George H. Pink, PhD

• Current Projects - (5)
• Completed Projects - (22)
• Publications - (23)

Current Projects - (5)

• 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.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  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.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  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.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare financing, 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.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare, Medicare Advantage (MA)
  
• 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.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Federally Qualified Health Centers (FQHCs), Healthcare access, Hospitals and clinics, Medicare, Rural Health Clinics (RHCs)
  

Completed Projects - (22)

• A Comparison of 2017-2019 Uncompensated Care of Rural and Urban Hospitals and a First Look at Uncompensated Care in 2020 and 2021
  This project compared 2017-2019 uncompensated care as a percent of operating expense for rural and urban hospitals and investigated uncompensated care data for 2020 and 2021.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare
  
• Ambulatory Care Provided to Rural Medicare Beneficiaries by Rural and Urban FQHCs, RHCs, and Acute Hospitals
  This project characterized the volume, cost, and case mix of ambulatory care provided to rural Medicare beneficiaries by rural and urban federally qualified health centers (FQHCs), rural health clinics (RHCs), and acute hospitals. The study included urban-rural and geographic comparisons of volume, cost, and case mix by provider type.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health services, Hospitals and clinics, Medicare
  
• Can a Model Predict Financial Distress Among Rural Hospitals?
  This project will extend an existing model of CAH financial distress to other types of rural hospitals. A valid model would be helpful to ORHP and state Offices of rural Health interested in predicting financial distress or closure of rural hospitals.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals (CAHs), Hospitals and clinics
  
• Changes in Care-Seeking After Rural Hospitals Merge
  This project seeks to understand how mergers affect the inpatient care-seeking of markets served by merging hospitals.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare access, Hospitals and clinics
  
• Characteristics of Rural Hospitals at High Risk of Financial Distress
  Updates the Financial Distress Index Model with current hospital and market data. Evaluates changes in risk status and geographic distribution over time. Conducts an in-depth analysis of high risk hospitals.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare financing, Hospitals and clinics
  
• Community and Financial Experience of Medicare Dependent Hospitals in Comparison to Other Rural Hospitals
  This research will investigate the community and financial experience of Medicare Dependent Hospitals (MDHs) in comparison with other rural hospitals. Analysis of the financial experience will include comparison of the long-term profitability of MDHs to other rural hospitals, estimation of the potential profitability consequences of eliminating the payment classification, and estimation of the potential consequences of maintaining the payment classification but failing to update the base year from which costs are trended forward.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
  
• Current and Longer Term Challenges of Rural Hospitals: A Survey of Rural Hospital Executives
  This project involved surveying rural hospital executives about how they will respond to current and long-term challenges related to financial and regulatory burdens.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health reform, Healthcare financing, Hospitals and clinics, Medicare
  
• Decline in Inpatient Volume at Rural Hospitals
  The purpose of this study was to compare the decline in inpatient volume of rural hospitals to urban hospitals and among rural hospitals of different size, region, rurality, and payment type.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare access, Hospitals and clinics
  
• Developing a Financial Performance Measurement System for Critical Access Hospitals
  This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals (CAHs), Healthcare financing
  
• Developing a Post-COVID Financial Distress Index
  This project updated and improved the North Carolina Rural Health Research Program's Financial Distress Index, which uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the current risk of financial distress.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare
  
• Estimating the Number of Hospitals that Might Convert to Rural Emergency Hospitals
  This project reviewed the literature to establish what is known about freestanding emergency centers (FECs) and implications for a rural community. The number and types of rural hospitals that would be eligible to convert to an FEC as an alternative to closure of acute inpatient care was estimated.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health reform, Healthcare access, Healthcare financing, Hospitals and clinics, Medicare
  
• Estimation of the Fixed and Variable Costs of a Rural Emergency Hospital
  This project: 1) informed the design of CMS Rural Emergency Hospital (REH) payment methods, particularly the Medicare monthly additional facility payment; 2) estimated patient break-even volumes for the long-run financial sustainability of REHs; and; 3) provided a tool that rural hospitals can use to estimate the cost of operating a REH.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Legislation and regulation, Medicare
  
• How Have the Sources of Revenue for Rural Hospitals Changed Since 2005?
  Rural hospitals have seen a steadily decreasing average acute daily census. If outpatient revenue is not expanding to fill that decrease, the decrease in patient revenue could further threaten hospital viability.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare financing, Hospitals and clinics, Medicare
  
• Importance of Surgery to Rural Hospital Financial Condition and Market Share
  This study explores the provision of surgical services in rural hospitals and its relationship to financial performance. The percentage of rural hospitals that offer surgical services and the number that have discontinued surgical services over the last decade will be described, and, for those that have discontinued services, the impact on financial condition will be explored.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Hospitals and clinics
  
• Low Volume Hospitals
  This analysis compared rural low-volume hospitals (LVHs) to non-LVH characteristics and estimate the financial impact of eliminating the LVH program and reverting to the original (2005) LVH classification and payment adjustment.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare
  
• Rural Hospital Mergers and Acquisitions - Who is Being Acquired and What Happens Afterwards?
  This study compares the financial and market characteristics of recently acquired rural hospitals to other rural hospitals and investigates the post-acquisition change in services and financial performance of these hospitals. This study will inform rural advocates, federal and state agencies, and regulators as to how mergers and acquisitions (M&As) of small rural hospitals affect access to care for Medicare beneficiaries, and the potential financial consequences of M&As to small rural hospitals.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Healthcare financing, Hospitals and clinics, Medicare
  
• Rural-urban Comparison of Hospital Financial Performance by Medicare Payment Classification
  This project will compare the financial performance of rural and urban short term general hospitals by Medicare payment classifications (PPS only, Medicare dependent hospitals, sole community hospitals, rural referral centers, and critical access hospitals).
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare
  
• The Financial and Community Experience of Sole Community Hospitals in Comparison to Other Rural Hospitals
  This research will investigate the financial and community experience of Sole Community Hospitals (SCHs) in comparison with other rural hospitals. The availability of alternative facilities, and the socioeconomic and demographic characteristics of SCH service areas will be compared to other rural hospital service areas.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS), Rural statistics and demographics
  
• Three Models of a Rural Emergency Hospital
  This project used secondary data about small rural emergency departments and expert opinion to develop three clinical and operational models of a Rural Emergency Hospital (REH). The REH models were based on case mix, service mix, patient volume, clinical staffing, and technology.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Legislation and regulation, Medicare
  
• What Does it Cost to Operate a Rural Free-Standing Emergency Department (RFED)?
  In recent months, there have been numerous media reports of rural hospital closures and the adverse effect on communities. In the face of hospital closure, one alternative for maintaining access to healthcare is a rural free-standing emergency department (RFED).
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals (CAHs), Healthcare financing, Medicare
  
• What Happens after Acute Inpatient Care is No Longer Provided by a Rural Hospital?
  This project will investigate the precursors to closure of acute inpatient care by rural hospitals and the post-closure configuration of health care services in the community.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Hospitals and clinics
  
• What Would be the Financial Consequence of Eliminating Low Volume Hospital Payments?
  Analysis will include comparison of the long-term profitability of low-volume hospitals to other rural hospitals and estimation of the potential profitability consequences of eliminating the payment classification altogether.
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare, Medicare Prospective Payment System (PPS)
  

Publications - (23)