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Rural Hospitals Resources

Selected recent or important resources focusing on Rural Hospitals.

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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MedPAC Report to the Congress: Physician Supervision Requirements in Critical Access Hospitals and Small Rural Hospitals
Provides background information on Medicare physician supervision requirements, and examines how enforcement of these requirements impacts access to care, quality of care, and recruitment efforts in Critical Access Hospitals (CAHs) and small rural hospitals. Findings are based on interviews with CMS officials, hospital association representatives, and CAH administrators in several states.
Date: 12/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
Information concerning potential effects of Medicaid Disproportionate Share Hospital (DSH) payment on rural hospitals in 47 states. Features statistics on hospital Medicaid DSH payments by census region, with breakdowns by 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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Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not
Examines how Medicaid expansion affected the financial health of safety-net hospitals, and compares hospitals in expansion states with hospitals in non-expansion states. Findings are based on data from Medicare's fiscal year 2012-2015 hospital cost reports, and explain changes in operating margins, Medicaid inpatient days, Medicaid revenues and costs, and uncompensated care costs.
Author(s): Allen Dobson, Joan DaVanzo, Randy Haught, Phap-Hoa Luu
Date: 11/2017
Type: Document
Sponsoring organization: Commonwealth Fund
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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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Global Budgets for Safety-Net Hospitals
Discusses the purpose and basic structure of the all-payer global budget system within the context of safety-net hospitals. Describes how global budgeting may be used to improve safety-net hospitals' finances by capturing the savings of wellness and prevention strategies.
Author(s): Joshua M. Sharfstein, Sule Gerovich, David Chin
Location: JAMA
Date: 10/2017
Type: Document
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Medicare Payment Basics: Hospital Acute Inpatient Services Payment System
Provides an 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), special payments for rural hospitals, and more.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Performance-Based Payment Adjustment Programs
Briefly explains the three Medicare Performance-Based Payment Adjustment programs for hospitals and how such programs may affect rural hospitals. The programs are the Hospital Acquired Condition Reduction Program (HACRP), the Hospital Readmission Reduction Program (HRRP), and the Hospital Value-Based Purchasing Program (HVBPP).
Date: 09/2017
Type: Document
Sponsoring organization: National Organization of State Offices of Rural Health
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Financial Distress and Closures of Rural Hospitals
Webinar recording presents an analysis of indicators of financial distress and the causes of closures of rural hospitals. Discusses realistic benchmarks rural hospitals should meet to maintain financial stability. Highlights data on rural hospitals currently at high risk of financial stress across the country.
Additional links: Presentation Slides, Transcript
Date: 09/2017
Type: Video/Multimedia
Sponsoring organization: Rural Health Research Gateway
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Trends in Emergency Department Visits, 2006–2014
Presents information on emergency department (ED) visits and trends in the U.S. between 2006 and 2014. Based on data from the Healthcare Cost and Utilization Project (HCUP), shows ED visit frequency by age, sex, metro/nonmetro location, primary payer type, region, diagnosis, and several other indicators.
Author(s): Brian J. Moore, Carol Stocks, Pamela L. Owens
Date: 09/2017
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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National Hospital Ambulatory Medical Care Survey: 2014 Emergency Department Summary Tables
Provides data on ambulatory care emergency department hospital visits. Table 1 includes brief metro/non-metro overview information, and Table 15 has metro/non-metro injury visit data.
Date: 09/2017
Type: Document
Sponsoring organization: National Center for Health Statistics
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Value-Based Strategic Planning Guide 2017: Rural Hospital Value-Based Strategy Summit
Customizable strategy resources to help small and rural hospital leaders develop, manage, measure, and implement their strategic plans. Templates focus on preparing rural hospitals to transition to value-based care and population health.
Additional links: Balanced Scorecard Template, Strategy Map Template
Date: 08/2017
Type: Document
Sponsoring organization: National Rural Health Resource Center
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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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An Emerging Approach to Payment Reform: All-Payer Global Budgets for Large Safety-Net Hospital Systems
Examines the possibility of implementing global all-payer budgets in safety-net hospital systems throughout the U.S. Provides background on the all-payer model, and discusses the experiences of rural hospitals in Maryland and Pennsylvania, where current global budgeting demonstrations are ongoing.
Author(s): Joshua M. Sharfstein, Sule Gerovich, Elizabeth Moriarty, David Chin
Date: 08/2017
Type: Document
Sponsoring organization: Commonwealth Fund
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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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Rural and Urban Hospitals in the United States
Shows the number of rural and urban hospitals in the United States as of January 1, 2016. Hospitals are organized according to type and urban/rural designation.
Date: 08/2017
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Hospital Consumer Assessment of Healthcare Providers and Systems Overview: Vendor Directory
Provides information about the benefits and challenges of implementing a HCAHPS survey process in small rural hospitals, specifically Critical Access Hospitals (CAHs). Includes a full directory of vendors currently authorized to perform HCAHPS data collection.
Date: 08/2017
Type: Document
Sponsoring organization: National Rural Health Resource Center
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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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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 eight states with significant rural populations, and examines ADE rates based on hospital characteristics and across four 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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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
Location: Rural Monitor
Date: 03/2017
Type: Document
Sponsoring organization: Rural Health Information Hub
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Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program
Describes the Medicare Hospital Readmission Reduction Program (HRRP), analyzes the impact of the program on Medicare beneficiaries and healthcare facilities, and highlights identified issues regarding its implementation. Tables and charts display differences in penalties incurred by urban and rural facilities, and include estimates for FY 2017.
