Rapid Response to Requests for Rural Data Analysis: Rural Health Research Products & Journal Articles

2024

The First Year of Rural Emergency Hospitals: REHs Serve Relatively Disadvantaged Counties
Policy Brief
Date: 10/2024
This brief looks at community characteristics (socio-economic, race and ethnicity, and health status and access characteristics) of communities with a hospital that converted to a Rural Emergency Hospital (REH) in 2023—the first year of the new rural hospital payment designation.
News Media Coverage of Rural Hospital Closures and the Causes
Policy Brief
Date: 10/2024
This study augments previous research with findings from a structured framework of attributed causes of rural hospital closures through the analysis of news media reports.
Changes in Rural Pharmacy Presence 2023
Policy Brief
Date: 08/2024
This data brief continues the RUPRI Center's series of reports exploring the availability of retail pharmacy services in rural areas of the U.S. It provides information on rural communities that have kept, lost, or gained a retail pharmacy between 2018 and 2023.
2018-23 Profitability of Rural Hospitals by Ownership and System Affiliation
Policy Brief
Date: 06/2024
This study compares the 2018-23 profitability of rural hospitals based on ownership and system affiliation status. The purpose of this brief is to describe the profitability of rural hospitals over a five-year period consisting of two years before and three years after COVID-19.
2018-23 Profitability of Rural Hospitals by With and Without Rural Health Clinics and Long-Term Care
Policy Brief
Date: 06/2024
This study compares the 2018-23 profitability of rural hospitals for hospitals that provide and do not provide long-term care, and that operate and do not operate rural health clinics.
2018‐23 Profitability of Rural and Urban Hospitals by Medicare Payment Designation
Policy Brief
Date: 06/2024
This study compares profitability of three types of hospitals in both urban and rural locations: Critical Access Hospitals, Prospective Payment System-only (PPS) hospitals by number of acute beds, and PPS hospitals with special payment designations hospitals over a five-year period.
Differences in Measurement of Operating Margin: An Update
Policy Brief
Date: 05/2024
This study uses recent Medicare Cost Report data to compare rural and urban hospitals using the three definitions for operating margin. Researchers assess the distribution and extent of extreme values of operating margin.

2023

Medicare Advantage Enrollment Update 2023
Policy Brief
Date: 11/2023
This policy brief continues RUPRI Center's annual update of Medicare Advantage (MA) enrollment including the changes in enrollment in types of MA plans, and health policy changes that may have had an impact.
Rural Emergency Hospital Map and Data
Date: 10/2023
This interactive map tracks hospitals that have converted to Rural Emergency Hospitals since January 2023.
Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
Journal Article
Date: 09/2023
The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.
Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Policy Brief
Date: 08/2023
This brief identifies patterns and trends in Medicare Advantage participation (penetration rates, number of plans, and enrollment), both within and across metropolitan and nonmetropolitan counties.
COVID-19 Vaccination Rates
Policy Brief
Date: 03/2023
This rural data brief provides a longitudinal examination of completion of primary COVID-19 vaccination series in the age-eligible population in metropolitan, micropolitan, and noncore counties.
Medicare Advantage Enrollment Update 2022
Policy Brief
Date: 01/2023
The 2022 report continues the RUPRI Center's annual series of Medicare Advantage (MA) enrollment updates. In addition to tracking overall and nonmetropolitan/metropolitan enrollment, this brief also reports on changes in enrollment in types of MA plans and considers policy changes from previous years that may have impacted MA plan enrollment.

2022

Characteristics of Rural Hospitals Eligible for Conversion to Rural Emergency Hospitals and Three Rural Hospitals Considering Conversion
Policy Brief
Date: 12/2022
This brief presents 2021 data for Rural Emergency Hospital (REH)-eligible hospitals, compares financial and operational measures of three rural hospitals that have expressed interest in REH conversion to all REH-eligible hospitals, and discusses what factors may ultimately determine the number of rural hospitals that convert to REH.
Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22
Policy Brief
Date: 08/2022
Since the 2014 implementation of Health Insurance Marketplaces (HIMs), considerable changes have been observed in the number of insurance companies offering plans across the United States. This policy brief describes changes in HIM plan issuers over the 2014-2022 period with an emphasis on variation across metropolitan and non-metropolitan places.
Predictors of Hospital Bypass for Rural Residents Seeking Common Elective Surgery
Journal Article
Date: 08/2022
This article used Healthcare Cost and Utilization Project State Inpatient Databases to evaluate rates and predictors for patients bypassing rural hospitals for common procedures.
Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021
Policy Brief
Date: 08/2022
Independently owned retail pharmacies in rural areas experienced a higher rate of closure than micropolitan and metropolitan areas. Closures have raised concerns about access to prescription medications as well as pharmacist-provided primary care services, which are often the sole source in rural areas for obtaining health services.
Types of Rural and Urban Hospitals and Counties Where They Are Located
Policy Brief
Date: 07/2022
The purpose of this brief is to provide a snapshot of the types of rural and urban hospitals and the counties where they are located.
Predictors of Hospital Choice Among Rural Patients Seeking Elective Surgery: A Scoping Review
Policy Brief
Date: 04/2022
The purpose of this scoping review was to identify literature describing determinants of hospital choice among rural patients seeking elective surgery.
Rural Hospital Profitability During the Global COVID-19 Pandemic Requires Careful Interpretation
Policy Brief
Date: 03/2022
Many small rural hospitals struggle with profitability compared to their urban counterparts. The findings brief describes the pre-pandemic (2011-19) trend of rural hospital profitability and explains why possible increases in reported profitability during the pandemic (2020-21) may mask the long-term financial challenges of rural hospitals.
Rural Hospitals That Closed Between 2017‐20: Profitability and Liquidity in the Year Before Closure
Policy Brief
Date: 01/2022
This brief examines the preclosure profitability and liquidity performance of rural hospitals that closed between 2017‐20 and compare it to the median performance of rural hospitals that remained open during the same year.

