Rural Hospitals – Resources

Analysis of Hospital Operating Margins and Provision of Safety Net Services
Explores the association between five hospital safety net services - undercompensated care measured using the Disproportionate Share Hospital index, uncompensated care, essential community services, neighborhood disadvantage, and Sole Community Hospital and Critical Access Hospital status - and hospital operating margins. Includes information on the relationship between bed count, Census region, urban/rural location, ownership status, and having a Graduate Medical Education residency program with operating margins.
Author(s): Lukas K. Gaffney, Kenneth A. Michelson
Citation: JAMA Network Open, 6(4), e238785
Date: 04/2023
Type: Document
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Better Together: Rural Hospital High-Value Networks
Examines how rural hospital high-value networks can create economies of scale and value-based care capacity in order to enter into value-based payment contracts.
Author(s): Clint MacKinney, Nate White, Brett Norell
Citation: Rural Monitor
Date: 04/2023
Type: Document
Sponsoring organization: Rural Health Information Hub
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Caitlin Carroll on Rural Hospital Survival
A podcast episode featuring Caitlin Carroll of the University of Minnesota's School of Public Health. Discusses the financial challenges rural hospitals face and common paths for unprofitable hospitals - continuing as-is, closure, or merging with another hospital system.
Date: 04/2023
Type: Audio
Sponsoring organization: Health Affairs
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In Need of a Checkup: Examining the Cybersecurity Risks to the Healthcare Sector
Recording of a March 16, 2023, U.S. Senate Committee on Homeland Security and Governmental Affairs hearing on cybersecurity threats facing the healthcare sector. Features testimony from Kate Pierce, the former Chief Information Officer and Chief Information Security Officer of an Alabama Critical Access Hospital, who discusses cybersecurity in small and rural hospitals.
Additional links: Kate Piece, Fortified Health Security - Testimony
Date: 03/2023
Type: Video/Multimedia
Sponsoring organization: Senate Committee on Homeland Security and Governmental Affairs
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CMS Bundled Payments for Care Improvement Advanced Model: Fourth Evaluation Report
Third annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Explores the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 3. Analyzes BPCI Advanced outcomes for beneficiaries from populations that have been historically underserved, including beneficiaries in rural areas and areas with a high Area Deprivation Index (ADI).
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Emergency Department Visits Related to Mental Health Disorders Among Adults, by Race and Hispanic Ethnicity: United States, 2018–2020
Report explores the rates of mental health-related visits to emergency departments (EDs) by race and Hispanic ethnicity. Breaks down data by race, mental health disorder, and urbanization level, among other measures.
Author(s): Zachary J. Peters, Loredana Santo, Danielle Davis, Carol J. DeFrances
Date: 03/2023
Type: Document
Sponsoring organization: National Center for Health Statistics
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Availability of Hospital-Based Cancer Services Before and After Rural Hospital Closure, 2008–2017
Explores the effect rural hospital closures have had on rural cancer care. Draws from American Hospital Association data from 2008 to 2017 and explores the differing outcomes hospital closures had on oncology care, radiation services, and cancer screening in rural areas.
Author(s): Whitney E. Zahnd, Peiyin Hung, Sylvia Kewei Shi, et al.
Citation: Journal of Rural Health, 39(2), 416-425
Date: 03/2023
Type: Document
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Rural Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid
Provides an overview of rural hospital finances before the COVID-19 pandemic and compares operating margins in hospitals in states that expanded Medicaid with those that did not expand Medicaid. Describes financial trends during pandemic. Highlights selected policy initiatives intended to support rural hospitals or restructure the rural healthcare delivery system.
Author(s): Zachary Levinson, Jamie Godwin, Scott Hulver
Date: 02/2023
Type: Document
Sponsoring organization: KFF
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Rural Health Safety Net Under Renewed Pressure as Pandemic Fades
Examines financial and operational metrics for rural hospitals, comparing hospitals in states that did and did not expand Medicaid, as well as the discontinuation of obstetrics and chemotherapy services. Discusses how the Rural Emergency Hospital (REH) designation can provide a path forward for some rural facilities and explores seven characteristics that may have the greatest impact on a facility's consideration to convert to an REH.
Date: 02/2023
Type: Document
Sponsoring organization: Chartis Center for Rural Health
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Community Sociodemographics and Rural Hospital Survival Analysis
Policy brief highlights the specific sociodemographic characteristics of rural communities that correlate with hospitals that are in financial distress. Examines the community factors for 985 rural hospitals in financial distress according to the Financial Distress Index from 2010 to 2019.
Author(s): Claudia A. Rhoades, Brian E. Whitacre, Alison F. Davis
Date: 01/2023
Type: Document
Sponsoring organization: Center for Economic Analysis of Rural Health
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