The North Carolina Rural Health Research and Policy Analysis Center and the UNC Department of Health Policy and Administration are collaborating with the other rural health research and policy analysis centers in a comprehensive review of the Rural Hospital Flexibility Program (RHFP). The UNC researchers have the lead role in understanding the financial effects of the RHFP on Critical Access Hospitals (CAHs). Along with the other collaborators, UNC will use a combination of primary and secondary data collection to evaluate the program effects. UNC will conduct:

• An extensive telephone survey of the 47 FLEX Coordinators to determine the progress of each state s program and its impact on rural health systems. Questions focus on the conversion process of CAHs, network development and hospital partnerships, improvements in EMS systems, Medicaid payment arrangements for CAHs and recruitment and retention initiatives of the health care providers in rural areas.
• Telephone interviews with state Medicaid agency officials in all states regarding reimbursement policies for services delivered to Medicaid beneficiaries at CAHs. The objectives of the study are to determine if and how Medicaid reimbursement policies differ for CAHs, how those policies were developed, and whether the policies would have a significant affect on rural hospitals eligible for CAH status. This component is a joint project with the University of Southern Maine.
• A financial analysis which will use standard ratio calculations and summary data from Medicare cost reports.
• A balanced scorecard approach to ascertain the positioning of CAHs for long-term strategic success by measuring each hospital s performance in four areas financial perspective, internal perspective, customer perspective, and innovation and learning perspective.

There may be products related to this project; please contact the lead researcher for more information.