differ for rural versus urban areas.
  • Rural Hospitals With Long-Term Unprofitability
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2020
    The purpose of this study is to examine the characteristics of rural hospitals that had negative total margins in 2016, 2017, and 2018. We examined net patient revenue, Medicare payment classification, region, and state for 311 rural hospitals.
  • Understanding the Broader Context of Rural Hospitals and Profitability
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2020
    The intent of this infographic is to quantify rural hospital profitability in the broader context of all hospitals. This infographic compares the number of rural and urban hospitals and rural and urban operating revenue and operating income.
  • Occupancy Rates in Rural and Urban Hospitals: Value and Limitations in Use as a Measure of Surge Capacity
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2020
    The purpose of this brief is to provide healthcare leaders and policymakers with information about historic occupancy rates (the percent of available beds that are occupied) as an input for state and system-level planning to manage population health during a pandemic.

2019

2018

  • Trends in Hospital System Affiliation, 2007-2016
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2018
    This policy brief updates a RUPRI Center brief published in 2014 and documents the continued growth in system affiliation by both metropolitan and non-metropolitan hospitals.
  • Rural Hospital Mergers From 2005 Through 2016
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2018
    This brief describes the number and geographic distribution of rural hospital mergers from 2005-2016.
  • Availability of Respiratory Care Services in Critical Access and Rural Hospitals
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2018
    This policy brief describes the availability of respiratory care services and respiratory therapists in Critical Access Hospitals (CAHs) and in rural and urban Prospective Payment System (PPS) hospitals.
  • Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 06/2018
    The purpose of this brief is to compare uncompensated care in rural and urban hospitals and to describe how it varies across regions of the country.
  • Market Characteristics Associated With Rural Hospitals' Provision of Post-Acute Care
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2018
    This brief uses data from Medicare cost reports, the Provider of Services File, and the U.S. Department of Agriculture to provide a window into current hospital-based post-acute care offerings by summarizing both hospital- and market-level factors that are associated with rural hospitals that provided post-acute care between 2012 and 2015.
  • Rural and Urban Provider Market Share of Inpatient Post-Acute Care Services Provided to Rural Medicare Beneficiaries
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2018
    The purpose of this brief is to characterize rural providers' market share of inpatient post-acute care services provided to rural Medicare beneficiaries.
  • Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 03/2018
    This study examines whether the loss of obstetric services in hospitals in rural U.S. counties led to changes in childbirth outcomes or locations.
  • Geographic Variation in the 2016 Profitability of Urban and Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2018
    This study describes the geographic variation in 2016 profitability of critical access hospitals (CAHs), other rural hospitals (Medicare Dependent Hospitals, Sole Community Hospitals, and rural Prospective Payment System (PPS) hospitals denoted as "ORH"), and urban PPS hospitals by census region, census division, and state.
  • Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
  • Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.
  • Access to Care: Populations in Counties With No FQHC, RHC, or Acute Care Hospital
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2018
    To help provide a quick understanding of how many people may have more limited access to primary care and where they live, this brief focuses on three main primary care providers in rural areas (Federally Qualified Health Centers, Rural Health Centers, and acute care hospitals).
  • Range Matters: Rural Averages Can Conceal Important Information
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2018
    This short brief uses three examples to demonstrate how focusing on averages without also considering the data range can conceal important information: 1) average rural hospital profitability, 2) distance from closed rural hospitals to the next closest hospital, and 3) HIV prevalence by county.