Author(s): Cristina Boccuti, Giselle Casillas
Date: 03/2017
Type: Document
Sponsoring organization: Kaiser Family Foundation
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Making the Most of Evolving Payment Policies to Enhance Hospital-based Care in Rural Communities
Presentation slides from the 2017 Rural Health Care Leadership Conference that discuss the transition from volume to value for rural hospital payment and how to make the most of resources available to facilities. Includes examples of services and documents for reference as well as data and statistics surrounding Medicare Advantage and Accountable Care Organizations in rural communities.
Author(s): Keith J. Mueller
Date: 02/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Early Death After Discharge From Emergency Departments: Analysis of National US Insurance Claims Data
Report regarding the incidence of early death after release from emergency departments in the United States and what risk factors may contribute to those deaths. Compares urban and rural hospital location, with data for Critical Access Hospitals and rural non-CAHs. Includes data for rural and urban populations as well as poverty level, previous healthcare use, and other demographics.
Author(s): Ziad Obermeyer, Brent Cohn, Michael Wilson, Anupam B Jena, David M Cutler
Location: BMJ, 356(j239)
Date: 02/2017
Type: Document
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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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Cybersecurity: How a Rural Alaska Hospital is Safeguarding Its Patients’ Information
Provides an overview of cybersecurity threats and challenges faced by rural healthcare facilities. Describes how the IT staff at the South Peninsula Hospital, a Critical Access Hospital in Alaska, safeguards their hospital's data.
Author(s): Allee Mead
Location: Rural Monitor
Date: 01/2017
Type: Document
Sponsoring organization: Rural Health Information Hub
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Factsheet: Rural and Small Hospitals
Fact sheet and position statement from the American Hospital Association identifying key legislation and policy priorities for rural and small hospitals, with a particular focus on Critical Access Hospitals.
Date: 01/2017
Type: Document
Sponsoring organization: American Hospital Association
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Hurricane Response: CMS Waivers and Exceptions for Facilities
Outlines the Centers for Medicare and Medicaid Services' response to Hurricanes Nate, Maria, Irma, and Harvey. The actions are focused on maintaining access to care for affected Medicare and Medicaid beneficiaries. Includes information about administrative actions and waivers for Critical Access Hospitals, Medicare-dependent small rural hospitals, low-volume providers, and other participating facilities.
Date: 2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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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. Also examines policy options that the IRS could use to enhance community benefit spending focused on improving 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, and 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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Task Force on Ensuring Access in Vulnerable Communities
Report from a task force created by the American Hospital Association (AHA) charged with identifying access-related challenges facing vulnerable communities, and examining ways in which hospitals can ensure access is maintained. Includes sections identifying characteristics of vulnerable communities, essential healthcare services to be maintained, emerging strategies, barriers to implementation, policy and advocacy issues, and more. Also includes multiple case examples where the emerging strategies and best practices have been used in vulnerable communities across the country.
Additional links: Executive Summary, Rural Chart Pack, Video
Date: 11/2016
Type: Document
Sponsoring organization: American Hospital Association
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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
Location: 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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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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Characteristics of Safety-Net Hospitals, 2014
Examines the characteristics of safety net hospitals and inpatient stays at these facilities in 2014, based on data from 40 states. Compares safety net hospitals to non-safety net hospitals. Includes information by hospital location for metropolitan, micropolitan, and noncore (rural) areas.
Author(s): Janet Pagon Sutton, Raynard E. Washington, Kathryn R. Fingar, Anne Elixhauser
Date: 10/2016
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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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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Trends in Risk of Financial Distress among Rural Hospitals
Illustrates 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) payment type for the 2013-2016 period.
Author(s): Brystana G. Kaufman, Randy Randolph, George H. Pink, Mark Holmes
Date: 10/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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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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Exploring Global Budgets and All-Payer Rate Setting Approaches: How Does it Impact Rural Providers?
A slide presentation on hospital payment methodologies focusing on the incentives of population health and value-driven payment models. Compares the impact of the all-payer model for hospitals in Maryland with volume-based payment approaches. Also includes information on payment reform initiatives in Vermont and Pennsylvania.
Author(s): Alana Knudson, Rebecca Oran
Date: 08/2016
Type: Presentation Slides
Sponsoring organization: Rural Health Reform Policy Research Center
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Profitability of Rural and Urban Hospitals
Infographic comparing rural and urban hospital profit margins from 2012-2014 and illustrating the geographic variation of profits across states.
Date: 08/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Overall Hospital Quality Star Ratings on Hospital Compare: Overview for Flex Programs and Rural Stakeholders
Provides background information and the methodology used for the development of the CMS Overall Hospital Star Ratings posted on the Hospital Compare website. Discusses the implications these ratings have on Critical Access Hospitals and other small rural hospitals.
Date: 07/2016
Type: Document
Sponsoring organization: Stratis Health
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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 key strategies to meet the challenges of the changing healthcare environment. Includes discussion on alternative payment models, the impact of market forces, successful examples and lessons learned, and offers information for the development of tools supporting hospitals and networks as they transition to value-based purchasing and population health.
