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Rural Hospitals – Resources

Selected recent or important resources focusing on Rural Hospitals.

NRHA COVID-19 Technical Assistance Center
Supports the needs of rural providers and communities impacted by the COVID-19 pandemic. Assists rural healthcare organizations through financial consultations, operational support, and help obtaining essential medical resources, including Personal Protection Equipment (PPE).
Date: 06/2020
Type: Website
Sponsoring organization: National Rural Health Association
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COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing
Addresses issues related to Medicare fee-for-service (FFS) billing during the COVID-19 public health emergency. Covers COVID-19 test specimen collection, diagnostic laboratory services, hospital services, ambulance services, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), telehealth, skilled nursing facility services, home health, and other services.
Date: 06/2020
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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American College of Emergency Physicians: COVID-19
Information to assist with patient care during the response to COVID-19. Addresses clinical assessment and management, testing, emergency department issues, EMS issues, and more.
Date: 06/2020
Type: Website
Sponsoring organization: American College of Emergency Physicians
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COVID-19 Related Cybersecurity Information
Resources to help hospitals and health systems mitigate risk related to cybersecurity threats during the COVID-19 response.
Date: 06/2020
Type: Website
Sponsoring organization: American Hospital Association
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Updates and Resources on Novel Coronavirus (COVID-19)
Resources for hospitals and health systems to help them respond to COVID-19. Includes news from AHA on the latest developments.
Date: 06/2020
Type: Website
Sponsoring organization: American Hospital Association
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National Trends in the Safety Performance of Electronic Health Record Systems From 2009 to 2018
Evaluates safety performance of electronic health records (EHRs) to prevent potential adverse drug effects (ADEs), assesses hospital EHR safety performance for specific subcategories of potential ADEs, and examines the associations of EHR vendors with safety performance. Features statistics including characteristics of surveyed hospitals, with breakdowns by size and urban or rural location.
Author(s): David C. Classen, A. Jay Holmgren, Zoe Co, et al.
Citation: JAMA Network Open, 3(5)
Date: 05/2020
Type: Document
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Fact Sheet: Rural Community Hospital (RCH) Demonstration
Provides an overview of the Rural Community Hospital demonstration program. Describes reimbursement challenges that rural hospitals face and the early results of the program.
Date: 05/2020
Type: Document
Sponsoring organization: American Hospital Association
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COVID-19: Telehealth and Virtual Care Best Practices
Provides an overview of how hospitals and health systems are using telehealth services and online tools to address COVID-19. Describes how to utilize online assessment tools, remotely care for patients, protect healthcare workers, and leverage telehealth services vendors. Includes links to additional resources throughout.
Date: 05/2020
Type: Document
Sponsoring organization: American Hospital Association
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Hospital Burden of Opioid-Related Inpatient Stays: Metropolitan and Rural Hospitals, 2016
Examines burden on hospitals of opioid-related hospitalizations for metropolitan, rural-adjacent to metro, and rural remote hospitals. Includes data by region. Provides detailed information by urban-rural location, including information on the distribution of opioid-related stays, bed size, and occupancy level.
Author(s): Pamela L. Owens, Audrey J. Weiss, Marguerite L. Barrett
Date: 05/2020
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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Most Rural Hospitals Have Little Cash Going into COVID
Findings brief exploring two scenarios in which rural hospitals have cash on hand for either 180 days or 7 days, representing the estimate of time the facilities could operate without receiving additional revenue, prior to the outbreak of COVID-19 in the U.S. Features statistics showing median days cash on hand by Medicare Payment Classification, with breakdowns by 7 types of hospitals, including Critical Access Hospitals and Sole Community Hospitals.
Date: 05/2020
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Project N95: The National COVID-19 Medical Equipment Clearinghouse
Clearinghouse to help healthcare providers and facilities request needed personal protective equipment (PPE), including N95 masks, surgical masks, isolation gowns, and ventilators. A request form is available, and the expectation is that PPE will be available in the coming weeks and will be distributed where it is most urgently needed.
Date: 05/2020
Type: Website
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National Health Service Corps Site Reference Guide
Provides clarification for National Health Service Corps (NHSC) sites regarding eligibility requirements, qualification factors, compliance, roles and responsibilities, and other factors for becoming an NHSC approved site. Acts as a supplemental resource to the information provided in the online NHSC Site Application.
Date: 05/2020
Type: Document
Sponsoring organization: Health Resources and Services Administration
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Four Stages of Planning and Implementation During COVID-19: One Rural Hospital's Preparations
Highlights a rural California hospital's four stage plan in preparing for a potential patient surge related to the COVID-19 pandemic and addresses actions achieved to ensure quality in the current care and treatment of patients. Discusses the steps taken to provide care through community outreach and to maintain financial support.
Date: 04/2020
Type: Document
Sponsoring organization: American Hospital Association
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Fact Sheet: Expansion of the Accelerated and Advance Payments Program for Providers and Suppliers During COVID-19 Emergency
Explains the expansion of the CMS Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers under the COVID-19 public health emergency. Explains eligibility for the payments and offers a step-by-step guide on how facilities can request accelerated or advance payment. Beginning April 26, 2020 CMS will not be accepting new applications for the Advance Payment Program and will reevaluate all pending and new applications for Accelerated Payments in light of the CARES ACT Provider Relief Fund support.
Date: 04/2020
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Patterns of Hospital Bypass and Inpatient Care‐Seeking by Rural Residents
Analyzes state inpatient data from 2014-2016 across 16 states to determine how inpatient hospital bypass behavior - rural residents utilizing a hospital other than their local hospital – is motivated by patient and hospital characteristics. Compares hospital characteristics, including Critical Access Hospitals (CAHs), by rural bypass level and compares patient demographics by rural bypass status.
Author(s): Tyler Malone, Mark Holmes
Date: 04/2020
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural Hospital Participation in Medicare Accountable Care Organizations
Report explores the rates of rural hospital participation in Medicare Shared Savings Program (SSP) Accountable Care Organizations (ACOs). Details some of the factors that correspond to participation and compares rates by region and by rural status.
Date: 04/2020
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Geographic Variation in the 2018 Profitability of Urban and Rural Hospitals
Compares the profitability of Critical Access Hospitals, other rural hospitals, and urban hospitals in 2018 by census region, census division, and state. Examines the reasons for geographic variation in the profitability of urban and rural hospitals.
Additional links: 2016‐18 Profitability of Urban and Rural Hospitals by Medicare Payment Classification, Rural Hospitals with Long‐Term Unprofitability, Understanding the Broader Context of Rural Hospitals and Profitability
Author(s): Andrew W. Maxwell, Ann Howard, George H. Pink
Date: 04/2020
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Ethical and Legal Challenges During the COVID‐19 Pandemic – Are We Thinking About Rural Hospitals?
Discusses the legal framework and ethical decisions hospitals are faced with during the COVID-19 pandemic. Highlights emergency preparedness planning for rural hospitals with limited workforce and resources.
Author(s): Love Patel, Amy Elliott, Erik Storlie, et al.
Citation: Journal of Rural Health
Date: 04/2020
Type: Document
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2020 Rural Hospital Sustainability Index
Reports on an analysis of rural hospital financial viability. Identifies the number of hospitals by state at financial risk of closing and the number by state at high financial risk that are considered essential for community trauma access. Full report is available with email registration.
Additional links: State-Based Data
Author(s): David Mosley, Daniel DeBehnke
Date: 04/2020
Type: Document
Sponsoring organization: Guidehouse
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KSB Hospital Response for Coronavirus (COVID-19) - Katherine Shaw Bethea Hospital, Dixon, Ill.
Profiles a rural Illinois hospital's experience developing drive-through screening for COVID-19. Offers lessons learned early on in the process regarding the training of staff and partnering with county health departments.
Date: 04/2020
Type: Document
Sponsoring organization: American Hospital Association
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Rural Hospital Shifts Operations in Anticipation of COVID-19 Surge
Explores the strategic and operational changes made at King's Daughters Medical Center, a rural hospital in Mississippi, in anticipation of a surge of COVID-19 patients. Discusses supply conservation strategies, financial strain, and staffing changes.
Date: 04/2020
Type: Document
Sponsoring organization: American Hospital Association
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The Impact of COVID-19 on Rural Hospitals
Examines how COVID-19 is impacting already vulnerable rural hospitals. Evaluates access to ICU beds, loss of outpatient revenue, and the number of days of cash on hand.
Additional links: The Rural Health Safety Net Under Pressure: Understanding the Potential Impact of COVID-19
Date: 04/2020
Type: Document
Sponsoring organization: Chartis Center for Rural Health
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Planning Resources by Setting: Hospitals and Healthcare Systems
Details the Center for Disease Control and Prevention's emergency preparedness and response resources for hospitals. Features tools, reports, and guidance for hospitals during an environmental or public health emergency.
Date: 04/2020
Type: Website
Sponsoring organization: Centers for Disease Control and Prevention
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Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020
Reports on hospitals' challenges and needs in responding to the coronavirus 2019 (COVID-19) pandemic. Addresses access to testing, supplies, and equipment; workforce issues; facility capacity; the need for financial assistance; and information needs. Identifies strategies hospitals reported using the help protect staff and manage patient care. Includes information on rural hospitals' concerns.
Date: 04/2020
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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CARES Act: Provisions to Help Rural Hospitals
Provides an overview of aspects of the Coronavirus Aid, Relief, and Economic Security (CARES) Act designed to support rural hospitals. Highlights provisions related to access to capital, Medicare payments, and telehealth, among others.
Date: 04/2020
Type: Document
Sponsoring organization: American Hospital Association
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Guidance for Infection Control and Prevention of COVID-19 in Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAHs): FAQs, Considerations for Patient Triage, Placement, Limits to Visitation and Availability of 1135 Waivers
Provides guidance and support to help hospitals take appropriate action to address potential and confirmed COVID-19 cases. Covers how to mitigate transmission, preparing for community spread, addressing staffing shortages, and patient visitation recommendations. Also covers CMS 1135 waivers of certain hospital/Critical Access Hospital (CAH) requirements related to the COVID-19 national emergency.