2021

2021 CMS Hospital Quality Star Ratings of Rural Hospitals
Policy Brief
Date: 10/2021
The purpose of this study is to 1) compare the 2021 CMS Hospital Quality Star Rating results for rural and urban hospitals, 2) to compare the 2021 and 2016 CMS Hospital Quality Star Rating results for rural hospitals, and 3) to identify implications for the usefulness of the CMS Hospital Quality Star Ratings for rural hospitals.
COVID-19 Cases and Vaccination Rates
Policy Brief
Date: 09/2021
This data brief examines the relationship between vaccination rates, COVID-19 one-week incidence and metropolitan/nonmetropolitan location. Additional information is provided for Census regions and individual states.
Medicare Advantage Enrollment Update 2021
Policy Brief
Date: 09/2021
The RUPRI Center's annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. However, between 2020 and 2021 the rate of growth in nonmetropolitan counties was more than twice as large as that in metropolitan counties.
Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
Policy Brief
Date: 09/2021
The purpose of this brief is to describe differences in Medicare Outpatient Prospective Payment System (OPPS) payments between rural and urban hospitals by Medicare payment classification and by number of acute beds.
Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties
Date: 08/2021
This data brief shows the spread of COVID-19 confirmed cases across the U.S., highlighting metropolitan and nonmetropolitan counties with confirmed cases of, and deaths from, COVID-19.
County-Level 14-Day COVID-19 Case Trajectories
Date: 08/2021
Many locations in the U.S. are relaxing their community-level COVID-19 mitigation measures. But one of the key "gating" indicators for doing this is a downward trajectory of new cases during a 14-day period. The rural data brief examines county-level 14-day trajectories for new confirmed COVID-19 cases.
COVID-19 Cases and Deaths, Metropolitan and Nonmetropolitan Counties Over Time (Update)
Report
Date: 08/2021
This data brief compares seven-day moving average COVID-19 incidence and mortality rates between metropolitan, micropolitan, and noncore counties in the U.S. The brief is updated twice a month.
Medicare Advantage Enrollment Update 2020
Policy Brief
Date: 05/2021
This annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. The percent of nonmetropolitan MA enrollees in Health Maintenance Organization (HMO) plans has increased every year since 2017. Metropolitan HMO enrollment has decreased every year since 2016.
Pharmacy Vaccination Service Availability in Nonmetropolitan Counties
Policy Brief
Date: 02/2021
Pharmacies will play a role in administering the COVID-19 vaccination to the general public. But there are many rural locations in the U.S. where pharmacy resources are limited. This rural data brief examines the availability of pharmacies capable of delivering COVID-19 vaccinations in nonmetropolitan areas.

2020

Rural Hospitalizations for COVID-19: Snapshot on December 10, 2020
Date: 12/2020
U.S. Department of Health and Human Services data were analyzed to compare rural and urban hospitals on two metrics: 1) the percentage of hospitalized patients with COVID-19, and 2) the percentage of hospital beds occupied by patients that have COVID-19.
Rural Hospitals Have Higher Percentages of Patients With COVID-19
Date: 12/2020
U.S. Department of Health and Human Services data were analyzed to compare the percentage of hospitalized patients with COVID-19 in rural versus urban hospitals.
Medicare Advantage Enrollment Update 2019
Policy Brief
Date: 10/2020
The annual update on Medicare Advantage (MA) shows that both metropolitan and nonmetropolitan enrollment has continued to grow for more than 10 years. However, the rate of growth has been higher in nonmetropolitan counties for the past two years. Local Preferred Provider Organization plans account for nearly half of nonmetropolitan MA enrollment.
A Comparison of Rural and Urban Specialty Hospitals
Policy Brief
Date: 09/2020
This brief describes key differences between specialty hospitals located in rural versus urban areas.
Urban Hospitals With a High Percentage of Inpatient Days for Rural Patients
Policy Brief
Date: 09/2020
The purpose of this brief is to describe characteristics of urban hospitals with a high percentage of inpatient days for rural patients and to compare how they differ from urban hospitals with lower percentages of rural inpatient days.
Telepharmacy Rules and Statutes: A 3-Year Update for All 50 States
Policy Brief
Date: 07/2020
This policy brief analyzed administrative rules and legislative statutes governing each state's pharmacy practice. Key features of telepharmacy regulations were investigated for comparative analysis. Twenty-one states currently authorize retail telepharmacy, but between these states the regulatory activity varies considerably.
Geographic Variation in the 2018 Profitability of Urban and Rural Hospitals
Policy Brief
Date: 04/2020
This study describes the geographic variability in 2018 profitability of Critical Access Hospitals, other rural hospitals, and urban Prospective Payment System hospitals by census region, census division, and state.
Rural Hospitals With Long-Term Unprofitability
Policy Brief
Date: 04/2020
The purpose of this study is to examine the characteristics of rural hospitals that had negative total margins in 2016, 2017, and 2018. We examined net patient revenue, Medicare payment classification, region, and state for 311 rural hospitals.
Understanding the Broader Context of Rural Hospitals and Profitability
Date: 04/2020
The intent of this infographic is to quantify rural hospital profitability in the broader context of all hospitals. This infographic compares the number of rural and urban hospitals and rural and urban operating revenue and operating income.