Author(s): Mark Chustz, et al.
Date: 07/2016
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Global Budgets for Rural Hospitals
Discusses the financial and budgetary challenges faced by rural hospitals, explains how some rural hospitals have responded, and presents the case for using global budgets as an alternative payment model. Includes information on some of the proposed policy solutions such as Maryland's all-payer system and the Save Rural Hospitals Act.
Author(s): Joshua M. Sharfstein
Location: The Milbank Quarterly, 94(2), 255-259
Date: 06/2016
Type: Document
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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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State Variations in the Rural Obstetric Workforce
Illustrates the challenges affecting the obstetric workforce in Critical Access Hospitals and other rural hospitals having at least 10 births in 2010 using data derived from a telephone survey conducted in 9 states.
Author(s): Peiyin Hung, Katy B. Kozhimannil, Michelle M. Casey, Carrie Henning-Smith, Shailendra Prasad
Date: 05/2016
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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An All-Payer View of Hospital Discharge to Postacute Care, 2013
Presents data on hospital discharges to different post-acute care settings: inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agency care. Includes information by hospital type for rural and urban hospitals, as well as by hospital size and region.
Author(s): Wen Tian
Date: 05/2016
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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Improving Efficiency and Preserving Access to Emergency Care in Rural Areas
Provides an overview of the current policies and strategies in place to ensure access to emergency department services in rural areas and the challenges they face today. Guides a discussion to alternative strategies that support outpatient-only services, such as a stand alone emergency department and a clinic that offers ambulatory services. Slides from MedPAC public meeting held on April 12, 2016.
Author(s): Jeff Stensland, Zach Gaumer
Date: 04/2016
Type: Presentation Slides
Sponsoring organization: Medicare Payment Advisory Commission
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2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
Compares the total margin and operating margin of rural and urban hospitals using 2012-2014 profitability data. Rural hospitals are divided by the size of the Prospective Payment System (the number of beds), and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), and Rural Referral Centers (RRCs).
Author(s): Sharita R. Thomas, G. Mark Holmes, George H. Pink
Date: 03/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Geographic Variation in the Profitability of Urban and Rural Hospitals
Analyzes and compares the 2014 profitability margins of rural and urban hospitals by census region, census division, and by state. Information on rural hospitals is broken down by Critical Access Hospitals (CAHs) and "other rural hospitals" (ORH), which includes Medicare Dependent Hospitals, Sole Community Hospitals, and rural PPS hospitals.
Author(s): Sharita R. Thomas, George H. Pink, G. Mark Holmes
Date: 03/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Reasons for Emergency Room Use Among U.S. Adults Aged 18-64: National Health Interview Survey, 2013 and 2014
Examines emergency room (ER) use among adults for 2013 and 2014. Includes data on the number of visits and reason for most recent ER visit, with information available by area of residence for metropolitan and nonmetropolitan areas. Reasons for ER visits included seriousness of the medical problem, doctor’s office or clinic not open, and lack of access to other providers.
Author(s): Renee M. Gindi, Lindsey I. Black, Robin A. Cohen
Date: 02/2016
Type: Document
Sponsoring organization: National Center for Health Statistics
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Report to Congress on Medicaid Disproportionate Share Hospital Payments
First annual report on Medicaid Disproportionate Share Hospital (DSH) payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Discusses Medicaid policy, current and future DSH allotments, and data needs. Table B-3 projects FY2018 DSH payments under different scenarios, with data for urban and rural hospitals and for Critical Access Hospitals.
Date: 02/2016
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Geographic Variation in Risk of Financial Distress among Rural Hospitals
Discusses the geographic variation in the number of rural hospitals predicted to be at high risk for closure as assigned by the Financial Distress Index (FDI) model. The FDI model uses existing hospital financial performance, government reimbursement, and organizational and market characteristics to determine risk levels associated with financial distress.
Author(s): Brystana Kaufman, Regina Rutledge, George Pink, Mark Holmes
Date: 01/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Prediction of Financial Distress among Rural Hospitals
Analyzes financial risk among rural hospitals across geography to inform policies aimed to prevent negative health impacts on residents due to loss of healthcare access.
Author(s): Brystana Kaufman, Regina Rutledge, George Pink, Mark Holmes
Date: 01/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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U.S. Hospital List (2016)
Comprehensive list of urban and rural U.S. hospitals that were reported open as of January 1, 2016. Includes 4,768 acute care hospitals and 1,373 specialty hospitals.
Date: 2016
Type: Directory
Sponsoring organization: North Carolina Rural Health Research Program
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Characteristics and Quality of Inpatient Stays at Hospitals Affiliated with Health Systems, 2009-2012
Compares hospitals in centrally organized multihospital systems, noncentralized systems, and independent hospitals. Looks at rural-urban location, region, bed size, other hospital and patient characteristics, and mortality rates for selected conditions.
Author(s): Brian Moore, Zeynal Karaca, Rachel Mosher Henke, Herbert Wong
Date: 12/2015
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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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.
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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Challenges of Rural Cancer Care in the United States
Highlights the impact of rurality affecting the care of rural cancer patients and healthcare providers treating cancer patients. Topics discussed include the availability of cancer specialists, limited transportation services, lower socioeconomic status, health insurance coverage, less access to clinic trials, and the shortage of palliative and end-of-life staff and services.