Date: 03/2020
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Hospital Readiness for COVID-19: Analysis of Bed Capacity and How It Varies Across the Country
Examines the distribution of hospital beds at the county-level in order to help local officials identify areas with the greatest need for inpatient beds during the COVID-19 outbreak. Discusses the development of an interactive county-by-county map to display hospital bed capacity. Highlights differences in capacity between nonprofit versus for-profit hospitals and rural versus urban hospitals. Provides recommendations for increasing hospitals' surge capacity.
Additional links: Understanding Hospital Bed Capacities Nationwide amid COVID-19
Author(s): Fredric Blavin, Diane Amos
Date: 03/2020
Type: Document
Sponsoring organization: Urban Institute
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Occupancy Rates in Rural and Urban Hospitals: Value and Limitations in Use as a Measure of Surge Capacity
Compares the acute care and intensive care unit occupancy rates between rural and urban hospitals. Presents state-by-state and national data. Explores the challenges of using this data to identify surge capacity in preparation of an increase in patient volume due to COVID-19.
Date: 03/2020
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural Health COVID-19 "Call First" Communication Toolkit
COVID-19 communication toolkit for rural hospitals and clinics. Focused on helping facilities demonstrate leadership in protecting the community, while taking steps to ensure that facilities are not overburdened. Includes customizable print and digital ads, radio scripts, social media posts, and other materials. Free, registration required.
Date: 03/2020
Type: Document
Sponsoring organizations: Legato Healthcare Marketing, National Rural Health Association
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COVID-19 Healthcare Planning Checklist
Resource to help state, local, tribal, and territorial governments prepare for and respond to COVID-19. Identifies specific activities jurisdictions can undertake, including activities addressing safety and infection control, EMS, and hospital and healthcare delivery.
Date: 03/2020
Type: Document
Sponsoring organization: Office of the Assistant Secretary for Preparedness and Response
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Report to Congress on Medicaid and CHIP, March 2020
Reports on three aspects of Medicaid: improving the structure of Disproportionate Share Hospital (DSH) payments, state reporting on the quality of care for individuals covered by Medicaid or the State Children's Health Insurance Program (CHIP), and the timeliness and quality of Medicaid demonstration evaluations. Chapter 1 examines the relationship between DSH allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the amounts and sources of hospitals' uncompensated care costs. Table 1-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2020
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Health Industry Cybersecurity: Management Checklist for Teleworking Surge During the COVID-19 Response
A guide for healthcare enterprise management on how to address important factors related to teleworking during a public emergency. Includes action items related to information technology and cybersecurity, legal and privacy considerations, and communication.
Author(s): Joint Cybersecurity Working Group
Date: 03/2020
Type: Document
Sponsoring organization: Healthcare and Public Health Sector Coordinating Council
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Medicare: Information on Medicare-Dependent Hospitals
Provides an overview of the Medicare-dependent hospital (MDH) program, how the MDH designation differs from other rural hospital designations, and how MDH hospitals have changed over time. Discusses the decrease in the number of MDHs over time. Examines a variety of operational and financial metrics across MDHs over time.
Additional links: Full Report
Date: 02/2020
Type: Document
Sponsoring organization: Government Accountability Office
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Impact of Medicaid Work Requirements on Hospital Finances
Explores the potential financial impact of approved or pending Medicaid Section 1115 demonstration waivers that include work requirements on hospitals in 16 states. Provides a fact sheet on each state, including a section comparing the potential impact of Medicaid work requirements on rural hospitals' operating margins to all hospitals in the state.
Date: 02/2020
Type: Document
Sponsoring organization: Commonwealth Fund
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Quantifying the Impact of the Rural Health Safety Net
Examines the vulnerability of 453 rural hospitals based on financial and operational metrics. Includes the Rural Vulnerability Study, infographics, and presentation slides on this analysis from the 2020 National Rural Health Association Policy Institute. Provides state data tables showing the financial impact of federal policies on rural hospitals.
Additional links: The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability
Date: 02/2020
Type: Website
Sponsoring organizations: Chartis Center for Rural Health, iVantage Health Analytics
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National Hospital Ambulatory Medical Care Survey: 2017 Emergency Department Summary Tables
Provides data on ambulatory care emergency department (ED) hospital visits. Table 1 provides metropolitan/nonmetropolitan ED visit data based on hospital location, Table 2 includes metro/nonmetro ED visit data by location of patient residence, and Table 14 has metro/nonmetro injury visit data based on hospital location.
Date: 01/2020
Type: Document
Sponsoring organization: National Center for Health Statistics
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U.S. Hospital List (2019)
Excel file providing a comprehensive list of urban and rural U.S. hospitals that were reported open as of January 1, 2019. Includes 4,663 acute care hospitals and 1,381 specialty hospitals.
Date: 2020
Type: Directory
Sponsoring organization: North Carolina Rural Health Research Program
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Access, Quality, and Financial Performance of Rural Hospitals Following Health System Affiliation
Examines the impact of health system affiliation on rural hospitals' quality and financial performance, as well as patients' access to care. Compares rural hospitals affiliated with a health system between 2008-2017 with those that did not affiliate with a health system.
Author(s): Claire E. O'Hanlon, Ashley M. Kranz, Maria DeYoreo, Ammarah Mahmud, Cheryl L. Damberg, Justin W. Timbie
Citation: Health Affairs, 38(12), 2095-2104
Date: 12/2019
Type: Document
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Impact of the Medicare Disproportionate Share Hospital Payment Cap on Rural and Urban Hospitals
Describes the number and location of hospitals that qualify for Medicare Disproportionate Share Hospital (DSH) payments and meet the criteria for a 12% payment cap. Examines how the payment cap and lost revenue impacts urban and rural hospitals. Presents options to modify DSH payments to ease the financial strain on rural hospitals.
Author(s): Paula Weigel, Fred Ullrich, Keith J. Mueller
Date: 12/2019
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Partial Psychiatric Hospitalization Program Availability in Non-Metropolitan and Metropolitan Hospitals Nationally
Describes the purpose of partial psychiatric hospitalization programs (PPHPs), and compares 2016 American Hospital Association (AHA) Annual Survey of Hospitals data on the availability and the characteristics of PPHPs among non-metropolitan and metropolitan hospitals in the U.S.
Author(s): Timothy Williams, Tyrone F. Borders, Lindsey Jasinski
Date: 12/2019
Type: Document
Sponsoring organization: Rural and Underserved Health Research Center
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Evaluation of the Maryland All-Payer Model: Volume I - Final Report
Evaluation of the All-Payer Model operating under an agreement with the Centers for Medicare & Medicaid Services (CMS) for hospitals in rural and urban settings implemented in Maryland in 2014. This model shifted the state's hospital payment structure to an annual, global hospital budget that includes both inpatient and outpatient hospital services. Report covers 4.5 years of implementation, and compares outcomes by rural and urban residency.
Author(s): Susan Haber, Heather Beil, Marisa Morrison, et al.
Date: 11/2019
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Hospitals: Here Today, Gone Tomorrow
Describes the conditions facing rural hospitals and their communities contributing to the high rate of rural hospital closure. Discusses state and federal legislation, policies, and programs developed to support rural hospitals. Provides data for 15 Southern states including their state and rural populations, percentage of population uninsured, Medicaid expansion status, percentage at high financial risk, and number of rural hospital closures.
Author(s): Nick Bowman
Date: 11/2019
Type: Document
Sponsoring organization: Southern Legislative Conference of The Council of State Governments
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Delta Region Community Health Systems Development (DRCHSD) Program: 340B Drug Pricing Program Guide
Provides rural hospital administrators with information regarding the 340B Drug Pricing Program. Offers State Offices of Rural Health (SORHs) directors and Flex Program coordinators a better understanding of the process hospitals must abide by to participate in the 340B Program.
Author(s): BKD CPAs & Advisors
Date: 10/2019
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Estimate of Federal Payment Reductions to Hospitals Following the ACA: 2010-2029: Estimates and Methodology
Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2019, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Type: Document
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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Medicare Payment Basics: Outpatient Hospital Services Payment System
Outlines Medicare's payments for outpatient hospital services. Features considerations for rural sole community hospitals.
Date: 10/2019
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Hospital Acute Inpatient Services Payment System
Overview of Medicare payments to hospitals for acute inpatient care. Includes information on rate setting, Medicare payments for medical education, payments to Medicare Disproportionate Share Hospitals (DSH), and special payments for rural hospitals.
Date: 10/2019
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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How Will Medicaid Work Requirements Affect Hospitals' Finances?
Examines the potential financial impact of approved or pending Medicaid Section 1115 demonstration waivers that include work requirements on hospitals in 18 states. Includes a section on the potential impact on rural hospitals' operating margins. Updates a March 2019 report of the same title covering 13 states.
Author(s): Randy Haught, Allen Dobson, Joan DaVanzo
Date: 09/2019
Type: Document
Sponsoring organization: Commonwealth Fund
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Rural Hospital Closures Reduce Access to Emergency Care
Recognizes the importance of hospital and emergency care services in providing healthcare in rural communities, and discusses the current hospital closure rate. Uses federal data to compare the financial viability of rural and urban hospitals, and the availability of emergency care in rural communities. Suggests policy recommendations for improving access to healthcare and emergency care for rural populations.
Author(s): Tarun Ramesh, Emily Gee
Date: 09/2019
Type: Document
Sponsoring organization: Center for American Progress
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Hospital Merger Benefits: Views from Hospital Leaders and Econometric Analysis - An Update
Revisits a study from 2016 on the effects of hospital acquisitions in terms of cost, care quality, and revenue. Highlights data by hospital type, including rural status, as well as several performance measures.
