NORC Walsh Center for Rural Health Analysis
Research Products & Journal Articles
Browse the full list of research publications from this Rural Health Research Center.
Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.
Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.
2010
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The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Final Report)
Date: 08/2010
This report discusses the impact of rurality on office-based physicians' participation in the 2007 Physician Quality Reporting Initiative (PQRI). PQRI offers a financial incentive to physicians and other eligible professionals who successfully report quality measures related to services provided under the Medicare Physician Fee Schedule. -
The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Policy Brief)
Policy Brief
Date: 08/2010
Rural practices may be at a disadvantage with respect to participating in the Physician Quality Reporting Initiative, not necessarily because of their geographic location, but because they tend to be smaller and have fewer resources and a less developed quality measurement infrastructure. -
Use of Emergency Departments for Conditions Related to Poor Oral Health Care
Date: 08/2010
Persistent and worsening shortages of oral healthcare providers in rural areas, combined with limited acceptance of Medicaid and the Children's Health Insurance Program, have left many patients without adequate access to dental care. -
Alternatives to the Outpatient Prospective Payment System: Assessing the Impact on Rural Hospitals
Date: 04/2010
The purpose of this policy brief is to explore alternatives to the outpatient prospective system and how these options would affect rural hospitals.
2009
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Satisfaction With Practice and Decision to Relocate: An Examination of Rural Physicians
Date: 05/2009
The goal of this project was to improve our understanding of the dynamics of physician practice location decision making. -
Achieving Success in QIO and Rural Hospital Partnerships (Final Report)
Date: 02/2009
This report describes four case studies that highlight the strategies employed by Quality Improvement Organizations (QIOs) to help small rural hospitals implement successful quality-improvement initiatives.
2008
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Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
Date: 10/2008
This brief presents research conducted to better understand critical access hospitals' (CAHs') experiences in operating emergency medical service (EMS) units. The benefits and challenges that CAH providers face in operating EMS services are discussed. -
Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services (Final Report)
Date: 08/2008
This study examined Medicare Cost Report and claims data for hospitals before and after critical access hospital (CAH) conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility. -
Urban-to-Rural Evacuation: Planning for Rural Population Surge (Final Report)
Date: 08/2008
This study assessed the likelihood of urban evacuation to rural areas and provides recommendations for rural planning and response. -
Financing Rural Public Health Activities in Prevention and Health Promotion (Final Report)
Date: 06/2008
This is the final report of a study to determine whether the flow of federal resources, from federal agencies, through states, and to communities, is influenced by state- and local-level public health infrastructure. -
Rural Public Health Financing: The Relationship Between Infrastructure and Local Program Funding
Policy Brief
Date: 06/2008
This study's purpose was to describe how federal funds for selected chronic disease prevention and health promotion activities are distributed to local health departments and non-governmental organizations at the local level and to identify infrastructure-related barriers that rural agencies may face in securing and using funds for such purposes. -
Critical Access Hospitals' Experience With Medicare Advantage Plans
Date: 03/2008
This report details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage plans.
2007
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Spontaneous Evacuation Following a Dirty Bomb or Pandemic Influenza: Highlights From a National Survey of Urban Residents' Intended Behavior
Date: 11/2007
This policy analysis brief reports the results of a national survey to assess the evacuation intentions of urban citizens following emergency scenarios. It includes information on how likely it would be for evacuees to go to rural or urban areas and discusses the potential impact of an urban evacuation on rural areas. -
Rural Hospitals' Experience With the 340B Drug Pricing Program
Policy Brief
Date: 09/2007
This policy brief describes the results of surveys of rural hospitals participating in the 340B drug-pricing program and of rural eligible but non-participating hospitals. It includes information on factors affecting participation in the program and the benefits and challenges of participation. -
How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
Policy Brief
Date: 07/2007
This policy brief examines the financial effect that changes in current Medicare bad debt payment policy, as proposed in the FY2007 budget, might have on rural hospitals. -
340B Drug Pricing Program: Results of a Survey of Participating Hospitals
Date: 05/2007
This report presents survey results of pharmacy directors at rural hospitals buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program, the program's financial impact, and which program features presented barriers to its broader implementation. -
Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals
Policy Brief
Date: 04/2007
This policy brief reports findings from a national survey of rural hospitals designed to investigate how differences among the hospitals affect their implementation of health information technology. -
Urban-to-Rural Evacuation: Planning for Population Surge
Policy Brief
Date: 04/2007
This policy brief discusses disaster planning and how rural preparedness officials face significant informational, organizational, and infrastructural constraints in their abilities to prepare for a potential population surge from urban areas. -
Why Are Fewer Hospitals in the Delivery Business?