Author(s): Mary Charlton, Jennifer Schlichting, Catherine Chioreso, et al.
Location: Oncology Journal, Practice & Policy, 29(9), 633-640
Date: 09/2015
Type: Document
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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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Performance Measurement for Rural Low-Volume Providers
Identifies challenges to measuring healthcare performance among low-volume rural providers, and presents recommendations to meet these challenges. Primary focus is on finding appropriate quality measures for use within Centers for Medicare and Medicaid Services' (CMS) pay-for-performance programs, and encouraging rural participation in CMS quality improvement initiatives.
Date: 09/2015
Type: Document
Sponsoring organization: National Quality Forum
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The Economic Impacts of 26-50 Bed PPS Hospitals & 51-100 Bed PPS Hospitals on the Local Economies
Discusses the key characteristics of rural prospective payment system (PPS) hospitals and how they impact the economies of the communities where they are located. Uses data from the American Hospital Association (AHA) database, and analyzes the employment and labor income of two size categories of hospitals - 26 to 50 beds, and 51 to 100 beds. Includes a template for PPS hospitals to estimate their economic impact.
Author(s): Gerald A. Doeksen, Cheryl F. St. Clair, Fred C. Eilrich
Date: 08/2015
Type: Document
Sponsoring organization: National Center for Rural Health Works
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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 & 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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Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
Describes the factors, including health insurance status and degree of rurality, that influence rural pregnant women to give birth in non-local hospitals.
Author(s): Katy Kozhimannil, MPA Michelle Casey, Peiyin Hung, Shailendra Prasad, Ira Moscovice
Date: 06/2015
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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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
Location: Rural Monitor
Date: 05/2015
Type: Document
Sponsoring organization: Rural Health Information Hub
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Results from 2012 Tax-Exempt Hospitals’ Schedule H Community Benefit Reporting
Reports community benefit of hospitals by measuring financial costs incurred through charity care, financial assistance and spending to fill gaps in Medicaid and Medicare payments. Findings are divided into urban/suburban and rural locations by zip code.
Date: 05/2015
Type: Document
Sponsoring organizations: American Hospital Association, Ernst & Young LLP
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Statement by Tim Wolters, Citizens Memorial Hospital and Lake Regional Health System, before the Committee on Appropriations Subcommittee on Labor, Health and Human Services, and Education and Related Agencies
Testimony presented at a May 7, 2015 Labor-HHS Subcommittee hearing on rural health. Discusses the impact rural hospitals have on their communities and the challenges rural Prospective Payment System (PPS) hospitals face that make them vulnerable to cuts in Medicare reimbursement.
Author(s): Tim Wolters
Date: 05/2015
Type: Document
Sponsoring organization: Senate Committee on Appropriations
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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 Thomas, Brystana Kaufman, Randy Randolph, et al.
Date: 04/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Revisions to State Operations Manual (SOM) Appendices A, G, L and T Related to Hospitals, Rural Health Clinics, Ambulatory Surgical Centers and Swing Beds
Revises the Centers for Medicare & Medicaid Services' State Operations Manual (SOM) to reflect regulation changes affecting Hospitals, Rural Health Clinics, Ambulatory Surgical Centers and Swing Beds in hospitals.
Date: 04/2015
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Sole Community Hospitals: Early Indications Show That TRICARE's Revised Reimbursement Rules Have Not Affected Access to Care
Reports on the impact of a January 2014 revision to TRICARE’s reimbursement for Sole Community Hospitals (SCHs), which serve primarily rural areas. The new TRICARE reimbursement rules approximate Medicare’s for these hospitals. Looks at the impact of revised SCH reimbursement on healthcare access for servicemembers and their dependents. Findings based on claims data, as well as interviews with 10 SCHs and with national stakeholders. Appendices include information on SCHs with a high number of TRICARE admissions.
Date: 04/2015
Type: Document
Sponsoring organization: Government Accountability Office
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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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A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals
Policy brief evaluating a March 2015 report from the Office of the Inspector General (OIG), U.S. Department of Health and Human Services, commenting on Medicare reimbursement policy for swing bed services in Critical Access Hospitals (CAHs). Evaluates the methods and data of the OIG report.
Author(s): Kristin Reiter, Mark Holmes
Date: 03/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Medicare Could Have Saved Billions at Critical Access Hospitals If Swing-Bed Services Were Reimbursed Using the Skilled Nursing Facility Prospective Payment System Rates
Reports the Inspector General’s findings from a study of swing bed services and reimbursement at Critical Access Hospitals (CAHs). Concludes that swing bed usage has significantly increased in recent years and that there would be significant savings to the Medicare program if swing bed services were reimbursed at skilled nursing facility (SNF) prospective payment system (PPS) rates.
Date: 03/2015
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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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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Community Factors and Hospital Readmission Rates
National study of hospitals with 30-day readmission rates for patients discharged from July 1, 2007 to June 30, 2010 with acute myocardial infarction, heart failure, or pneumonia. Features statistics with breakdowns including rural or urban status, access to nursing homes, number of beds per hospital, and patient socioeconomic status.
Author(s): Jeph Herrin, Justin St. Andre, Kevin Kenward, et al.