Author(s): Monica Noether, Sean May, Ben Stearns
Date: 09/2019
Type: Document
Sponsoring organization: American Hospital Association
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Small Rural Hospital Transition (SRHT) Project Guide: A Rural Hospital Guide to Improving Care Management: 2019 Update
A guide for rural hospital leadership that identifies best practices in care management. Addresses care management roles and staffing needs and covers utilization review and discharge planning. Helps identify opportunities for process improvement. Also discusses competencies needed to transition to a value-based reimbursement environment focused on population health.
Author(s): Stroudwater
Date: 08/2019
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Rural Hospital Care Coordination and Population Health Management Summit Report
Materials related to the 2019 Rural Care Coordination and Population Health Management Summit, which focused on the role community care coordination plays in helping healthcare leaders prepare for population health management. Includes a short video of panelist interviews as well as a findings report from the summit and a care management best practices guide.
Date: 08/2019
Type: Website
Sponsoring organization: National Rural Health Resource Center
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Impact of Rural and Urban Hospital Closures on Inpatient Mortality
Examines the impact of California's hospital closures from 1995-2011 on adjusted inpatient mortality for sepsis, stroke, asthma/chronic obstructive pulmonary disease, and acute myocardial infarction. Features statistics including the number of closures by year, patient demographics with breakdowns by urban or rural location, and differential impacts of rural and urban closures with breakdowns by condition.
Author(s): Kritee Gujral, Anirban Basu
Citation: NBER Working Paper Series, Working Paper 26182
Date: 08/2019
Type: Document
Sponsoring organization: National Bureau of Economic Research
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A Rural Hospital Guide to Improving Chronic Obstructive Pulmonary Disease
A guide for rural hospital leaders, Rural Health Clinics, and their partners to help them understand rural chronic obstructive pulmonary disease (COPD) services and adopt best practices for COPD diagnosis, treatment, and long-term care. Addresses rural COPD prevalence and services, clinical diagnosis and treatment, service models, care management, technologies, and community support services. Includes considerations for implementing a pulmonary rehab program, roles and staffing needed, and basic billing and coding.
Date: 08/2019
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Medicaid: States' Use and Distribution of Supplemental Payments to Hospitals
Examines the use of disproportionate share hospital (DSH) payments, which are given to hospitals with more Medicaid and uninsured patients. Addresses differences in state Medicaid expansion status, uninsured percentage, and uncompensated care in relation to DSH payments. Includes state data on DSH payments and uncompensated care costs by rural/urban hospital location, as well as data on Critical Access Hospital (CAH) and Sole Community Hospital DSH payments by state.
Additional links: Full Report
Date: 07/2019
Type: Document
Sponsoring organization: Government Accountability Office
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MedPAC Data Book: Health Care Spending and the Medicare Program, 2019
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural to urban throughout. Chart 6-1 addresses rural hospital closures.
Date: 06/2019
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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The Role of Hospitals in Population Health: Findings from National Conversations, Statewide Survey and Local Perspectives
Reviews the literature on population health and the role of hospitals and health systems in advancing population health. Discusses efforts by hospitals to address population health at a national level based on interviews with key informants, and in Kansas based on an online survey and discussions with hospitals. Offers recommendations for organizations interested in engaging with population health efforts.
Additional links: Executive Summary
Author(s): Tatiana Y. Lin, Carlie Houchen
Date: 06/2019
Type: Document
Sponsoring organization: Kansas Health Institute
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Results from 2016 Tax-Exempt Hospitals' Schedule H Community Benefit Reports
Summarizes the benefits nonprofit hospitals provide their communities based on an analysis of IRS Form 990 Schedule H. Addresses the percent spent on financial assistance, health professions education, community building activities, and other categories included on Schedule H, with breakdowns for rural and Critical Access Hospitals.
Date: 05/2019
Type: Document
Sponsoring organization: American Hospital Association
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Strategy Map and BSC Learning Collaborative Recordings
Offers a series of 5 webinar recordings with rural hospitals and experts on how to use the included templates to create a Balanced Scorecard and Strategy Map. Addresses best practices on demonstrating value, developing metrics to drive performance, using self-assessment results for strategic planning, and more.
Date: 05/2019
Type: Video/Multimedia
Sponsoring organization: National Rural Health Resource Center
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Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
Findings brief describing the geographic variation in the 2019 Centers for Medicare and Medicaid Services (CMS) hospital wage index by rural and urban definitions. Includes data comparisons for rural and urban definitions by Census region, frontier and remote (FAR) codes, and state.
Author(s): Kristie W. Thompson, Ann Howard, George H. Pink
Date: 05/2019
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals
Findings brief describing and comparing rural and urban hospitals by Medicare payment classification, amount of patient revenue, and number of beds. Features statistics with breakdowns by urban and rural locations.
Author(s): George H. Pink, Kristie W. Thompson, H. Ann Howard
Date: 05/2019
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Trends in Risk of Financial Distress among Rural Hospitals from 2015 to 2019
Details the proportion of rural hospitals, including Critical Access Hospitals (CAHs), at high risk of financial distress by Census region and Centers for Medicare & Medicaid Services (CMS) reimbursement type from 2015 to 2019.
Author(s): Sharita R. Thomas, George H. Pink, Kristin Reiter
Date: 04/2019
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Characteristics of Communities Served by Rural Hospitals Predicted to be at High Risk of Financial Distress in 2019
Uses updated results from the Financial Distress Index to compare communities that are home to rural hospitals at high financial risk with areas having rural hospitals not at high risk. Features statistics including demographics, socioeconomics, and health status, with breakdowns by location in the South, the Midwest, the Northeast, and the West.
Author(s): Sharita R. Thomas, George H. Pink, Kristin Reiter
Date: 04/2019
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Geographic Variation in the 2019 Risk of Financial Distress among Rural Hospitals
Uses updated results from the Financial Distress Index to show geographic variation in rural hospitals at risk of financial distress and possible closure or reduction of services. Features statistics showing percentage of rural hospitals in each risk category in 2019 by census region, and a state-level map showing number and percentage of rural hospitals at high risk.
Author(s): Sharita R. Thomas, George H. Pink, Kristin Reiter
Date: 04/2019
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Facility-Based Ambulatory Care Provided to Rural Medicare Beneficiaries in 2014
Chartbook describing claims, costs, and common diagnoses in facility-based ambulatory care provided to rural Medicare patients. Features statistics in various categories with breakdowns by Federally Qualified Health Centers in rural and urban areas, Rural Health Clinics, Critical Access Hospitals, and Prospective Payment Systems in rural and urban areas.
Author(s): Alex R. Schulte, Denise A. Kirk, Kristie W. Thompson, George H. Pink
Date: 03/2019
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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MedPAC Report to the Congress: Medicare Payment Policy: Hospital Inpatient and Outpatient Services: Chapter 3
Examines the adequacy of Medicare payments to hospitals and offers recommendations for changes. Includes a discussion of rural hospital closures and provides rural/urban breakdowns for hospital occupancy rates, Medicare inpatient discharges, and Medicare margins.
Date: 03/2019
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress on Medicaid and CHIP, March 2019
Reports on three aspects of Medicaid: improving the structure of Disproportionate Share Hospital (DSH) payment reductions, oversight of upper payment limits for supplemental payments to hospitals, and Disproportionate Share Hospital (DSH) payments to states. Chapter 3 includes the annual report on DSH payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Table 3-1 identifies DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2019
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Hospital-Based Incident Command Systems: Small and Rural Hospitals
Provides slides and additional links from a webinar featuring case studies of how rural, Indian Health Service, and Critical Access Hospitals responded to emergencies and used Incident Command Systems in Tennessee, Nebraska, Texas, South Dakota, Georgia, and Utah. Features training examples and actual situations - shooting incidents, school bus accidents, water contamination, and more - addressing challenges faced and lessons learned.
Date: 03/2019
Type: Presentation Slides
Sponsoring organization: Office of the Assistant Secretary for Preparedness and Response
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State Support to Rural Hospitals Fact Sheet
Overview of the Small Rural Hospital Improvement Program (SHIP) and the Medicare Rural Hospital Flexibility (Flex) program supporting rural hospitals and Critical Access Hospitals. Highlights with data the impact of these programs on a national level.
Date: 02/2019
Type: Document
Sponsoring organization: Health Resources and Services Administration
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Do Hospital Closures Affect Patient Time in an Ambulance?
Examines the impact of hospital closures on patient travel time to an emergency department (ED) by ambulance. Uses national data on hospital closures and hospital-based ambulance services and compares rural/urban differences.
Author(s): SuZanne Troske, Alison Davis
Date: 02/2019
Type: Document
Sponsoring organization: Rural and Underserved Health Research Center
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How Rural Hospitals Improve Value and Affordability
Issue brief discussing four strategies rural hospitals are undertaking to improve the quality of care and patient experience, while decreasing the cost of healthcare services. Covers strategies on population health, new models of care, telehealth, and workforce programs. Includes multiple case studies and rural program examples for each strategy.
Date: 02/2019
Type: Document
Sponsoring organization: American Hospital Association
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Rural Health Research Recap: Quality of Care in Rural Hospitals
Describes methods used to collect data on rural hospital care quality and offers findings comparing quality in rural and urban hospitals. Features statistics on CMS star quality ratings in 2017, with breakdowns by rural and urban locations.
Author(s): Shawnda Schroeder
Date: 01/2019
Type: Document
Sponsoring organization: Rural Health Research Gateway
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NHA Human Trafficking Toolkit
Resources and information to help hospitals and hospital staff address human trafficking. Includes information on screening and assessment, patient care tips, examples of posters and other awareness materials, and examples of policies and procedures. Lists Nebraska programs that can help adults and minors impacted by trafficking.
Date: 2019
Type: Document
Sponsoring organization: Nebraska Hospital Association
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Technical Assistance for Hospitals Applying to the Pennsylvania Rural Health Model — A CMMI-Sponsored Rural Hospital Global Budget Model
Describes the experiences of the Rural Health Value program in coaching hospitals in Pennsylvania that were interested in participating in a global budget model. Explains a process to quickly develop a plan focused on community health rather than exclusively on clinical services, to facilitate the transition from volume to value.
