North Carolina Rural Health Research and Policy Analysis Center

Current Projects

• Developing a Decision Aid for Selecting Rural Designations for Public Health Research
  This project develops a CDC decision aid to help researchers select the most appropriate rural-urban classification for their work. Using federal schemes, it illustrates how classifications affect analysis, tailored to the unique needs of rural public health research and practice.
  Topics: Public health, Rural statistics and demographics
  
• Did Hospitals That Converted to Rural Emergency Hospital (REH) Avoid Closure?
  The goal of the Rural Emergency Hospital (REH) is to preserve access to essential services for rural residents, and to decrease the likelihood of hospital closures; some worry that the REH offers an option for otherwise financially strong hospitals to shed services. This study will investigate whether hospitals that converted to an REH in 2023 and 2024 would have likely closed in the absence of the REH designation.
  Topics: Healthcare access, Healthcare financing, Hospitals and clinics, Medicare, Rural Emergency Hospitals (REHs)
  
• Do Standby Costs and Low Patient Volume Affect the Financial Viability of Rural Hospitals?
  Rural hospitals face high fixed costs spread over low patient volumes, raising per-case costs and threatening financial sustainability. This study estimates the "low-volume premium" and examines whether standby costs and patient volume predict rural hospital closures nationally.
  Topics: Hospitals and clinics, Medicare
  
• Economic Impact of Labor and Delivery Unit Closure
  Since 2020, over 100 rural hospitals have closed labor and delivery (L&D) units, leaving most rural areas without local maternity care. These closures may increase travel, worsen maternal outcomes, and affect local economies. This study examines how L&D closures impact county population and labor force size, especially among adults ages 18–49.
  Topics: Healthcare access, Hospitals and clinics, Maternal health
  
• Effect of Rural Hospital Consolidation on Patient Distance to Specialty Services
  Hospital closures and consolidation raise concerns about access as less profitable service lines—obstetrics, cancer, and substance use treatment are less profitable than other specialty service lines—and may be eliminated after mergers. This project examines how consolidation affects spatial access to care.
  Topics: Healthcare access, Hospitals and clinics, Maternal health, Substance use and treatment
  
• Evaluating the Variation in Rural and Urban Hospital Wages and Wage Index Pre- and Post-COVID-19 Pandemic
  The primary purpose of the wage index is to address the differences in labor costs that hospitals experience based on their geographical location.
  Topics: Healthcare financing, Hospitals and clinics, Medicare, Workforce
  
• Financial Consequences of Growth in the Number of Rural Referral Centers
  Since Centers for Medicare & Medicaid Services amended its regulations to allow hospitals in urban areas to reclassify as rural, over 400 hospitals have obtained status as a Rural Referral Center. This project will estimate the costs to hospital Medicare payment and profitability.
  Topics: Healthcare financing, Hospitals and clinics, Medicare
  
• Medicare Disproportionate Share Hospital and Uncompensated Care Payments Since the ACA
  This project will compare disproportionate share hospital payments and uncompensated care payments to rural and urban hospitals for the years 2013-2022.
  Topics: Medicare, Medicare Prospective Payment System (PPS)
  
• Rural-Urban Differences in Medicaid Beneficiary Coverage Transitions
  This study examines rural-urban differences in Medicaid coverage, focusing on churn rates and coverage types. We hypothesize higher churn and lower partial coverage in rural areas, potentially reflecting administrative barriers or lower access to social services, using T-MSIS data stratified by age, rurality, state, sex, and eligibility.
  Topics: Healthcare access, Medicaid and CHIP
  
• The Early Experience of Rural Emergency Hospitals
  Since 2021, North Carolina Rural Health Research Program research has tracked Rural Emergency Hospital (REH) conversions, finding that REHs often serve disadvantaged communities and frequently faced high financial distress pre-conversion. This study compares REH converters with eligible non-converters and estimates the effect of REH conversion on hospital profitability.
  Topics: Healthcare access, Hospitals and clinics, Medicare, Rural Emergency Hospitals (REHs)
  
• Using the FDI to Predict Likelihood of Specific Service Line Outcomes
  Rural hospitals face ongoing threats to service availability, including reductions in key service lines like obstetrics, behavioral health, and hospice. This study explores the potential of the Financial Distress Index (FDI) to inform planning by identifying hospitals at risk of service reductions.
  Topics: Health services, Healthcare financing, Hospitals and clinics
  
• Usual Source of Primary Care for Rural Medicare Beneficiaries Before and During COVID-19
  The global pandemic was highly disruptive to existing health care use patterns, potentially affecting rural America more than urban communities. This study will describe the usual sources of primary care (USC) for rural Medicare beneficiaries before and during COVID-19 to provide insight into how COVID-19 affected USC of Medicare beneficiaries.
  Topics: Federally Qualified Health Centers (FQHCs), Healthcare access, Hospitals and clinics, Medicare, Rural Health Clinics (RHCs)