2017

2016

  • How Would Rural Hospitals Be Affected by Loss of the Affordable Care Act's Medicare Low-Volume Hospital Adjustment?
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2016
    Using data from the Hospital Market Service Area File, the Hospital Cost Report Information System, and Nielsen-Claritas Pop-Facts, this study examined the effect the low-volume hospital payment adjustment has on a hospital's finances. It also looked at the effects of losing the payment adjustment.
  • Relationship Between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality Among Rural U.S. Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 11/2016
    This study focused on maternity care quality by taking a look at hospitals' policies regarding induced labor and Cesarean deliveries.
  • The Financial Importance of the Sole Community Hospital Payment Designation
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2016
    Assesses the financial importance of the Sole Community Hospital (SCH) program by: the proportion of SCHs that was reimbursed at the hospital specific rate between 2006 and 2015; the profitability of providing services to Medicare patients in SCHs between 2006 and 2015, and; the financial consequences if the SCH program had not existed in 2015.
  • To What Extent Do Community Characteristics Explain Differences in Closure Among Financially Distressed Rural Hospitals?
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2016
    This study examined the differences between rural hospitals at high risk of financial distress that stayed open and those that closed.
  • The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2016
    This brief compares rural Low Volume Hospital (LVH) to non-LVH characteristics and estimates the financial impact of eliminating the LVH program and reverting to the original (2005) LVH classification and payment adjustment.
  • Trends in Risk of Financial Distress Among Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2016
    From January 2005 to July 2016, 118 rural hospitals have closed permanently, and the rate of rural hospital closures is increasing. Hospital closures impact millions of rural residents. Identifying hospitals at high risk of closure and assessing the trends over time may inform strategies to prevent or mitigate the effects of closures.
  • Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2016
    Analyzes the reasons behind hospital- and county-level factors for rural obstetric unit closures.
  • Factors Associated With High-Risk Rural Women Giving Birth in Non-NICU Hospital Settings
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2016
    Identifies rick factors for childbirth in facilities without neonatal intensive care unit (NICU) capacities among high-risk rural women. The study found that rural women with preterm birthday and multiple gestation pregnancies were less likely to give birth in a hospital with NICU capacity if no local hospital had this capacity.
  • The Practice of Midwifery in Rural U.S. Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2016
    Analyzes the role of certified nurse-midwives (CNMs) in providing maternity care in rural US hospitals and to examine state-level variations on rural CNM practice. CNMs play an important role in the maternity care workforce in rural US hospitals.
  • Location of Childbirth for Rural Women: Implications for Maternal Levels of Care
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    This study looks into the rate at which rural women give birth at nonlocal hospitals. Approximately 75% of rural women gave birth at local hospitals. However, after controlling for clinical complications, rural Medicaid beneficiaries were less likely to give birth at nonlocal hospitals, implying a potential access challenge for this population.
  • Quality Measures and Sociodemographic Risk Factors: The Rural Context
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    This policy brief aims to inform discussions concerning whether or not to adjust provider quality measures for differences in patient characteristics by examining how rurality and key sociodemographic variables might affect quality-of-care outcomes.
  • State Variations in the Rural Obstetric Workforce
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    Many types of staff are necessary to successfully run an obstetrics unit. Rural hospitals face unique staffing challenges. This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
  • Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2016
    Views on how the implementation of the Affordable Care Act's (ACA) expanded insurance coverage is affecting the financial performance of rural hospitals. The study found that while respondents believe the expanded insurance coverage was the right thing to do for patients, they worried coverage may not be adequate to ensure access to care.
  • 2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2016
    The profitability of urban hospitals to that of rural hospitals are compared for fiscal years 2012-2014 based on size and rural Medicare payment classifications.
  • Geographic Variation in the Profitability of Urban and Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2016
    Historic and recent evidence suggest that unprofitability can reduce hospital services and quality, or worse, lead to closure. This study describes the current geographic variability of hospital profitability by comparing the 2014 profitability of CAHs, other rural hospitals, and urban hospitals by census region, census division, and state.
  • Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2016
    Examines how Critical Access Hospitals perform compared to Prospective Payment System hospitals on measures of quality.
  • Geographic Variation in Risk of Financial Distress Among Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2016
    From 2005 to 2015, 112 rural hospital closures have been identified. The closures impact millions of rural residents. This brief describes the geographic variation in the proportion of rural hospitals forecasted to be at high risk of distress in 2015.
  • Prediction of Financial Distress Among Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2016
    From 2005 to 2015, more than 100 rural hospitals have closed their doors to patients in need of inpatient services. To understand factors affecting rural hospital financial distress and to develop an early warning system to identify hospitals at risk, the North Carolina Rural Health Research Program developed the Financial Distress Index.