Date: 2019
Type: Document
Sponsoring organization: Rural Health Value
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The Rural Hospital and Health System Affiliation Landscape - A Brief Review
Describes choices available to rural hospitals and health systems when considering affiliations with urban-based hospitals, examines motivations for these affiliations, and presents a list of some affiliation structures with examples. Features statistics showing trends in hospital system affiliation by census region from 2007-2016, with breakdowns by metropolitan and nonmetropolitan hospitals and nonmetropolitan Critical Access Hospitals.
Author(s): Onyinye Oyeka, Fred Ullrich, A. Clinton MacKinney, Joseph Lupica, Keith J. Mueller
Date: 11/2018
Type: Document
Sponsoring organization: Rural Policy Research Institute
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Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments
Reports on 41 examinations of wage data of individual acute care hospitals from 2004 to 2017 to describe significant vulnerabilities observed in the wage index system for Medicare payments. Includes discussion on the rural floor wage index and the effects it has on wage index accuracy. Offers recommendations to reform the hospital wage index system.
Date: 11/2018
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Trends in Hospital System Affiliation, 2007-2016
Policy brief reporting trends in hospital system affiliation from 2007 to 2016 for hospitals in metro and nonmetro areas, and Critical Access Hospitals (CAHs). Offers characteristic statistics by hospital type and affiliation and highlights trends in hospital system affiliation by Census region.
Author(s): Onyinye Oyeka, Fred Ullrich, Keith Mueller
Date: 10/2018
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Report to Congress: Rural Community Hospital Demonstration
Summarizes findings from the Rural Community Hospital Demonstration (RCHD) over the twelve years authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the Affordable Care Act (ACA). Reports on the characteristics of the participating hospitals and the effect of the demonstration on hospital finances and other outcomes. Also discusses steps the hospitals expected to take at the end of the demonstration, if it had not been extended for an additional five years by the 21st Century Cures Act of 2016.
Date: 10/2018
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Factors Affecting the Development of Medicaid Hospital Payment Policies: Findings from Structured Interviews in Five States
Study examining Medicaid hospital payment policies with a focus on factors affecting payment mix and structure, the impact of state policies and financing methods, how states target hospital services or types such as rural hospitals, barriers to and drivers of change to payment methods, and more. Focuses on five states that made or are making significant hospital policy changes: Arizona, Louisiana, Michigan, Mississippi, and Virginia. Appendix B includes state profiles.
Author(s): Thomas Marks, Kathy Gifford, Steven Perlin, Melisa Byrd, Timothy Beger
Date: 10/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Chart Book: The Far-Reaching Benefits of the Affordable Care Act's Medicaid Expansion
Compares states that expanded Medicaid coverage and those that did not expand Medicaid coverage using a variety of measures such as healthcare access and health outcomes. Addresses the impact on rural hospitals on pages 19-21 for Medicaid revenue, operating margins, and uncompensated care.
Date: 10/2018
Type: Document
Sponsoring organization: Center on Budget and Policy Priorities
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Ensuring Access to Quality Health Care in Vulnerable Communities
Highlights the health characteristics and conditions of vulnerable populations in rural and urban communities, and the essential healthcare services as identified by the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities. Discusses several strategies recommended by the task force to address social determinants of health, enhance virtual care services to reform healthcare delivery and payment methods, and support hospitals in their efforts to provide the needed health services.
Author(s): Jay Bhatt, Priya Bathija
Citation: Academic Medicine, 93(9), 1271-1275
Date: 09/2018
Type: Document
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Rural Hospital Closures: Number and Characteristics of Affected Hospitals and Contributing Factors
Examines rural hospital closures from 2013-2017, including their financial health, hospital characteristics, and the impact on healthcare access. Compares data to 2008-2012 closures and discusses the implications for federal healthcare policies. Addresses the role of Medicare rural hospital designations, new healthcare delivery and payment models, and other rural Health and Human Services (HHS) programs. Identifies the number of rural hospitals that closed for each state.
Additional links: Full Report
Date: 09/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Hospital Mergers and Public Accountability: Tennessee and Virginia Employ a Certificate of Public Advantage
Examines how state officials can use the certificate of public advantage (COPA) to supervise hospital mergers to benefit the public, particularly in rural areas where mergers may be sought to address financial challenges. Focuses on a case study where officials in Tennessee and Virginia developed COPAs in response to a proposed rural hospital merger affecting both their states. Addresses the role of the states, their processes, and policy implications for other states.
Author(s): Erin C. Fuse Brown
Date: 09/2018
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Rural Hospital Mergers from 2005 through 2016
Examines the number of mergers of rural hospitals across the U.S. from 2005-2016. Looks at the effect of mergers and acquisitions on rural healthcare.
Author(s): Dunc Williams Jr., Sharita R. Thomas, Hilda A. Howard, George H. Pink
Date: 08/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural Hospitals and Medicaid Payment Policy
Describes how rural hospitals serve Medicaid beneficiaries and the process through which Medicaid programs pay rural hospitals. Features statistics from 2015 with breakdowns by urban hospitals, Critical Access Hospitals (CAHs), and other rural hospitals.
Date: 08/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Emerging Strategies to Ensure Access to Health Care Services: Rural Hospital-Health Clinic Integration
Provides an overview of the benefits of sharing resources between rural hospitals and clinics, including Federally Qualified Health Centers. Offers suggestions for federal policy solutions and actions for hospital and health system to deploy.
Date: 08/2018
Type: Document
Sponsoring organization: American Hospital Association
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Availability of Respiratory Care Services in Critical Access and Rural Hospitals
Policy brief describing availability of respiratory therapy and therapists in Critical Access Hospitals and in urban and rural Prospective Payment System hospitals. Includes statistics with breakdowns by hospital type and rural or urban location.
Author(s): Michelle Casey, Alex Evenson, Ira Moscovice, Zhengtian Wu
Date: 06/2018
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
Findings brief describing how uncompensated hospital care varies across regions of the country, using data from the 2014-2016 Medicare Cost Report Worksheet S-10. Features statistics including breakdowns by Critical Access Hospitals, other rural hospitals, and urban hospitals.
Author(s): Krystal G. Garcia, Kristie Thompson, Hilda A. Howard, George H. Pink
Date: 06/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural Hospital Transitional Care Program Reduces Medicare Spending
Evaluates the impact of a weekly transitional care intervention, conducted by phone for recently discharged patients, on service use and spending among Medicare fee-for-service beneficiaries at a community-based hospital in rural Worcester County, Maryland.
Author(s): Keith Kranker, Linda M. Barterian, Rumin Sarwar, et al.
Citation: American Journal of Managed Care, 24(5), 256-260
Date: 05/2018
Type: Document
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MAP 2018: Recommendations for a Core Set of Rural-Relevant Measures for Hospitals and Selected Ambulatory Care Settings and Measuring and Improving Access to Care
Describes selection criteria and processes used to create a draft core set of measures, lists the measures, and describes measurement gap areas identified by the Measures Applications Partnership (MAP) Rural Health Workgroup, a public-private partnership of healthcare stakeholders. Second in a series of 3 reports documenting the Workgroup's continuing efforts.
Date: 05/2018
Type: Document
Sponsoring organization: National Quality Forum MAP Rural Health Workgroup
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Toward Hospital Global Budgeting: State Considerations
Overview of hospital global budgeting, using case studies from Maryland, Pennsylvania, and Vermont. Explores ways in which global budgets can offer some financial stability for rural hospitals.
Author(s): Robert Murray
Date: 05/2018
Type: Document
Sponsoring organization: State Health & Value Strategies
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Market Characteristics Associated with Rural Hospitals' Provision of Post-Acute Care
Findings brief summarizing hospital- and market-level factors related to post-acute care (PAC) provided in rural hospitals from 2012-2015. Features statistics from 2012-2015 rural Medicare cost reports, PAC provision by census region in 2015, and percent of hospitals in frontier and remote areas in 2015 with breakdowns by type and PAC provision.
Author(s): Abby F. Hoffman, Randy K. Randolph, Alex R. Schulte, George H. Pink
Date: 04/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural and Urban Provider Market Share of Inpatient Post-Acute Care Services Provided to Rural Medicare Beneficiaries
Findings brief examining rural patients' access to rehabilitation and skilled nursing care, using claims data from January 2013 through March 2014. Features statistics including numbers of patient days and discharges and average length of stay, with breakdowns by type and location of facility and type of care.
Author(s): Alex R. Schulte, Denise A. Kirk, Randy K. Randolph, George H. Pink
Date: 04/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Hospitals and Health Systems Ensuring Access in Their Communities: A Compendium of Case Examples
Identifies 9 primary strategies used by hospitals to increase access to healthcare services in rural and urban areas and offers examples of each. Covers virtual care options such as telehealth, emergency and urgent care models such as freestanding emergency departments (EDs), rural hospital networks, partnerships with Indian Health Service providers, and strategies to address social determinants of health.
Date: 02/2018
Type: Document
Sponsoring organization: American Hospital Association
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The Role of Rural Hospitals in Addressing Opioid and Other Substance Use Problems
Provides slides from the January 2018 Small Rural Hospital Transition HELP Webinar on strategies for rural hospitals to engage in opioid and substance use issues. Addresses drivers of substance use disorders, barriers to treatment, prevention strategies, community coalitions, and more. Includes program examples for prevention, screening, and treatment.
Author(s): John Gale
Date: 01/2018
Type: Presentation Slides
Sponsoring organization: Maine Rural Health Research Center
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Cybersecurity Toolkit for Rural Hospitals and Clinics
Describes 4 steps to help rural clinics and hospitals develop and maintain cybersecurity programs: awareness, assessment, implementation and remediation, and education. Includes a list of resources, checklists, and tools appropriate for all users.