Date: 04/2007
This study examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. It looks at potential causes for this trend and explores the effects of medical malpractice reforms. -
Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals (Working Paper)
Date: 02/2007
This paper reports the full findings from a national survey of rural hospitals designed to investigate how differences among the hospitals affect their implementation of health information technology. -
340B Drug Pricing Program: Results of a Survey of Eligible but Non-Participating Rural Hospitals
Date: 01/2007
This paper summarizes the results of a 2006 survey of pharmacy directors at rural hospitals that are eligible but currently not participating in the 340B Drug Pricing Program, which enables certain types of safety-net organizations to obtain discounted outpatient medications.
2006
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Roadmap for the Adoption of Health Information Technology in Rural Communities
Date: 08/2006
This report assists rural providers who are just beginning their investigations into using health information technology and its applicability to their organizations. -
Attention From the Top: Roles of State Offices of Rural Health Policy in Preparing for Bioterrorism and Other Health System Emergencies
Date: 07/2006
This report presents results from a follow-up survey of directors of state offices of rural health on emergency preparedness in rural communities. -
Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes
Date: 05/2006
This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes and to ascertain whether there are agency characteristics that are associated with better or worse outcomes. -
Rural Public Health Infrastructure: Case Studies to Assess the Impact of Structure on Service Delivery
Date: 01/2006
The purpose of this study is to contribute to a more thorough understanding of how public health governance affects how states structure and organize the delivery of public health services and how this influences the strategies adopted for meeting community public health needs in rural areas.
2005
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Contracting With Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
Policy Brief
Date: 12/2005
This policy brief summarizes the experience of critical access hospital (CAH) administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. -
Revisions to Medicare's Disproportionate Share Payment Policy to Incorporate Bad Debt and Charity Care
Date: 09/2005
This report investigates the impact of possible changes to the Medicare disproportionate share payment policy, designed to incorporate information on the hospital's uncompensated care burden as well as to improve the payment formulae. -
Utilization of Home Health Services Among Rural Medicare Beneficiaries Before and After the PPS
Date: 08/2005
This report describes a study conducted on the rural effects of the PPS, including whether the PPS contributed to changes in the demographic and clinical characteristics of home care users, the likelihood of using each of six home care disciplines, and the intensity of services. -
Home Health Payment Reform: Trends in the Supply of Rural Agencies and Availability of Home-Based Skilled Services
Date: 03/2005
Findings from this study suggest that changes in home health reimbursement were associated with dramatic reductions in the supply of home care agencies; however those reductions appear to have occurred primarily during the time in which the Interim Payment System was in place. -
Patterns of Post-Acute Utilization in Rural and Urban Communities: Home Health, Skilled Nursing, and Inpatient Medical Rehabilitation
Date: 03/2005
This report describes rural Medicare beneficiaries' patterns of post-acute utilization of home health services, skilled nursing facilities, and inpatient rehabilitation facilities. -
Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy
Journal Article
Date: 2005
Examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. The authors conclude that rural hospitals are not disproportionately harmed by the post-acute-care transfer policy.
2004
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Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
Date: 08/2004
This policy paper provides, in chart form, sections of the MMA that were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policy makers. -
Exploring the Impact of Medicare's Post-Acute Care Transfer Payment Policy on Rural Hospitals
Date: 07/2004
This policy analysis brief describes a change in Medicare post-acute transfer payment policy and its impact on rural and urban hospitals. It includes data on the financial impact and hospital discharge behavior before and after the change. -
Access To Primary Care and Quality of Care in Rural America
Date: 06/2004
This report provides findings from a population-based study addressing the impact of the availability of healthcare resources on the rate of potentially avoidable hospitalizations. It suggests shortcomings with previous research conducted in communities that experienced problems accessing primary care services. -
Rural Implications of Medicare's Post-Acute Care Transfer Payment Policy
Date: 06/2004
This study examines the behavioral and financial impacts of the initial 10-DRG policy and projects the likely financial impact of extending the policy to cover additional DRGs or discharges to swing beds. -
Perspectives of Rural Hospitals on Bioterrorism Preparedness Planning
Date: 04/2004
Representatives from several rural hospitals met to discuss various aspects of bioterrorist preparedness in terms of workforce and training, physical capacity and supplies, communication, and coordination with other entities. -
Understanding the Role of the Rural Hospital Emergency Department in Responding to Bioterrorist Attacks and Other Emergencies: A Review of the Literature and Guide to the Issues
Date: 04/2004
This report reviews issues affecting rural hospitals' levels of readiness for a bioterrorist attack. Issues examined include physical capacity, sufficiency of health personnel, preparedness plans, disease surveillance systems, and communication/coordination. Concerns about funding cut across all the issues of preparedness. -
Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Requirements
Date: 03/2004
Rural hospitals in this study recognized the importance of ensuring the confidentiality of patient health information and have made substantial progress in achieving compliance with HIPAA privacy standards. Each recognized that additional work will be required to effectively secure patient privacy. -
Financially Distressed Rural Hospitals in Four States
Date: 01/2004
The effect of the outpatient prospective payment system on the financial performance of rural hospitals was simulated in four states: Iowa, Texas, Washington, and West Virginia. -
Medicare Home Health Care in Rural America
Policy Brief
Date: 01/2004
This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies.