Location: Health Services Research, 50(1), 20-39
Date: 02/2015
Type: Document
Sponsoring organization: Health Research & Educational Trust
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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 Karim, George Holmes, George Pink
Location: The Journal of Health Care Finance
Date: 02/2015
Type: Document
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Financially Fragile Rural Hospitals: Mergers and Closures
Highlights a national trend of financial stress on rural hospitals that have led to facility and service closures and mergers in recent years. Discusses the causes of the financial stress, including the implementation of the Affordable Care Act, the lack of Medicaid expansion in some states, and operational challenges in transitioning to value-based care.
Author(s): Mark Holmes
Location: North Carolina Medical Journal, 76(1), 37-40
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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Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants?
Report discusses the various payment models that may affect the financial performance of rural hospitals and the variables (geographic, community, market, and hospital) that affect rural hospital costs.
Author(s): Kristin Moss, G. Mark Holmes, George H. Pink,
Date: 02/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
Illustrates the utilization and performance of emergency departments (EDs) across the urban/rural spectrum for non-emergency health conditions. Identifies and discusses the potential risk factors that may impact ED use for non-emergent healthcare.
Author(s): Yvonne Jonk, Marilyn G. Klug, Gary Hart
Date: 02/2015
Type: Document
Sponsoring organization: Rural Health Reform Policy Research Center
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International Classification of Disease: CMS's Efforts to Prepare for the New Version of the Disease and Procedure Codes
Review of the efforts undertaken by the Centers for Medicare and Medicaid Services (CMS) to prepare for the transition to the 10th revision of the International Classification of Diseases (ICD-10) codes. Evaluates the materials developed and activities undertaken by CMS to help providers’ transition and describes concerns of stakeholder organizations, including rural-specific considerations.
Additional links: Highlights
Date: 01/2015
Type: Document
Sponsoring organization: Government Accountability Office
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Rural Health Networks and New Forms of Governance
Profiles Wilderness Health, a formal network of rural and urban independent hospitals in Minnesota focused on performance improvement. The network participates in the Integrated Health Partnership, Minnesota’s Medicaid Accountable Care Organization (ACO) model.
Date: 2015
Type: Document
Sponsoring organization: Rural Health Value
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Meaningful Use Attestations Among US Hospitals: The Growing Rural-Urban Divide
An analysis of the Electronic Health Record Incentive Program adoption in metropolitan, micropolitan, and rural hospitals in the U.S. Compares rural and urban hospitals that were attesting to meaningful use and receiving federal incentive payments.
Author(s): Ryan H. Sandefer, David T. Marc, Paul Kleeberg
Location: Perspectives in Health Information Management, 2015 (Spring), 1-10
Date: 2015
Type: Document
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National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables
Provides data on emergency department hospital visits, including information for non-metropolitan hospitals. Table 27 provides detailed hospital and emergency department characteristics by metropolitan status. Additional tables that include metro/non-metro data include Table 1, with general overview information, and Table 14, with injury visit data.
Date: 11/2014
Type: Document
Sponsoring organization: National Center for Health Statistics
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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 eleven small rural hospitals. 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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Observation Care Services for Medicare Beneficiaries in Rural Hospitals: Policy Issues and Stakeholder Perspectives
Seeks to provide a greater understanding of rural-specific issues surrounding hospital outpatient observation status and the related implications for rural hospitals, skilled nursing facilities (SNFs), and Medicare beneficiaries. Results are based on a multi-state, qualitative analysis of input from three respondent groups: state hospital associations, long-term care ombudsman offices, and Quality Improvement Organizations (QIOs). Analysis focuses on the use of observation status by Medicare beneficiaries from 2010-2013.
Author(s): Walter Gregg, Samantha Mills, Yvonne Jonk
Date: 10/2014
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Geographic Variation in Potentially Preventable Hospitalizations for Acute and Chronic Conditions, 2005-2011
Examines potentially preventable hospitalizations for adults from 2005 to 2011. Includes data for acute and chronic conditions by location of patient residence for large and small metropolitan, micropolitan, and remote rural areas.
Author(s): Celeste M. Torio , Roxanne M. Andrews
Date: 09/2014
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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FY 2013 Small Rural Hospital Improvement Program Hospitals
Map showing all U.S. hospitals participating in the Small Rural Hospital Improvement Grant Program (SHIP) during fiscal year 2013.
Date: 08/2014
Type: Map/Mapping System
Sponsoring organization: Federal Office of Rural Health Policy
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Care Coordination Comparative Matrix
Identifies rural health networks that are developing or implementing value-based models and recaps brief interviews with the network leaders that are implementing or developing care coordination initiatives. The matrix allows rural health networks to share features and lessons learned through the process of implementing the care coordination programs with one another.
Date: 08/2014
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Rural Hospital Performance Improvement (RHPI) Project: Best Practice Concepts in Revenue Cycle Management
Provides rural hospitals a full explanation of revenue cycle management from patient admission to evaluating measures of success and offers guidance that is generally accepted as best practice concepts. 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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Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward?
Examines the implications of mergers and acquisitions for small rural hospitals. Addresses the characteristics of rural hospitals that merged and the changes in hospital financial performance, staffing, or services following a merger.