Date: 01/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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2018 OPPS Medicare Part B Payment Impact Analysis
Examines how changes to the CY 2018 Medicare Outpatient Prospective Payment System (OPPS) will impact hospitals' net Part B payments. Discusses the payment reduction for drugs purchased through the 340B Program and how the reduction will affect rural and urban hospitals. Includes a state-by-state analysis of aggregate impacts.
Additional links: Full Report
Date: 01/2018
Type: Document
Sponsoring organization: Avalere
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Rural Hospital Closures
Webinar recording discusses rural hospital closures across the U.S. Details the various causes of closures and the effect this has on healthcare access in rural communities, as well as possible solutions for preventing rural hospital closures. Features presentations from representatives of the NC Rural Health Research Program, the Episcopal Health Foundation, and the A&M Rural and Community Health Institute.
Additional links: Audio Recording, PowerPoint Handout, Webinar Transcript
Date: 01/2018
Type: Video/Multimedia
Sponsoring organization: Rural Health Information Hub
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Optimizing Rural Health: A Community Healthcare Blueprint
Provides three in-depth case studies of rural Texas communities facing hospital closures to learn more about how communities respond, discussing the findings and similarities. Identifies lessons learned in regards to community awareness, community engagement, how access is defined, hospital board leadership, and finances to guide other rural communities facing similar challenges.
Date: 2018
Type: Document
Sponsoring organizations: A&M Rural and Community Health Institute, Center for Optimizing Rural Health
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An Empirical Study of the Determinants of Location of Hospital Mergers and Acquisitions: 1997-2016
Examines trends in hospital mergers and acquisitions based on acquirer ownership status, whether the merger or acquisition was out-of-state, and whether the hospital acquired was rural. Discusses areas for future research based on the findings.
Author(s): David R. Williams, Trent J. Spaulding
Citation: Journal of Health Care Finance, 45(1), 1-20
Date: 2018
Type: Document
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Rural Health Research Recap: Effects of Rural Hospital Closures
Summarizes key findings from the Rural Health Research Centers' most recent research on the effects of rural hospital closures. Examines rural hospital closures and conversions, payment models, the loss of obstetric services, and more. Provides links to each of the referenced source documents.
Date: 12/2017
Type: Document
Sponsoring organization: Rural Health Research Gateway
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Rural Health Research Recap: Rural Hospital Closures
Summarizes key findings from the Rural Health Research Centers' most recent research on rural hospital closures. Discusses hospitals by U.S. census region, rural hospital closures between 2005 and 2017, urban and rural hospital profitability, and the financial distress index. Provides links to each of the referenced source documents.
Date: 12/2017
Type: Document
Sponsoring organization: Rural Health Research Gateway
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Using Hospital Community Benefits to Improve Access to Oral Health Care
Explains how nonprofit hospitals can use targeted oral health programs to fulfill their community benefit obligations, while also improving oral health in the communities they serve. Provides guidance on how to effectively advocate for such programs, and shares tips for assessing community needs.
Author(s): Cheryl Fish-Parcham
Date: 12/2017
Type: Document
Sponsoring organization: Families USA
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Characteristics of Communities Served by Hospitals at High Risk of Financial Distress
Study compares communities served by rural hospitals that have a high risk of financial distress with those that do not. Looks at community demographics, socio-economics, and health status.
Author(s): Erica L. Richman, George H. Pink
Date: 12/2017
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Worsening Rural-Urban Gap in Hospital Mortality
Results of a study of nonmaternal, nonneonatal hospitalizations in 2008 and 2013, showing the association between rural or urban residence and hospital mortality. Features statistics including hospital mortality by condition in 2013 and hospital deaths among rural patients by year and payer status.
Author(s): Nicole Villapiano, Theodore J. Iwashyna, Matthew M. Davis
Citation: Journal of the American Board of Family Medicine, 30(6), 816-823
Date: 11/2017
Type: Document
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Emerging Strategies to Ensure Access to Health Care Services: Emergency Medical Center
Provides an overview of the emergency medical center (EMC) model, which would allow struggling hospitals to convert to EMC status and provide emergency and outpatient services, without having to provide inpatient acute care services. Also outlines rural-specific federal policy proposals that seek to create similar hospital designations, with the goal of improving access to and the delivery of care in underserved communities.
Date: 11/2017
Type: Document
Sponsoring organization: American Hospital Association
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Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
Provides information concerning the potential effects of Medicaid Disproportionate Share Hospital (DSH) payment on rural hospitals in 47 states. Features statistics on hospital Medicaid DSH payments by state and census region, with breakdowns for urban, rural, and Critical Access Hospitals.
Author(s): Erin M. Mobley, Fred Ullrich, Keith J. Mueller
Date: 11/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Ensuring Access with a Hospital's Conversion to a Freestanding Emergency Department
Outlines Ellijay, Georgia-based North Georgia Medical Center's transition from a traditional community hospital to a freestanding emergency department (ED). Shares administrative, legal, and logistical challenges that, once overcome, resulted in Piedmont Mountainside Hospital Emergency Services - a successful, community-focused, freestanding ED.
Date: 11/2017
Type: Document
Sponsoring organization: American Hospital Association Rural Health Services
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Social Determinants of Health Series: Transportation and the Role of Hospitals
Presents a report on the role of hospitals in providing health-based transportation services. Features case studies of 4 different hospital programs' approach to addressing their patients' lack of access to reliable transit.
Date: 11/2017
Type: Document
Sponsoring organization: American Hospital Association
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Differences in Community Characteristics of Sole Community Hospitals
Findings brief presenting a snapshot of Sole Community Hospitals (SCHs) and their communities in 2015, and identifying trends in characteristics of selected SCHs and their communities from 2006 through 2015. Features statistics including breakdowns by large rural, small rural, and isolated rural location.
Author(s): Sharita R. Thomas, Mark Holmes, George H. Pink
Date: 11/2017
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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The Effects of Multiple Chronic Conditions on Adult Patient Readmissions and Hospital Finances
Reports on a study of the financial impact of patients hospitalized with multiple chronic conditions on a regional hospital serving rural Virginia. Focuses on total margin per admission, readmission rates, and the number of clinical conditions per patient. Identifies differences in hospital margin for patients with different chronic conditions, such as chronic obstructive pulmonary disorder (COPD). Discusses the potential return on investment for preventing admissions and readmissions.
Author(s): Michael Mihailoff, Shreyasi Deb, James A. Lee, Joanne Lynn
Citation: Inquiry, 54, 1-6
Date: 09/2017
Type: Document
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Hospital-Community Partnerships to Build a Culture of Health: A Compendium of Case Studies
Presents insights from nine communities across the U.S. that have successful hospital-community partnerships. Each case study provides a description of the community, background information on the partner organizations, and an overview of the impacts and lessons learned. Several case studies include rural communities, rural populations, and/or rural partner organizations.
Date: 08/2017
Type: Document
Sponsoring organization: Health Research & Educational Trust
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Housing and the Role of Hospitals
Provides an overview of the role of housing in health, and discusses what hospitals can can do to address housing instability as a social determinant of health. Offers five case studies of innovative hospital and health system programs related to housing, including a rural California program that provides safe transitional housing to chronically homeless patients after discharge from the hospital.
Date: 08/2017
Type: Document
Sponsoring organizations: American Hospital Association, Health Research & Educational Trust
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The Economic Impacts of 26-50 Bed Prospective Pay System (PPS) Hospitals and 51-100 Bed PPS Hospitals on the Local Economies
Estimates the economic impact of different size rural Prospective Payment System (PPS) hospitals on their communities. Uses a sample of 347 rural hospitals from 41 states. Discusses direct impacts, such as employee wages and benefits, as well as secondary benefits such as construction activity and retail spending.
Author(s): Fred C. Eilrich, Cheryl F. St. Clair, Gerald A. Doeksen
Date: 07/2017
Type: Document
Sponsoring organization: National Center for Rural Health Works
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The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
Findings brief describing variation in the number of hospitals in rural areas providing Medicare post-acute care (PAC) and hospice care, average amount of revenue generated for these services, and financial importance to rural hospitals. Includes statistics on 2015 Medicare PAC and hospice care revenue as percentage of patient revenue in 1,205 Critical Access Hospitals and 964 Prospective Payment System hospitals.
Author(s): Alex Schulte, H. Ann Howard, George H. Pink
Date: 07/2017
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars Is the Problem
Examines the characteristics of rural hospitals with and without quality star ratings, and explains how the current methodology disproportionately affects rural hospitals. Makes recommendations for improving the utility of the Hospital Quality Star Rating system, especially for the purpose of comparing quality among rural hospitals or between rural and urban hospitals.
Author(s): Kristie W. Thompson, Randy K. Randolph, Kristin L. Reiter, George H. Pink, G. Mark Holmes
Date: 06/2017
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
Describes ways for rural communities to develop optimal healthcare delivery systems after a local hospital closure. Features 3 case studies from Arizona, Michigan, and Illinois. Includes tables showing options currently available under federal and state laws, and policies under consideration.
Author(s): Keith J. Mueller, Charlie Alfero, Andrew F. Coburn, et al.
Date: 06/2017
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Identifying Adverse Drug Events in Rural Hospitals: An Eight-State Study
Analyzes adverse drug events (ADEs), or events involving patient injury resulting from medication use, and identifies ways to improve medication safety in rural hospitals. Uses 2013 data from 8 states with significant rural populations, and examines ADE rates based on hospital characteristics and across 4 main categories: steroids, antibiotics, opiates/narcotics, and anticoagulants. Companion brief lists resources that can be used to reduce and prevent ADEs in rural hospitals, including rural prospective payment system (PPS) hospitals and Critical Access Hospitals (CAHs).
Additional links: Resources to Reduce Adverse Drug Events in Rural Hospitals
Author(s): Michelle Casey, Peiyin Hung, Emma Distel, Shailendra Prasad
Date: 05/2017
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Community-Based Health Needs Assessment Activities: Opportunities for Collaboration Between Public Health Departments and Rural Hospitals
Describes how and why rural areas have conducted health needs assessments, and explores opportunities and barriers to collaborative projects attempted by local public health departments and rural hospitals. Also provides recommendations for State Offices of Rural Health and state health officials, as they encourage local-level public health departments and rural hospitals to complete joint assessments.