2003
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Survey of Critical Access Hospital (CAH)-Affiliated Emergency Medical Service (EMS) Providers
Date: 09/2003
This survey provides a description of emergency medical services providers in rural communities, particularly those with critical access hospitals. -
Rural Hospitals' Strategies for Achieving Compliance With HIPAA Privacy Regulations: Case Studies of Rural Hospitals
Date: 08/2003
Rural hospitals in this study recognized the importance of ensuring the confidentiality of patient health information and have made substantial progress in achieving compliance with HIPAA privacy standards. Each recognized that additional work will be required to effectively secure patient privacy. -
Who Receives Inpatient Charity Care in California?
Date: 08/2003
This policy analysis brief examines the results of a study regarding how California hospitals determine charity care. -
Medicare Home Health Care in Rural America (Full Report)
Date: 06/2003
This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies. -
Rural Beneficiaries' Projected Drug Coverage Under Three Medicare Prescription Drug Proposals
Date: 06/2003
This study estimates the expected increase in urban and rural Medicare beneficiaries eligible for drug coverage under three Medicare prescription drug proposals. It also gives an estimate of the urban and rural per capita federal payments for drug coverage under the proposals. -
Designing a Medicare Drug Benefit: Balancing Government-Based and Market-Based Approaches, the Implications for Rural Beneficiaries
Date: 01/2003
This study examines the relationship between various Medicare prescription drug benefit design characteristics and their impact on rural areas based on analysis of competing legislative proposals. -
2003 Index of Hospital Quality
Date: 2003
Published annually by U.S. News & World Report, this report describes a series of factors regarding ranking of measuring hospital quality.
2002
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Rural Dimensions of Medicare Reimbursement for Inpatient and Outpatient Institutional and Physician Services
Date: 12/2002
This report examines major Medicare payment policies from the rural perspective and summarizes major payment policies with explicit rural dimensions that directly affect physicians and hospitals. It looks at whether direct rural impacts are consistent with legislative and regulatory intentions. -
Achieving Equity in Medicare Disproportionate Share Payments to Rural Hospitals: An Assessment of the Financial Impact of Recent and Proposed Changes to the Disproportionate Share Hospital Payment Formula
Journal Article
Date: 09/2002
Examines how Benefits Improvement and Protection Act revisions to the Medicare disproportionate share hospital (DSH) program are likely to affect rural hospital financial performance. The study shows that paying rural hospitals based on the rules used for urban hospitals could improve access to care in rural communities. -
Federal Funding for Emergency Medical Services
Date: 07/2002
This report includes recent trend data from 1994 to the present on aggregate federal spending on emergency medical services (EMS) and funding targeted explicitly to rural areas. It also discusses the role various federal agencies have played and traces the history of federal legislation to support EMS programs. -
Are Fundamental Changes to Medicare's Disproportionate Share Methodology Needed?