Author(s): Marissa Noles, Kristin L. Reiter, George H. Pink, G. Mark Holmes
Date: 08/2014
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural Residents Who Are Hospitalized in Rural and Urban Hospitals: United States, 2010
NCHS data brief focused on hospitalized rural residents, with a comparison of those treated at rural versus urban hospitals. Includes data on patients' age, payment source (Medicare, Medicaid, private insurance), number of procedures, and discharge status. Based on data from the 2010 National Hospital Discharge Survey.
Author(s): Margaret Jean Hall, Maria F. Owings
Date: 07/2014
Type: Document
Sponsoring organization: National Center for Health Statistics
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Medicare Rural Hospital Flexibility Critical Access Hospital Designation Resource Guide 2014
Provides information and resources for rural hospitals participating in Medicare to convert into a Critical Access Hospital (CAH) status.
Date: 06/2014
Type: Document
Sponsoring organization: California State Office of Rural Health
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Rural and Urban Hospitals' Role in Providing Inpatient Care, 2010
NCHS data brief comparing inpatient care at rural and urban hospitals. Covers the amount of inpatient care provided, patient characteristics, first-listed diagnoses, number of procedures, and discharge location. Based on 2010 National Hospital Discharge Survey data.
Author(s): Margaret Jean Hall, Maria Owings
Date: 04/2014
Type: Document
Sponsoring organization: National Center for Health Statistics
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National Health Service Corps Site Reference Guide
Serves as clarification for NHSC sites regarding eligibility requirements and qualification factors, the application and recertification process, site roles and responsibilities, clinician recruitment, and technical assistance. This document is a supplement to the online NHSC Site Application.
Date: 04/2014
Type: Document
Sponsoring organization: Health Resources and Services Administration
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Adoption of Sodium Reduction Strategies in Small and Rural Hospitals, Illinois, 2012
Results of a 4-month-long intervention in which 30 hospitals promoted lower-sodium food choices in their cafeterias and vending machines, and made available information regarding benefits of sodium reduction.
Author(s): Nancy Amerson, Marguerite Nelson, Abigail Radcliffe, et al.
Location: Preventing Chronic Disease, 11
Date: 03/2014
Type: Document
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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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Overview of Hospital Stays in the United States, 2011
This statistical brief presents the annual statistical report on inpatient hospital stays using data from the Healthcare Cost and Utilization Project. Includes rural areas, which according to the data, accounts for the smallest share of stays, but the highest per capita.
Author(s): Anne Pfuntner, Lauren M. Wier, Anne Elixhauser
Date: 11/2013
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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How Hospital Leaders Can Build Good Working Relationships with Physicians
Explores potential barriers to physician engagement and 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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Examination of the Relative Importance of Hospital Employment in Non-Metropolitan Counties Using Location Quotients
Examines the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations.
Author(s): J.L. Smith
Location: Rural and Remote Health, 13, 2497
Date: 07/2013
Type: Document
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Obstetric Services and Quality Among Critical Access, Rural, and Urban Hospitals in Nine States
Compares the characteristics and quality of obstetric care in Critical Access Hospitals, other rural hospitals, and their urban counterparts.
Author(s): Katy Kozhimannil, Peiyin Hung, Maeve McClellan, et al.
Date: 06/2013
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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The Role of Small and Rural Hospitals and Care Systems in Effective Population Health Partnerships
Explains how small and rural hospitals and their systems can develop community and other partnerships to effectively implement population health management and improve their community's health status. Includes five case studies.
Date: 06/2013
Type: Document
Sponsoring organization: Health Research & Educational Trust
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Implications of Proposed Changes to Rural Hospital Payment Designations
Discusses the short-term policy implications of proposed changes to the designation and payment guidelines for small rural hospitals.
Date: 12/2012
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Quality Reporting for CAHs and Rural PPS Hospitals: The Potential Impact of Composite Measures (Policy Brief)
Assesses the use of composite scores for public reporting of quality measures as one way of addressing the low volume issue for small rural hospitals, including Critical Access Hospitals (CAHs) and Rural Prospective Payment System (PPS) hospitals.
Author(s): Michelle Casey, Peiyin Hung, Ira Moscovice
Date: 07/2012
Type: Document
Sponsoring organization: Upper Midwest Rural Health Research Center
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Community Health Needs Assessment Toolkit
Provides a toolkit to complete the requirement of the Patient Protection and Affordable Care Act of 2010 which requires that all 501(c)(3) rural hospitals conduct a community health needs assessment.
Author(s): Gerald A. Doeksen, Cheryl F. St. Clair, Val C. Schott
Date: 05/2012
Type: Document
Sponsoring organization: National Center for Rural Health Works
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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 seen on healthcare quality, hospital finances, and recruitment and retention of physicians.
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 (Findings Brief)
Includes interviews of hospital administrators and staff about the use of swing beds including 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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Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia
Explores the relationship between potentially preventable hospital readmissions and a) use of outpatient follow-up care, b) discharge destination, c) rural versus urban residence of the patient, and d) time to follow-up care.
Additional links: Policy Brief
Author(s): Marilyn G. Klug, Kyle Muus
Date: 03/2012
Type: Document
Sponsoring organization: Upper Midwest Rural Health Research Center
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The Rural Hospital Governance Workbook
Includes resources on hospital board composition, board roles and responsibilities, board accountability and board compliance.