Date: 05/2017
Type: Document
Sponsoring organization: Association of State and Territorial Health Officials
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Strategies for Superbugs: Antibiotic Stewardship for Rural Hospitals
Discusses the need for antibiotic stewardship (AS) and challenges rural hospitals face in implementing AS programs. Highlights efforts underway for a group of hospitals in Utah and at Critical Access Hospitals in Idaho and Utah.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 03/2017
Type: Document
Sponsoring organization: Rural Health Information Hub
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Obstetric Care Quality and Access for Rural U.S. Women
Webinar recording presenting information gathered from recent studies of obstetric care in rural hospitals, including quality, workforce, and predictors of non-local childbirth. Overarching themes include the discussion of access to obstetric care for women in rural communities and whether rural hospitals can provide it. Presented by Katy Kozhimannil, University of Minnesota School of Public Health/Director of Research at the U of M Rural Health Research Center. Approximately 60 minutes.
Additional links: Presentation Slides, Transcript
Author(s): Katy Kozhimannil
Date: 01/2017
Type: Video/Multimedia
Sponsoring organizations: Rural Health Research Gateway, University of Minnesota Rural Health Research Center
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Improving Community Health through Hospital Community Benefit Spending: Charting a Path to Reform
Provides background on the origin and importance of nonprofit hospital community benefit spending, and explains the difference between community building and community benefit activities. Examines policy options that the IRS could use to enhance community benefit spending focused on improving social determinants of health community-wide. Includes rural-specific statistics and multiple comparisons of items identified in community health needs assessments (CHNAs).
Author(s): Sara Rosenbaum, Maureen Byrnes, Sara Rothenberg, Rachel Gunsalus
Date: 12/2016
Type: Document
Sponsoring organizations: George Washington University Department of Health Policy and Management, Milken Institute School of Public Health
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Comparing the Community Benefit Spending of Critical Access, Other Rural, and Urban Hospitals
Examines the levels and types of community benefit spending by Critical Access, rural, and urban hospitals. Compares the spending by percentage of total expenses, as well as by category, direct patient care versus community-building activities.
Author(s): John Gale, Zach Croll, Andrew Coburn, Jamar Croom
Date: 11/2016
Type: Document
Sponsoring organization: Flex Monitoring Team
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Freestanding Emergency Departments: An Alternative Model for Rural Communities
Describes the freestanding emergency department (FSED) model as an option for rural communities that can no longer support inpatient services. Looks at both hospital-based and independent FSEDs, examines financial viability of the model, and features rural FSEDs in Illinois and Arizona.
Author(s): Jenn Lukens
Citation: Rural Monitor
Date: 11/2016
Type: Document
Sponsoring organization: Rural Health Information Hub
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The Financial Importance of the Sole Community Hospital Payment Designation
Investigates the economic importance of the Sole Community Hospital (SCH) program by reviewing data between 2006 and 2015 regarding the proportion of SCHs reimbursed at the hospital-specific rate, and their profitability of providing services to Medicare patients. Also, discusses the economic consequences that would occur if the SCH program was not in operation in 2015.
Author(s): Sharita R. Thomas, Randy Randolph, G. Mark Holmes, George H. Pink
Date: 11/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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State Office of Rural Health Roadmap for Working with Vulnerable Hospitals
Toolkit designed to assist State Offices of Rural Health (SORHs) when working with vulnerable hospitals and communities. Outlines the types of technical assistance (TA) that SORHs may provide before and after hospital closures and includes resources to help SORHs facilitate that assistance. Provides a self-assessment to help SORHs determine their capacity and select the appropriate levels of TA, as well as sample Critical Access Hospital needs assessments and benchmarking reports.
Date: 10/2016
Type: Document
Sponsoring organization: National Organization of State Offices of Rural Health
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The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals
Compares rural low volume hospitals (LVH) with non-LVH (Inpatient Prospective Payment System) hospitals. Discusses the financial impact of removing the LVH program and returning to the 2005 LVH classification and payment adjustment, and the effect this will have on Medicare beneficiaries.
Author(s): Rebecca G. Whitaker, G. Mark Holmes, George H. Pink
Date: 10/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural Hospital Participation and Performance in Value-based Purchasing and Other Delivery System Reform Initiatives
Reports on the participation of delivery system reform initiatives by rural hospitals, and discusses the supporting factors and challenges for successful participation. Includes data comparing rural and urban Hospital Value-Based Payment (HVBP) performance.
Author(s): Karen E. Joynt, Nguyen Nguyen, Lok Wong Samson, et al.
Date: 10/2016
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Medicaid Expansion Affects Rural and Urban Hospitals Differently
Examines the impact of Medicaid expansion on urban and rural hospitals. Details specific effects of Medicaid expansion on Medicaid-covered hospital discharges, costs of uncompensated care, and operating margins. Provides policy recommendations regarding uncompensated care and Medicaid disproportionate share hospital (DSH) payments.
Author(s): Brystana G. Kaufman, Kristin L. Reiter, George H. Pink, George M. Holmes
Citation: Health Affairs, 35(9), 1665-1672
Date: 09/2016
Type: Document
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Variation in the Rate of Cesarean Section Across U.S. Hospitals, 2013
Provides data on the rate of total and low-risk C-sections across U.S. hospitals in 2013, looking at variations in C-section rates by hospital characteristics. Figure 3 provides data for metropolitan, micropolitan, and rural hospitals.
Author(s): Kamila Mistry, Kathryn R. Fingar, Anne Elixhauser
Date: 09/2016
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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Network Board Development Guide
Designed to assist rural health networks in their efforts to establish, maintain, and improve the effectiveness of their board of directors. Offers suggestions in the areas of improving governance, member recruitment, meeting management, ethics, and legal requirements.
Date: 09/2016
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
Examines factors associated with obstetric unit closure based on a mixed methods study of rural hospitals in 9 states between 2010 and 2014. Addresses hospital characteristics such as accreditation, ownership, and Critical Access Hospital status; distance to next closest hospital with obstetric services; and county-level characteristics including health workforce supply.
Author(s): Peiyin Hung, Katy B. Kozhimannil, Michelle M. Casey, Ira S. Moscovice
Citation: Health Services Research, 51(4), 1546-1560
Date: 08/2016
Type: Document
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2016 Financial Leadership Summit Report: Strategies for Rural Hospitals Transitioning to Value-based Purchasing and Population Health
Provides rural hospital administrators strategies for meeting the challenges of a changing healthcare environment. Includes discussion on alternative payment models, the impact of market forces, successful examples. and lessons learned. Offers information for developing tools to support hospitals and networks as they transition to value-based purchasing and population health. Includes a webinar and report.
Additional links: Webinar Playback: Rural Strategies for Transitioning to Value-based Purchasing and Population Health, Webinar Slides: Rural Strategies for Transitioning to Value-based Purchasing and Population Health
Author(s): Mark Chustz
Date: 07/2016
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Engaging Your Board and Community in Value-Based Care Conversations
Provides starting points for healthcare organizations to engage in value-based care conversations with their board and community members to support strategic planning and informed decision-making.
Date: 05/2016
Type: Document
Sponsoring organization: Rural Health Value
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Prediction of Financial Distress among Rural Hospitals
Explains the concept of the Financial Distress Index (FDI), which seeks to predict and analyze financial distress among rural hospitals. Examines the predictive ability of the FDI by scoring rural hospitals using financial data from previous years' cost reports.
Author(s): Brystana Kaufman, George Pink, Mark Holmes
Date: 01/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Estimated Costs of Rural Freestanding Emergency Departments
Provides an overview of the rural freestanding emergency department (RFED) model as a feasible alternative for hospitals at risk of closure, or preparing for closure, to keep emergency services within the rural community.
Author(s): J. Dunc Williams, Paula H. Song, George H. Pink
Date: 11/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
Evaluates the rural-urban differences in the proportion of hospitals that receive penalties under the Centers for Medicare & Medicaid Services (CMS) Readmission Reduction Program, and compares the specific health condition risk-adjusted readmission rates by rural and urban location. Analyzes characteristics of hospitals receiving readmission penalties.
Author(s): Peiyin Hung, Michelle Casey, Ira Moscovice
Date: 10/2015
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Small Rural Hospital Transition (SRHT) Project Guide: A Rural Hospital Guide to Improving Care Management
Helps hospital management teams recognize best practices associated with care management and other opportunities for performance improvement to support quality of care. Includes information regarding care management roles and staffing needs with a focus on the discharge planning process. Serves as a resource for State Offices of Rural Health directors and Flex Program coordinators to help rural hospitals with transition efforts in developing training programs that will support performance improvement.
Author(s): Stroudwater
Date: 10/2015
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Hospital Value-based Purchasing: Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of-Care Trends
Evaluates the initial effects of the Hospital Value-based Purchasing (HVBP) program on Medicare bonus payments and penalties, the quality of care provided, and selected quality improvement efforts during FY 2013-15. Analyzes data from safety net, small urban, and small rural hospitals.
Additional links: Full Report
Date: 10/2015
Type: Document
Sponsoring organization: Government Accountability Office
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Small Rural Hospital Transition (SRHT) Project Guide: A Guide for Rural Hospitals to Identify Populations and Shift to Population Health
Helps hospital management teams recognize specific patient populations associated with a higher percentage of total healthcare expenditures and helps hospitals focus their programs on these population groups to improve quality of care, healthcare outcomes, and reduce healthcare costs. Serves as a resource for State Offices of Rural Health directors and Flex Program coordinators to help rural hospitals with transition efforts to value-based payment models.
