North Carolina Rural Health Research and Policy Analysis Center

Current Projects

• Alternative Methods for Defining Rural Hospital Service Area Market
  Options for describing the population served by a rural hospital are limited; geopolitical areas such as counties are convenient, but ZIP-based methods may be more accurate. In this project, we will consider multiple options that tradeoff ease, accuracy, ability to capture trends, and availability.
  Topics: Hospitals and clinics, Medicare
  
• 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)
  
• 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
  
• Long-term Implications of Declining Inpatient Revenue on Bed Surge Capacity and Emergency Preparedness
  Inpatient use and key health care services offered at rural hospitals have declined over the past decade. Has the quest for efficiency in hospitals led to a dangerously low surge capacity and ability to effectively handle public health emergencies?
  Topics: Hospitals and clinics, Medicare
  
• Medicare Advantage and Financial, Hospital, and Community Characteristics of Rural Hospitals
  This project will compare financial, hospital, and community differences among rural hospitals located in areas with lower versus higher rates of Medicare Advantage penetration.
  Topics: Hospitals and clinics, Medicare, Medicare Advantage (MA)
  
• 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 Utilization
  Nationwide, approximately 1 in 4 rural residents are insured by Medicaid, yet we lack basic understanding of rural-urban differences in Medicaid utilization.
  Topics: Medicaid and CHIP, Minority health
  
• 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)