Date: 2012
Type: Document
Sponsoring organization: Grand Itasca Clinic & Hospital
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Rural Hospital Replacement Facility Study, 2011
Studies Critical Access Hospitals (CAHs) operating in replacement facilities. Addresses the impact associated with a new facility, including patient volumes, operating efficiency, and financial impacts.
Date: 2012
Type: Document
Sponsoring organization: Stroudwater Associates
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Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions in the United States, by Insurance Type, 2000 to 2004
Examines the trends and regional variations of rural hospital charges due to ambulatory care sensitive conditions.
Author(s): Wanqing Zhang, Li-Wu Chen, Tao Li, Keith Mueller
Date: 08/2011
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Trends in the Provision of Surgery by Rural Hospitals
Reports that the number of rural hospitals that did not provide surgery increased between 2001 and 2008. Shows results based on hospital location and Medicare payment classification.
Author(s): George M. Holmes, Saleema A. Karim, George H. Pink
Date: 07/2011
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Emergency Department Visits in Rural and Non-Rural Community Hospitals, 2008
Presents data on the use of EDs in rural areas from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS). The information focuses on patient and hospital characteristics of rural and non-rural emergency department visits in the United States in 2008.
Author(s): Anika Hines, Taressa Fraze, Carol Stocks
Date: 06/2011
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform
Examines the challenges, including financial and workforce resources, facing rural hospitals as they implement the Patient Protection and Affordable Care Act.
Date: 04/2011
Type: Document
Sponsoring organization: American Hospital Association
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The 2011 Report to the Secretary: Rural Health and Human Services Issues
Report to the Secretary of the U.S. Department of Health and Human Services focused on rural childhood obesity, place-based initiatives for rural early childhood development, and rural implications of accountable care organizations and payment bundling. Includes recommendations to address these issues and provides appendices describing the 2010 site visits.
Date: 03/2011
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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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, workforce, and health information technology.
Author(s): Beth Blevins
Location: Rural Monitor, 2011(Winter)
Date: 02/2011
Type: Document
Sponsoring organization: Rural Health Information Hub
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Two Days In December: A Report from the Rural Hospital Quality Leadership Summit
Includes a summary of the Rural Hospital Quality Leadership Summit held in December 2010 in Minneapolis, MN.
Author(s): Bob Hartl, Toni Pearson
Date: 2011
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Nurse Staffing and Rural Hospital Performance (Policy Brief)
Examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.
Author(s): Gestur Davidson, Kathy Belk, Ira Moscovice
Date: 12/2010
Type: Document
Sponsoring organization: Upper Midwest Rural Health Research Center
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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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Rural Hospital Support for Emergency Medical Services
Discusses the proportion and characteristics of rural hospitals that support or operate EMS units, the financial investments made by these hospitals, and the communities in which these hospitals are located.
Additional links: Findings Brief
Author(s): Victoria A. Freeman, Hilda A. Howard, Ruth Lavergne
Date: 11/2010
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Geographic Differences in Potentially Preventable Readmission Rates in Rural and Urban Hospitals
Presents results from a study that estimated potentially preventable hospital readmissions (PPRs) in three types of acute care hospitals: urban prospective payment system (PPS) hospitals, rural PPS hospitals, and Critical Access Hospitals (CAHs).
Author(s): Marilyn G. Klug, Alana Knudson, Kyle Muus
Date: 11/2010
Type: Document
Sponsoring organization: Upper Midwest Rural Health Research Center
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Emergency Department Visits for Adults in Community Hospitals, 2008
Uses statistics from the 2008 Nationwide Emergency Department Sample to analyze rates of emergency room visits. Compares data by demographics, acute vs. chronic care, rural vs. urban, high-income vs. low-income, and admissions vs. treat-and-release.
Author(s): Pamela L. Owens, Ryan Mutter
Date: 11/2010
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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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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Final HIT Incentive Rule Stage 1 Quality Metrics Objective Summary and Challenge Identification
Serves as the first in a series of reports intended to help rural community hospitals develop strategies to meet the meaningful use objectives, then utilize the data to achieve process and quality improvement.
Author(s): Beth Dibbert, Louis Wenzlow
Date: 09/2010
Type: Document
Sponsoring organization: Wisconsin Office of Rural Health
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A Comparison of Rural Hospitals with Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment
Compares the financial performance and condition of rural hospitals with special Medicare payment provisions - Critical Access Hospitals (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), and Rural Referral Centers (RRCs) - to urban and rural hospitals paid under prospective payment.
Additional links: Findings Brief: Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals with Special Medicare Payment Provisions
Author(s): G. Mark Holmes, George H. Pink, Sarah A. Friedman, Hilda A. Howard
Date: 08/2010
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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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: Key Facts: Rural Acute Care Hospital Boards of Directors: CAH’s Lag in Oversight
Author(s): Janice C. Probst, Royce Adams, Amy B. Martin
Date: 06/2010
Type: Document
Sponsoring organization: South Carolina Rural Health Research Center
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Patient Assessments and Quality of Care in Rural Hospitals
Analyzes the relationships between rural patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care.
