North Carolina Rural Health
 Research Program
December 2013
Welcome to the inaugural issue of the North Carolina's Rural Health Research Program's e-newsletter. We hope that it informs and educates. The NCRHRP is part of the Cecil G. Sheps Sheps Center at The University of North Carolina at Chapel Hill and conducts research on various rural health policy issues through our projects and funding streams such as the North Carolina Rural Health Research and Policy Analysis Center and the Medicare Rural Hospital Flexibility Program.

Please contact us if you have any comments or questions about our program or the contents of this newsletter.
Rapid Response Finding Briefs
As part of our Rapid Response Project the Program recently published five new Findings Briefs, each of which provide information for policy makers and stakeholders as policy changes for Critical Access Hospitals (CAHs) are considered.

Profitability of Rural Hospitals
Urban hospitals paid under PPS and Rural Referral Centers consistently had the highest profitability in comparison to hospitals with other payment classifications. Read Brief...


Geographic Variation in the Profitability of Critical Access Hospitals

The profitability of Critical Access Hospitals varies greatly across states and U.S. Census divisions.The decertification of CAHs and the loss of cost-based reimbursement are likely to reduce hospital profitability, with some states and regions being more adversely affected than others. Read Brief...  


Change in Profitability and Financial Distress of CAHs from Loss of Cost-Based Reimbursement

Changes to CAH reimbursement, notably a reversion to prospective payment, would have marked negative effects on CAH profitability and financial health. Roughly three quarters of CAHs would operate at a loss. Read Brief...  


Implications for Beneficiary Travel Time if Financially Vulnerable Critical Access Hospitals Close
Changes to CAH reimbursement may spur some CAHs to close, with the most financially vulnerable more likely to close. The average resident of those communities would experience a 80 percent increase in distance to the nearest hospital if those CAHs were to close. Read Brief ...

Rural and Urban Differences in Inpatient Related Costs and Use among Medicare Beneficiaries
Medicare beneficiaries who are admitted to rural hospitals tend to have lower outpatient costs than Medicare beneficiaries admitted to urban hospitals. The analysis suggests that consideration of the total cost of an acute episode of care be considered, not just the cost of the acute inpatient stay. Read Brief...
Data Highlight
We believe in the power of a good graph or chart to help explain complex data. So with that in mind, we would like to highlight one that we felt was particularly compelling from the Change in Profitability and Financial Distress of CAHs from Loss of Cost-Based Reimbursement Findings Brief. It presents the distribution of risk of financial distress by Medicare revenue scenario and distance to the nearest hospital. In particular, it shows clearly that under both revenue reduction scenarios, and regardless of hospital location, the percent of hospitals at low risk (grey segment) decreases while the percent of hospitals at high risk (black segment) increases.

Risk of Financial Distress by Medicare Revenue Scenario

and Distance to Nearest Hospital

Publications and Articles
The Program has had a number of other publications released over the past few months including:
Click here for a complete list of publications.
NC RHRP In The News
Recently, the Program was cited in a U.S. News and World Report article about hospital closures across the U.S.
George Pink Awarded Outstanding Researcher

George Pink, PhD, senior research fellow at the NC Rural Health Research Program and Humana Distinguished Professor of health policy and management at The University of North Carolina's Gillings School of  Global Public Health was honored by The National Rural Health Association (NRHA)  with its Outstanding Researcher Award, May 9 during the NRHA's 36th annual Rural Health Conference in Louisville, Ky.  


The Program Enters
Second Year

This past October the North Carolina Rural Health Research Program entered into the second of a four year cooperative agreement with the federal Office of Rural Health Policy, funded by the Health Resources and Services Administration (HRSA).

Over the next year, the program  will focus their research on how the changing health care payment models will affect access to care and utilization in rural areas. 
NC RHRP Says Hello and Goodbye

Kristie Thompson is our new program manager, replacing Indira Richardson, who was with us for 11 years. Kristie comes to the program with extensive experience in health policy, having worked at the North Carolina Institute of Medicine, the NC Health and Wellness Trust Fund, and as a program manager for other programs within Sheps. Welcome Kristie!  


In other staffing news, our Deputy Director Andrea Radford has accepted a new position as director of Evaluation and Outcomes with Care Share Health Alliance. We are grateful that previous Deputy Director Victoria Freeman has agreed to step back into her former position. 

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North Carolina Rural Health Research Program (NC RHRP)

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