Author(s): Stroudwater Associates
Date: 09/2015
Type: Document
Sponsoring organization: National Rural Health Resource Center
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The Economic Impact of Recent Hospital Closures on Rural Communities
Estimates the direct and secondary economic impacts of recent hospital closures on rural communities, focusing on labor (wages, salaries, benefits) and employment (jobs) income. Uses data collected from 16 hospitals representing 13 states that have closed since 2010, of which 9 were designated as Critical Access Hospitals.
Author(s): Fred C Eilrich, Gerald A. Doeksen, Cheryl F. St. Clair
Date: 07/2015
Type: Document
Sponsoring organization: National Center for Rural Health Works
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Teaching Hospitals: Preparing Tomorrow's Physicians Today
Provides an overview of the value teaching hospitals bring in rural and urban areas, serving as training centers to prepare physicians in clinical settings, provide specialty training and specialty services, engage in research and innovation, and prepare healthcare professionals to adapt to changes in the healthcare environment. Discusses the federal (Medicare and Medicaid) financial support mechanisms teaching hospitals receive and the impact this support has on the increased cost of clinical training of new physicians.
Date: 06/2015
Type: Document
Sponsoring organization: American Hospital Association
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The Business of Rural Hospital Closures
Discusses how rural hospitals can stay viable in difficult times, with insights from Charles Owens, executive director of the Georgia Department of Community Health, State Office of Rural Health.
Author(s): Kate Menzies
Citation: Rural Monitor
Date: 05/2015
Type: Document
Sponsoring organization: Rural Health Information Hub
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A Comparison of Closed Rural Hospitals and Perceived Impact
Compares characteristics of rural hospitals that have closed or have converted to provide a mix of health services but no inpatient care. Measures perceived impact of rural hospital closures.
Author(s): Sharita R. Thomas, Brystana G. Kaufman, Randy K. Randolph, et al.
Date: 04/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Hospital Views of Factors Affecting Telemedicine Use
Discusses the observations of rural and urban hospital representatives, from both hub and spoke locations, regarding the obstacles and the driving forces in the development and expansion of telemedicine services.
Author(s): Kimberly A. S. Merchant, Marcia M. Ward, Keith J. Mueller,
Date: 04/2015
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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The 21st Century Rural Hospital: A Chart Book
Presents an extensive overview of the rural hospital of the 21st century. Discusses how rural hospitals have transformed from a traditional inpatient and emergency department facility to an integrated health system providing a wide variety of services. Contains sections with data about U.S. rural hospitals, the patient population, inpatient and outpatient services and finance.
Author(s): Victoria A. Freeman, Kristie Thompson, H. Ann Howard, Randy Randolph, G. Mark Holmes
Date: 03/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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The Effect of Surgery on the Profitability of Rural Hospitals
Examines the effect of surgery on the profitability of rural hospitals, through analysis of market data from 2000 to 2008.
Author(s): Saleema A. Karim, George M. Holmes, George H. Pink
Citation: The Journal of Health Care Finance, 41(4)
Date: 02/2015
Type: Document
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Variability in General Surgical Procedures in Rural and Urban U.S. Hospital Inpatient Settings
Analyzes rural and urban variations in frequently performed inpatient surgical procedures that could be handled by general surgeons rather than subspecialists.
Author(s): Mark P. Doescher, J. Elizabeth Jackson, Meredith A. Fordyce, Dana C. Lynge
Date: 02/2015
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Successful Health Insurance Outreach, Education, and Enrollment Strategies for Rural Hospitals
Shares best practices for hospitals to use in health insurance outreach and enrollment efforts based on interviews with administrators, staff, and community representatives at 11 small rural hospitals in 9 states. Also discusses certified application counselors, who help individuals enroll in health insurance, and the importance of using collaborative community partnerships to conduct insurance enrollment outreach and education.
Author(s): Walter Gregg, Alex Evenson, Adeniyi Togun
Date: 11/2014
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Community Engagement Toolkit for Rural Hospitals
Designed to help rural hospital administrators leverage their hospital's strengths and resources to engage in a meaningful dialogue about health reform and sustainable community partnerships. Includes several outlines, templates, and recommendations to help leaders assess their facility's current projects and prepare for future efforts.
Date: 10/2014
Type: Document
Sponsoring organization: Washington State Hospital Association
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Rural Hospital Performance Improvement (RHPI) Project: Best Practice Concepts in Revenue Cycle Management
Explains revenue cycle management from patient admission to evaluating measures of success for rural hospitals and offers guidance on best practices. The document is aimed to help hospital business administration improve their revenue cycle performance as well as provide State Offices of Rural Health directors, and Flex program coordinators, a better understanding on the subject so they may develop educational trainings.
Date: 08/2014
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Primer for Rural Health Network Memorandum of Agreement/Understanding
Defines and explains how to develop a Memorandum of Agreement (MOA)/Memorandum of Understanding (MOU) as a formal business document to be used when creating a network of two or more separate groups or organizations.
Date: 2014
Type: Document
Sponsoring organization: National Rural Health Resource Center
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How Hospital Leaders Can Build Good Working Relationships with Physicians
Explores potential barriers to physician engagement. Discusses strategies to help rural hospital leaders build good working relationships with physicians.
Date: 07/2013
Type: Document
Sponsoring organization: Rural Health Value
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Community Health Needs Assessment Toolkit
Designed to help rural hospitals conduct a community health needs assessment, which is a requirement for all 501(c)(3) hospitals.
Author(s): Gerald A. Doeksen, Cheryl F. St. Clair
Date: 05/2012
Type: Document
Sponsoring organizations: National Center for Rural Health Works, Oklahoma Office of Rural Health
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Hospital Readiness for Population-Based Accountable Care
Provides hospital leaders with a snapshot of hospitals' current readiness to participate in an Accountable Care Organization (ACO), as well as a tool with which to gauge their own organizations' relative preparedness for ACO participation. Includes rural throughout report.
Date: 05/2012
Type: Document
Sponsoring organization: Health Research & Educational Trust
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The Use of Hospitalists in Small Rural Hospitals
Describes small rural hospitals' use of hospitalists, who assume responsibility for patient care during inpatient hospital stays. Includes information on how hospitalists are used at these facilities. Discusses impacts on healthcare quality, hospital finances, and recruitment and retention of physicians.
Author(s): Michelle Casey, Ira Moscovice
Date: 04/2012
Type: Document
Sponsoring organization: Upper Midwest Rural Health Research Center
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Why Use Swing Beds? Conversations with Hospital Administrators and Staff
Includes interviews of hospital administrators and staff about the use of swing beds, including Critical Access Hospitals (CAHs). Addresses the role of swing beds in patient care, swing bed volume and financial considerations, swing beds in the context of all community post-acute skilled care, and swing beds as a benefit for community residents.
Author(s): Victoria A. Freeman, Andrea Radford
Date: 04/2012
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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An Interview with John Supplitt
Presents an interview with the senior director of the Section for Small or Rural Hospitals of the American Hospital Association. Discusses challenges facing rural hospitals, including workforce and health information technology issues.
Author(s): Beth Blevins
Citation: Rural Monitor
Date: 02/2011
Type: Document
Sponsoring organization: Rural Health Information Hub
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A Guide to Financing Strategies for Hospitals: With Special Consideration for Smaller Hospitals
Explores seven strategies that help hospitals achieve capital access. Discusses smaller organizations, such as rural hospitals, Critical Access Hospitals, and stand-alone community hospitals.
Date: 12/2010
Type: Document
Sponsoring organization: Health Research & Educational Trust
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Factors Influencing Rural Residents' Utilization of Urban Hospitals
Examines which patient, hospital, and county characteristics influence rural residents' use of urban hospitals.
Author(s): Margaret Jean Hall, Jill Marsteller, Maria Owings
Date: 11/2010
Type: Document
Sponsoring organization: Centers for Disease Control and Prevention
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The Impact of Freestanding Ambulatory Surgery Centers on Rural Community Hospital Performance, 1997–2006
Describes the impact of ambulatory surgery centers (ASCs) on rural hospital markets. Includes a comparison of urban and rural freestanding ASC services.
Additional links: Policy Brief
Author(s): Walter Gregg, Douglas Wholey, Ira Moscovice
Date: 10/2010
Type: Document
Sponsoring organization: Upper Midwest Rural Health Research Center
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Is Your Hospital's Board Prepared to Govern? Rural Acute Care Hospital Boards of Directors: Education and Development Needed
Examines the structural, leadership, and educational needs of rural hospital boards, as viewed by rural hospital board chairs and chief executive officers (CEOs).
Additional links: Fact Sheet
Author(s): Janice C. Probst, Royce Adams, Amy B. Martin
Date: 06/2010
Type: Document
Sponsoring organization: Rural and Minority Health Research Center (formerly the South Carolina Rural Health Research Center)
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Rural Health Update
Newsletter from the American Hospital Association. Shares case studies, resources, legislative and regulatory updates, and funding and training opportunities related to rural healthcare.
Type: Journal/Newsletter
Sponsoring organization: American Hospital Association
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Network Sustainability Toolkit
A resource to help rural leaders develop sustainable healthcare networks with increased long-term impact. Includes access to a network sustainability assessment, a collection of network-focused resources and tools, and case studies of successful rural health networks.
Additional links: An Introduction to RHI's Network Sustainability Toolkit: History and Background
Type: Website
Sponsoring organization: National Rural Health Resource Center
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MiCareMatters: Stories
Collection of articles highlighting the stories of rural Michiganders and their community hospitals.
Type: Website
Sponsoring organization: Michigan Health & Hospital Association
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AHA's Rural Report Podcast Series
Podcast series highlighting rural health challenges and models for addressing those challenges. Based on the 2019 American Hospital Association publication Rural Report: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-Quality, Affordable Care.
Type: Audio
Sponsoring organization: American Hospital Association
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Rural Hospital Closures Since 2010
Provides an interactive map showing hospital closures since 2010. Lists closures by year and Medicare payment type (Critical Access Hospital, Sole Community Hospital, Rural Referral Center, etc.), the number that have closed for each state, and the number that closed each year. Map shows locations of hospital closures and shades states based on whether or not they have adopted Medicaid expansion.