Additional links: Policy Brief
Author(s): Michelle Casey, Gestur Davidson
Date: 06/2010
Type: Document
Sponsoring organization: Upper Midwest Rural Health Research Center
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A Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (Findings Brief)
Compares the profitability of hospitals with the four classifications of rural hospitals that can qualify for special payment provisions under Medicare (Critical Access Hospitals, Medicare Dependent Hospitals, Sole Community Hospitals, and Rural Referral Centers) to urban and rural hospitals paid under prospective payment over a recent three-year period.
Author(s): George H. Pink, Rebecca T. Slifkin, Hilda A. Howard
Date: 04/2010
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Alternatives to the Outpatient Prospective Payment System: Assessing the Impact on Rural Hospitals
Explores alternatives to the Outpatient Prospective Payment System and how these options would affect rural hospitals.
Author(s): Janet Pagan-Sutton, Claudia Schur, Katie Merrell
Date: 04/2010
Type: Document
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
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Inpatient Stays in Rural Hospitals, 2007
Presents data on rural hospital stays in 2007 compared to urban hospital stays. Includes hospital, patient, and utilization characteristics. Also includes data on top diagnoses and procedures.
Author(s): Elizabeth Stranges, Laurel Holmquist, Roxanne M. Andrews
Date: 01/2010
Type: Document
Sponsoring organization: Agency for Healthcare Research and Quality
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Rural Hospital Renovation & Expansion Study
Summarizes the results of a survey assessing the impact of community hospital renovations on healthcare delivery and recruiting.
Author(s): Bill Wilson, Rick Geiler, Jim McClure, Scott Fowler
Date: 10/2008
Type: Document
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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 2017 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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Hospital Spotlights
Features Critical Access Hospitals (CAHs) from across the country, highlighting how each hospital is navigating the changing healthcare environment. Featured facilities are supported by the Small Rural Hospital Transition (SRHT) Project.
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 and Case Examples in Innovation
As the transformation of the nation's health system begins to take shape, rural hospitals and health systems will find themselves more accountable for patient outcomes, patient experience, cost of care, and population health. A collection of case examples demonstrating rural innovations and new models of care, payment and delivery are provided.
Type: Website
Sponsoring organization: American Hospital Association Section for Small or Rural Hospitals
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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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Network Aim for Sustainability Portal
A compilation of tools, resources, and educational materials based on the Baldrige Performance Excellence framework developed for rural health network grantees.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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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 2010 – Present
Interactive map displaying the location of rural hospital closures across the U.S. from January 2010 to present. Also 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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Assessing Your Leadership Competencies
Provides links to leadership resources for staff at rural healthcare organizations. Resources cover communication and relationship management, leadership, professionalism, knowledge of the health care environment, and business skills and knowledge.
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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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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Dartmouth Atlas of Health Care
Provides access to Medicare data on enrollee demographics, reimbursement, utilization and quality. Map-based interface with profiles by hospital and region. Also includes national maps and data by topic.
Type: Website
Sponsoring organization: The Dartmouth Institute for Health Policy and Clinical Practice
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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.
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 tailored to meet the health information technology (HIT) needs of Critical Access Hospitals (CAH) and small, rural hospitals. Addresses electronic health record (EHR) benefits, meaningful use, and implementation 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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Economic Impact: Tools and Templates
Access tools and templates for studying the economic impact, in rural areas, of 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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AHA Small or Rural Update
A quarterly newsletter which includes information on federal legislative and regulatory activity affecting payment, quality, and access to care for small or rural hospitals.
Type: Journal/Newsletter
Sponsoring organization: American Hospital Association Section for Small or Rural Hospitals
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Community Health Needs Assessment (CHNA)
Created to assist 501(c)(3) hospitals in conducting their community health needs assessments, which are required by the Patient Protection and Affordable Care Act (ACA), every 3 years.
Type: Website
Sponsoring organization: Institute for People, Place, and Possibility
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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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AHRQ Quality Indicators Toolkit for Hospitals
Helps hospitals understand the Quality Indicators (QIs) from the Agency for Healthcare Research and Quality (AHRQ), and support the use of them to successfully improve quality and patient safety in hospitals.
Type: Website
Sponsoring organization: Agency for Healthcare Research and Quality
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AHA: HIT Meaningful Use Resources
Helps hospital leaders better understand the Medicare and Medicaid electronic health records 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
A 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: National Library of Medicine
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WhyNotTheBest.org
Tracks performance on various measures of health care quality. Enables organizations to compare their performance against that of their peers in both rural and urban locations.
Type: Website
Sponsoring organization: Commonwealth Fund
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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 care for patients with specific medical conditions applying specific measures on patient experiences, timely and effective care, surgical procedures, readmissions & mortality rates, and payment and value of care.
Type: Website
Sponsoring organization: U.S. Department of Health and Human Services
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American Society of Health-System Pharmacists: Small and Rural Hospital Resource Center
Provides a compilation of pharmacy-related practice tools, articles, materials, and best practices relevant to health care practitioners in rural communities.
Type: Website
Sponsoring organization: American Society of Health-System Pharmacists
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HCUPnet
Online tool for accessing Healthcare Cost and Utilization Project data. Provides access to health statistics and information on hospital stays at the national, regional, state, and county level. Includes data on rural hospital diagnoses and procedures.
Type: Database
Sponsoring organization: Agency for Healthcare Research and Quality
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AHA: Rural Health Care
Information on American Hospital Association (AHA) advocacy activities related to rural hospitals. Includes news and 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: 12/15/2017