2019

2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals
Policy Brief
Date: 05/2019
This brief characterizes rural/urban disparities in the 2019 Centers for Medicare & Medicaid Services hospital wage index by describing and comparing the wage indices of rural and urban hospitals by the number of beds, the amount of net patient revenue, and Medicare payment classification.
Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
Policy Brief
Date: 05/2019
This brief describes the geographic variation of the 2019 Centers for Medicare & Medicaid Services hospital wage index by rural/urban definition, census region, Frontier and Remote Area codes and state.
Characteristics of Communities Served by Rural Hospitals Predicted to Be at High Risk of Financial Distress in 2019
Policy Brief
Date: 04/2019
This brief compares characteristics of communities served by rural hospitals predicted to be at high risk of financial distress to those served by rural hospitals predicted to not be at high risk of financial distress in 2019.
Geographic Variation in the 2019 Risk of Financial Distress Among Rural Hospitals
Policy Brief
Date: 04/2019
This brief investigates 2019 geographic variation in risk of financial distress among rural hospitals.
Trends in Risk of Financial Distress Among Rural Hospitals, 2015 to 2019
Policy Brief
Date: 04/2019
This brief investigates 2015 to 2019 trends in risk of financial distress among rural hospitals by census region and Medicare payment classification.

2017

Rural-Urban Variations in Medicare Live Discharge Patterns From Hospice, 2012-2013
Policy Brief
Date: 09/2017
This brief 1) provides an overview of the geographic distribution of "freestanding" (i.e., rather than those co-located in a hospital, home health agency, or skilled nursing facility) rural and urban hospices and, 2) explores live discharge rates for hospices operating in rural versus urban areas.
CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars Is the Problem
Policy Brief
Date: 06/2017
The purpose of this brief is to look more closely at the characteristics of rural hospitals with and without CMS Hospital Quality Star Ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.
Rural Health Snapshot (2017)
Date: 05/2017
The Rural Health Snapshot (2017) updates the 2010 Rural Health Snapshot. The document is a data sheet that compares a selection of health and healthcare access indicators for populations in rural and urban areas.

2013

Change in Profitability and Financial Distress of Critical Access Hospitals From Loss of Cost-Based Reimbursement
Date: 12/2013
Changes to Critical Access Hospitals' reimbursement, such as a reversion to prospective payment, would have marked negative effects on CAHs. About three quarters of CAHs would operate at a loss. The number of CAHs at high risk for financial distress would nearly triple, and nearly half would be at medium-high to high risk of financial distress.
Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close
Date: 12/2013
Changes to Critical Access Hospitals' reimbursement may spur some to close. This analysis considers the communities served by the 93 CAHs with the lowest profitability and therefore most likely to close due to a change in Medicare reimbursement.
Rural/Urban Differences in Inpatient Related Costs and Use Among Medicare Beneficiaries
Date: 12/2013
Medicare beneficiaries who are admitted to rural hospitals tend to have lower outpatient costs than their counterparts at urban hospitals. The differences are due to multiple factors. The analysis suggests that consideration of the total cost of an acute episode of care might be considered, not just the cost of the acute inpatient stay.
March 2013: Medicare Advantage Update
Date: 09/2013
This policy brief discusses current rural Medicare Advantage enrollment data.
September 2012: Medicare Advantage Enrollment Update
Date: 04/2013
This policy brief discusses current rural Medicare Advantage enrollment data.

2011

Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 (Final Report)
Date: 04/2011
This report provides descriptive evidence on current trends in the availability and use of swing beds and skilled nursing facility services in rural areas.

2010

Rural Health Snapshot 2010
Date: 08/2010
The Rural Health Snapshot displays selected indicators of access to healthcare, health behavior/risk factors, and mortality rates, comparing rural to urban residents.

2009

Profile of Sole Community Pharmacists' Prescription Sales and Overall Financial Position
Date: 08/2009
We conducted a survey of community pharmacists who owned the only retail outlets in their communities. Pharmacist-owners in independent pharmacies located at least 10 miles from the next closest retail pharmacy were interviewed to determine their reliance on prescription sales and to understand their stores' current financial positions.