Type: Map/Mapping System
Sponsoring organization: Stroudwater Associates
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Rural Emergency Department Transfer Communication - Resources
Provides resources for rural hospitals working on the Medicare Beneficiary Quality Improvement Project (MBQIP) emergency department (ED) transfer communication measure. Includes a section on developing an action plan, a quality improvement toolkit, a data collection training video and related tools, sample checklists, and more.
Type: Website
Sponsoring organizations: Quality Improvement Organization Program, Stratis Health
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Eligible Hospital / Critical Access Hospital eCQMs
Features updated electronic clinical quality measures (eCQMs) for Hospital Inpatient Quality Reporting (IQR) Program and the Medicare and Medicaid Promoting Interoperability programs for reporting in Eligible Hospitals and Critical Access Hospitals (CAHs).
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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SHIP Hospital Resources
Resources for hospitals related to value-based purchasing, Accountable Care Organizations, and payment bundling. Developed for hospitals participating in the Small Rural Hospital Improvement Grant Program (SHIP).
Type: Website
Sponsoring organization: National Rural Health Resource Center
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FAH Hospital Policy Blog
Shares perspectives on health policy issues affecting America's hospitals and patients. Includes a rural category, offering thoughts on policy issues specific to rural hospitals.
Type: Journal/Newsletter
Sponsoring organization: Federation of American Hospitals
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Scanning the Headlines: Small or Rural Hospitals
Provides a bibliographic list of recently published articles and reports concerning small and rural hospitals.
Type: Literature Search
Sponsoring organization: American Hospital Association
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Hospital Outpatient Regulations and Notices
Lists federal regulations and notices related to the Hospital Outpatient Prospective Payment System (OPPS), including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Acute Inpatient Prospective Payment System (IPPS) Regulations and Notices
Lists federal regulations and notices related to the Acute Inpatient Prospective Payment System (IPPS), including information on annual payment rate updates. Contains copies of proposed and final rules, along with any relevant corrections, as published in the Federal Register.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Stratis Health 2019 MIPS Estimator
Web-based tool allows providers to calculate a composite Merit-based Incentive Payment System (MIPS) score. Presents data submission methods to produce the highest base-line score and enables workflow adjustments to improve patient outcomes.
Type: Tool
Sponsoring organization: Stratis Health
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Compendium of Hospital & Community Partnerships
Outlines a number of innovative partnerships between rural hospitals and community organizations in Nebraska that work to expand local services, improve care quality, and reduce the cost of care in rural communities. Presents partnerships in case study format, sharing key steps, lessons learned, and project results.
Type: Website
Sponsoring organization: Bryan Health
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Hospital Spotlights
Features small rural hospitals from across the country, highlighting how they successfully implemented best practices to improve performance and adopted transition strategies to prepare for population health.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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Rural Hospital Toolkit for Transitioning to Value-based Systems
Toolkit developed to help rural hospitals improve their financial, operational, and quality performance. Shares best practices and strategies to help rural providers transition to value-based payment and population health. A PDF version released in September 2015 is also available.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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AHA Case Studies
A collection of case studies demonstrating community-level innovations and new models of care, payment, and healthcare delivery. Includes rural examples and those focused on serving vulnerable communities.
Type: Website
Sponsoring organization: American Hospital Association
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The Freestanding Emergency Department Financial Assessment Strategic Tool (FED FAST)
Provides a means to evaluate the financial feasibility of transforming a rural hospital into a rural freestanding emergency department (RFED) in high, medium, and low volume settings.
Type: Tool
Sponsoring organization: North Carolina Rural Health Research Program
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CMS State Operations Manual (SOM)
Provides guidance to state agencies that survey healthcare facilities and providers to determine if they are in compliance with the Medicare Conditions of Participation (CoP). Includes appendices with regulatory information specific to Critical Access Hospitals (Appendix W), and Federally Qualified Health Centers/Rural Health Clinics (Appendix G). Can be used by healthcare facilities as a tool to self-evaluate their compliance with Medicare CoP.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Community Hospital Demonstration
An overview of a CMS demonstration project which provides cost-based reimbursement for small rural hospitals too large to be Critical Access Hospitals. Examines the community benefits and financial impact for participating hospitals.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Section 242 Mortgage Insurance Success Stories
Features hospitals, including rural facilities, that have accessed capital through the HUD 242 mortgage insurance program.
Type: Website
Sponsoring organization: U.S. Department of Housing and Urban Development
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Rural Hospital Closures: January 2005 – Present
Interactive map displaying the location of rural hospital closures across the U.S. from January 2005 to present. Provides a sortable, printable list containing important facility information about each closed hospital.
Type: Website
Sponsoring organization: North Carolina Rural Health Research Program
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ICD-10 Toolkit
Provides guidance and assistance to rural healthcare providers in making the transition from ICD-9 to ICD-10. This toolkit is designed to be used in conjunction with any coder or physician training that a rural hospital or clinic may be doing.
Type: Tool
Sponsoring organization: National Rural Health Resource Center
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Medicare Learning Network: Acute Care Hospital Inpatient Prospective Payment System
Provides general information about the Acute Inpatient Prospective Payment System (IPPS), including IPPS payment rates and how IPPS payment rates are set. Includes sections on the Rural Referral Center (RRC) Program and the Sole Community Hospital (SCH) designation.
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Learning Network: Medicare Disproportionate Share Hospital
Provides an overview of the Medicare Disproportionate Share Hospital (DSH) adjustment provision and lists requirements that hospitals must meet in order to qualify for it.
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Resources for Critical Access Hospitals and Small Rural Hospitals
Provides information to meet the health information technology (HIT) needs of Critical Access Hospitals (CAHs) and small, rural hospitals. Covers benefits of HIT, overcoming barriers to HIT adoptions and implementation, and meaningful use resources.
Type: Website
Sponsoring organization: Office of the National Coordinator for Health Information Technology
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AHA Community Connections
Provides access to case studies spotlighting hospitals and health systems (some are in rural areas) that have successfully collaborated with local community organizations to promote care coordination, wellness, and prevention. Website also includes tools and resources to help healthcare facilities be accountable and transparent to their communities and deliver quality care.
Type: Website
Sponsoring organization: American Hospital Association
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Frontier Community Health Integration Project (FCHIP) Demonstration
Describes the Frontier Community Health Integration Project (FCHIP) demonstration including the project purpose, legislation, eligible states, partners, and program contacts.
Type: Website
Sponsoring organization: Rural Health Information Hub
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Economic Impact: Tools and Templates
Access tools and templates for studying the economic impact, in rural areas, of Federally Qualified Health Centers (FQHCs), Critical Access Hospitals, different health care providers, the social service sector, Medicaid, medical schools, and telemedicine.
Type: Website
Sponsoring organization: National Center for Rural Health Works
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Health.mil Rates and Reimbursement: Hospital Classifications
Identifies TRICARE reimbursement methodologies for Sole Community Hospitals (SCH) and Critical Access Hospitals (CAHs). Also lists CAH inpatient and outpatient cost to charge ratios (CCRs).
Type: Website
Sponsoring organization: Military Health System
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Toolkit for Using the AHRQ Quality Indicators
Resource for hospitals planning to use the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs), including the Patient Safety Indicators (PSIs), to track and improve inpatient quality and patient safety. Also serves as a general guide to applying improvement methods in a hospital setting.
Type: Tool
Sponsoring organization: Agency for Healthcare Research and Quality
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American Hospital Association EHRs - Meaningful Use Resources
Provides a listing of electronic health records (EHRs) resources to help hospital leaders better understand the Medicare and Medicaid EHR incentive programs and their associated "meaningful use" requirements.
Type: Website
Sponsoring organization: American Hospital Association
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National Hospital Care Survey (NHCS)
Discusses the National Hospital Care Survey (NHCS). Tracks trends and health care delivery in hospitals, including emergency, outpatient departments, and ambulatory surgery centers.
Type: Website
Sponsoring organization: Centers for Disease Control and Prevention
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Medicare Quarterly Provider Compliance Newsletter
Quarterly newsletter to help healthcare providers to address and avoid common Medicare billing errors and comply appropriately with payment audits.
Type: Journal/Newsletter
Sponsoring organization: Centers for Medicare and Medicaid Services
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PubMed Search: Rural Hospitals
Searches PubMed's collection of journal article citations on the topic of rural hospitals.
Type: Literature Search
Sponsoring organization: U.S. National Library of Medicine
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CMS Medicare Administrative Contractors
Provides information and resources concerning the Part A/Part B Medicare Administrative Contractors (MACs).
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Hospital Compare
Provides information on the quality of care provided by Medicare-certified hospitals. Includes data on patient experiences, timely and effective care, complications and deaths, unplanned hospital visits, use of imaging, and payment and value of care.
Type: Website
Sponsoring organization: U.S. Department of Health and Human Services
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Small or Rural Update Newsletter
Newsletter of the AHA Section on Small or Rural Hospitals targeted to small and rural hospitals. Each newsletter provides information on federal legislative and regulatory activity affecting payment, quality, and access to care.
Type: Journal/Newsletter
Sponsoring organization: American Hospital Association
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HCUPnet
Online tool for accessing Healthcare Cost and Utilization Project data. Provides access to health statistics for hospital inpatient, emergency department, and ambulatory surgery settings. Also provides access to population-based healthcare data by county and for the U.S.-Mexico Border Region. Includes data on diagnoses and procedures, quality indicators, and all stays.
Type: Database
Sponsoring organization: Agency for Healthcare Research and Quality
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AHA Rural Health Services
Information on American Hospital Association (AHA) work related to rural hospitals. Includes reports, case studies, webinars, podcasts, and other resources.
Type: Website
Sponsoring organization: American Hospital Association
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Additional resources are available related to this guide. See the full list of resources by topic for:


Last Updated: 6/5/2020