Date: 06/2002
This study examines whether the Medicare disproportionate share percentage is a useful predictor of Medicare costs per adjusted discharge and whether it is a good predictor of uncompensated care burdens. -
Capital Needs of Small Rural Hospitals
Date: 05/2002
This report examines the capital situation of rural hospitals with fewer than 50 beds to determine the total cost of bringing each facility into compliance with current laws, as well as the facilities' cost of borrowing and ability to borrow. -
Variance in the Profitability of Small-Town Rural Hospitals (Policy Brief)
Date: 04/2002
This policy brief discusses why some rural small-town hospitals are financially successful and others struggle with persistent financial difficulties. -
Essential Research Issues in Rural Health: The State Rural Health Directors' Perspective
Date: 03/2002
This policy brief describes the key issues confronting state rural health directors. Issues repeatedly raised by directors from a wide variety of states included workforce, telemedicine, emergency medical services, mental health, and lack of local data. -
How State Rural Health Directors Obtain Policy-Relevant Research Information
Date: 03/2002
This policy brief summarizes how information pertinent to rural health policy activities of the state offices is obtained. -
Variance in the Profitability of Small-Town Rural Hospitals (Full Report)
Date: 02/2002
This report documents the variance in profitability among small-town rural hospitals and evaluates the characteristics that distinguish highly profitable small-town hospitals from struggling ones. It also reports on strategies that small-town hospital administrators are using to achieve financial success.
2001
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Quality of Medicare Outpatient Claims Data and Its Implications for Rural Outpatient Payment Policy
Date: 12/2001
This study analyzes Medicare outpatient claims to see if the relatively poor quality of small rural hospitals' claims data have amplified the negative effects of the new payment system on small hospitals. -
Establishing a Fair Medicare Reimbursement for Low-Volume Rural Ambulance Providers
Date: 07/2001
This national study of ambulance transport costs looks at the advantages and disadvantages of several options for Medicare to compensate low-volume rural ambulance providers. -
Is the Rural Safety Net at Risk? Analyses of Charity and Uncompensated Care Provided by Rural Hospitals in Washington, West Virginia, Texas, Iowa, and Vermont
Date: 01/2001
This study examines recent trends in the provision of charity care and uncompensated care by rural hospitals in five states. It also identifies rural communities whose charity and uncompensated care may diminish if their hospitals face more intense financial pressures as a result of the Balanced Budget Act. -
Will the Outpatient Prospective Payment System Increase the Number of Distressed Rural Hospitals in Iowa, Texas, Washington, and West Virginia?
Date: 01/2001
This study simulates the financial impact of the outpatient prospective payment system rates and estimates the number and type of rural hospitals in the five states likely to become financially distressed as a result of its implementation.
2000
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Data Sources for Studying Uncompensated Care Provided by Rural Hospitals
Date: 08/2000
This policy analysis brief discusses data sources related to hospitals' provision of charity and uncompensated care. -
Potential Supply-Side Implications of the BBA Limits on Reimbursement to Provider-Based Rural Health Clinics
Date: 06/2000
This policy analysis brief examines whether provider-based (typically hospital operated) rural health clinics are likely to close due to the reimbursement cap introduced by the Balanced Budget Act of 1997. -
Medicare Reforms: The Rural Perspective
Date: 04/2000
This policy analysis brief discusses Medicare reforms considered by the National Bipartisan Commission on the Future of Medicare (created by the Balanced Budget Act of 1997), including prescription drug coverage, funding graduate medical education, and increasing the eligibility age. -
Rural Home Health Agencies: The Impact of the Balanced Budget Act
Policy Brief
Date: 04/2000
This policy analysis brief examines how the characteristics of rural and urban Medicare-certified home health agencies differ, estimates the impact of interim payment system on these agencies, and discusses policy implications for a Medicare home health prospective payment system. -
Rural and Urban Patterns of Home Health Use: Implications for Access Under the Interim Payment System
Policy Brief
Date: 03/2000
This policy analysis brief compares patterns of home health utilization among rural and urban Medicare beneficiaries in order to estimate the potential impact of an interim payment system on access to home care in rural areas of the country.
1999
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Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Full Report)
Report
Date: 11/1999
The State Children's Health Insurance Program (CHIP) provides states with an important source of funding to help low-income, uninsured children overcome financial barriers to medical care. CHIP may be especially important in covering children living in rural areas. This study qualitatively assesses CHIP outreach, enrollment, and provider issues. -
Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Policy Brief)
Policy Brief
Date: 11/1999
The State Children's Health Insurance Program (CHIP) provides states with an important source of funding to help low-income, uninsured children overcome financial barriers to medical care. This policy analysis brief assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia.
1998
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Anticipating the 1997 State Children's Health Insurance Program: What's Current in Five Rural States?
Date: 01/1998
This study examines aspects of existing children's health insurance or health services for low-income, uninsured children.