2015

  • Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2015
    Examines characteristics of rural hospitals that have merged or were acquired during 2005 and 2012. Also compares the change is rural hospital finances, staffing, or services after the merger or acquisition.
  • Rural Hospital and Physician Participation in Private Sector Quality Initiatives
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles 12 initiatives, half focused on physician quality improvement and half focused on hospital quality improvement.
  • Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2015
    Explores the differences of rural hospitals in states with Medicaid expansion and those with nonexpansion, in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013.
  • Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    The Hospital Readmissions Reduction Program reduces Medicare payments for hospitals with excess rates of patient readmissions for certain conditions. It assesses rural/urban differences in the proportion of hospitals penalized under the program over time and whether condition-specific hospital readmission rates differ for rural/urban hospitals.
  • Free Clinics in the Rural Safety Net, 2014
    Policy Brief
    Rural and Minority Health Research Center
    Date: 09/2015
    This brief explores two issues. First, it examines where free clinics are located and describes their availability in rural counties across all 50 states. Second, through telephone interviews with leadership at 14 of the 21 state free clinic associations, it explores the issues they face.
  • The Rising Rate of Rural Hospital Closures
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2015
    Discusses the increase in rural hospital closure rates, including the causes of closures and its impact on rural communities.
  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2015
    This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals and analyzes current patterns of non-local delivery by rural women's health insurance status and residential rurality.
  • Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs With Rural Presence
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015
    In this policy brief, we present the findings of a survey of 27 rural accountable care organizations, focusing on characteristics important to their formation and operation.
  • A Comparison of Closed Rural Hospitals and Perceived Impact
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2015
    This policy brief compares selected characteristics of abandoned rural hospitals and their markets to those of converted rural hospitals.
  • Hospital Views of Factors Affecting Telemedicine Use
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2015
    This brief expands upon previous research by examining hospital-based use of telemedicine by determining the type of use by hospitals, whether it be providing services as a hub or receiving services as a spoke, and then identifying factors from the hospitals' perspectives that affect use.
  • The 21st Century Rural Hospital: A Chart Book
    Chartbook
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2015
    This chartbook presents a broad profile of rural hospitals and includes information on location, who they serve, services they provide, how they ensure outpatient services for their communities, other community benefits they provide, and financial performance. Each page includes charts comparing rural hospitals to each other and to urban hospitals.
  • Variability in General Surgical Procedures in Rural and Urban U.S. Hospital Inpatient Settings
    Report
    WWAMI Rural Health Research Center
    Date: 03/2015
    This report addresses rural/urban differences in surgical practices in commonly performed inpatient surgical procedures that are typically handled by general surgeons. Findings indicate that rural hospitals concentrated on relatively common, low complexity procedures that can be handled by general surgeons.
  • Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2015
    This policy brief reports findings from a survey of rural health clinics (RHC) that examined their capacity to meet the National Council for Quality Assurance patient-centered medical home requirements and discusses the implications of the findings for efforts to support RHC capacity development.
  • Rural Provider Perceptions of the ACA: Case Studies in Four States
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2015
    This brief summarizes the perceptions from rural providers in four states regarding the early effects of the Affordable Care Act, including changes to patient populations, financial health, and capacity for rural hospitals and rural federally qualified health centers.
  • Surgical Services in Critical Access Hospitals, 2011
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015
    This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 02/2015
    This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.
  • Financially Fragile Hospitals: Mergers and Closures
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2015
    Evaluates the causes of financial stress in rural hospitals, and describes the impact rural hospitals have on their communities. Also discusses the ways in which rural hospitals and communities have responded to this financial stress.
  • The Effect of Surgery on the Profitability of Rural Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2015
    Presents research on the effect of providing surgery in rural hospitals. Examines the availability of surgery's effect on trauma outcomes and economies in rural communities.

2014

2013

  • Profitability of Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2013
    This study compares the profitability between 2010 and 2012 of urban and rural hospitals paid under the Medicare Prospective Payment System (U-PPS and R-PPS, respectively) to rural hospitals with special Medicare payment provisions.
  • Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2013
    This brief is a preliminary assessment of uncompensated care data quality included in Medicare Cost Report Worksheet S-10 for critical access hospitals and other rural hospitals to identify data quality issue implications for research and policy decisions. Worksheet S-10 data were collected from the Healthcare Cost Reporting Information System.

2012

2011

2010

2009

  • Implementing Patient Safety Initiatives in Rural Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 09/2009
    This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in eight small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of three patient safety interventions.
  • Potentially Preventable Readmissions in Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 08/2009
    Using 3-M algorithm software and Medicare inpatient claims data from five states, this brief examines potentially preventable readmission rates for rural and urban hospitals and discusses the rural implications of policy initiatives to reduce readmission rates.
  • Health Information Technology Policy and Rural Hospitals
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009
    This brief summarizes the implementation status of key health information technology (HIT) applications in critical access hospitals and other rural hospitals and discusses policies for encouraging HIT adoption in rural hospitals.
  • Rural Issues Related to Bundled Payments for Acute Care Episodes
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 06/2009
    Bundling Medicare payments 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 the challenges.
  • Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 03/2009
    This policy brief describes successful telepharmacy activities being implemented in rural hospitals and analyzes policy issues related to the implementation of telepharmacy projects in rural hospitals.
  • Achieving Success in QIO and Rural Hospital Partnerships (Final Report)
    NORC Walsh Center for Rural Health Analysis
    Date: 02/2009
    This report describes four case studies that highlight the strategies employed by Quality Improvement Organizations (QIOs) to help small rural hospitals implement successful quality-improvement initiatives.

2008

2007

2006

2005

  • Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety (Full Report)
    Upper Midwest Rural Health Research Center
    Date: 12/2005
    This study's results show that many small rural hospitals have limited hours of onsite pharmacist coverage and a significant number don't have a pharmacy computer or don't use one for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.
  • The State of Rural Hospital Nursing and Allied Health Professional Shortages
    Southwest Rural Health Research Center
    Date: 12/2005
    This study estimated shortages of nurses and allied health personnel among rural hospitals to gauge the difficulty experienced by rural hospitals in recruiting such personnel. The study also examined strategies these hospitals use in recruitment and retention of nurses and addressed strategies that might effectively address such shortages.
  • 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.
  • Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results?
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2005
    This policy brief explores how predictions of changes in hospital financial performance differ when comparing results using data from the Medicare Cost Report (MCR) to data from the audited hospital financial statement (FS). Results indicate that using the MCR rather than FS data is more valid.
  • Washington State Hospitals: Results of the 2005 Workforce Survey
    WWAMI Rural Health Research Center
    Date: 10/2005
    A survey of nonfederal acute care hospitals found growth in Washington's hospital sector is keeping demand for healthcare occupations high, even when vacancy rates for some jobs appear to be lower than in the past. This growth, and the shift away from contracting employees, should be considered in future workforce supply and demand projections.
  • Revisions to Medicare's Disproportionate Share Payment Policy to Incorporate Bad Debt and Charity Care
    NORC Walsh Center for Rural Health Analysis
    Date: 09/2005
    This report investigates the impact of possible changes to the Medicare disproportionate share payment policy, designed to incorporate information on the hospital's uncompensated care burden as well as to improve the payment formulae.
  • 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.
  • 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.
  • Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
    Maine Rural Health Research Center
    Date: 02/2005
    This book provides policymakers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current that affects rural health services and populations.
  • Comparing Patient Safety in Rural Hospitals by Bed Count
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 2005
    This report shares the results of a study to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals.

2004

2003

  • Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Regulations: Case Studies of Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2003
    Rural hospitals in this study recognized the importance of ensuring the confidentiality of patient health information and have made substantial progress in achieving compliance with HIPAA privacy standards. Each recognized that additional work will be required to effectively secure patient privacy.
  • Who Receives Inpatient Charity Care in California?
    NORC Walsh Center for Rural Health Analysis
    Date: 08/2003
    This policy analysis brief examines the results of a study regarding how California hospitals determine charity care.
  • Emergency Department Use by Medically Indigent Rural Residents
    Rural and Minority Health Research Center
    Date: 07/2003
    This report examined emergency department (ED) use, combining national data and South Carolina state data to estimate the uncompensated charges in rural EDs nationally and the ameliorating effects of rural community health centers on ED use by rural residents.
  • A Primer on Interpreting Hospital Margins
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2003
    This document explains the most commonly used measures of hospital profitability and how they are used to inform policy changes.
  • Rural Hospital HIPAA Readiness and Resource Needs
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    This rural policy brief presents a survey of rural hospitals regarding the extent of their preparation for HIPAA requirements and their need for resources to implement them.
  • Rural Hospitals: New Millennium and New Challenges
    University of Minnesota Rural Health Research Center
    Date: 02/2003
    This report discusses the changes in rural hospitals that took place in the decade of the 1990s and discusses some of the challenges that face rural hospitals in 2003. It includes discussion of rural hospitals' organizational structures, health service provision, payment/reimbursement, and financial performance.
  • Rate of Return on Capital Investments at Small Rural Hospitals
    University of Minnesota Rural Health Research Center
    Date: 01/2003
    This paper examines whether the aging of rural facilities is due to a lower rate of return on capital investment at these hospitals. This paper also investigates whether membership in a hospital system improves access to capital and results in the updating of buildings and equipment.
  • 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.
  • 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.
  • 2003 Index of Hospital Quality
    NORC Walsh Center for Rural Health Analysis
    Date: 2003
    Published annually by U.S. News & World Report, this report describes a series of factors regarding ranking of measuring hospital quality.

2002

  • Achieving Equity in Medicare Disproportionate Share Payments to Rural Hospitals: An Assessment of the Financial Impact of Recent and Proposed Changes to the Disproportionate Share Hospital Payment Formula
    Journal Article
    NORC Walsh Center for Rural Health Analysis
    Date: 09/2002
    Examines how Benefits Improvement and Protection Act revisions to the Medicare disproportionate share hospital (DSH) program are likely to affect rural hospital financial performance. The study shows that paying rural hospitals based on the rules used for urban hospitals could improve access to care in rural communities.
  • Rural Hospital Access to Capital: Issues and Recommendations
    University of Minnesota Rural Health Research Center
    Date: 07/2002
    This paper identifies programs that have assisted/could assist rural hospitals in meeting capital needs; assesses whether rural hospital borrowers have difficulty in meeting capital needs under existing grant, loan, and mortgage insurance programs; and discusses potential options for improving access to capital for rural hospitals.
  • Financial Incentives for Rural Hospitals to Expand the Scope of Their Services
    University of Minnesota Rural Health Research Center
    Date: 06/2002
    This paper examines the financial incentives that rural hospitals have to conduct surgery and treat more complex medical conditions. The objective is to evaluate whether rural hospitals that offer broader services are more profitable than hospitals with limited inpatient services.
  • Understanding Rural Hospital Bypass Behavior
    University of Minnesota Rural Health Research Center
    Date: 06/2002
    This study provides a descriptive analysis of rural hospital bypass behavior. It focuses on the extent to which patients admitted from rural areas are bypassing local facilities and whether there are changes in bypass patterns over time.
  • Capital Needs of Small Rural Hospitals
    NORC Walsh Center for Rural Health Analysis
    Date: 05/2002
    This report examines the capital situation of rural hospitals with fewer than 50 beds to determine the total cost of bringing each facility into compliance with current laws, as well as the facilities' cost of borrowing and ability to borrow.
  • Variance in the Profitability of Small-Town Rural Hospitals (Policy Brief)
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2002
    This policy brief discusses why some rural small-town hospitals are financially successful and others struggle with persistent financial difficulties.
  • Variance in the Profitability of Small-Town Rural Hospitals (Full Report)
    NORC Walsh Center for Rural Health Analysis
    Date: 02/2002
    This report documents the variance in profitability among small-town rural hospitals and evaluates the characteristics that distinguish highly profitable small-town hospitals from struggling ones. It also reports on strategies that small-town hospital administrators are using to achieve financial success.

2001

2000