Kristin Reiter, PhD

North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.843.8619
Email: reiter@email.unc.edu

University of North Carolina - Chapel Hill

Current Projects - (1)
Completed Projects - (5)
Publications - (19)

Current Projects - (1)

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)

Completed Projects - (5)

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
Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
This study assessed the financial impact of changing Critical Access Hospital (CAH) swing bed reimbursement from the cost-based system to the skilled nursing facility (SNF) prospective payment system (PPS).
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals (CAHs), Healthcare financing, Long-term care, Medicare, Post-acute care
How Have Changes in Insurance Coverage Under Health Reform Affected Uncompensated Care and Financial Performance in Rural Hospitals?
This two-year project will explore the effects of changes in insurance coverage under health reform on the following outcomes in rural hospitals: (1) bad debt; (2) charity care; (3) payer mix (Medicare, Medicaid, other); (3) financial performance; and (4) hospital revenue cycle management. Results will inform federal and state agencies, rural providers and communities as to how implementation of the Patient Protection and Affordable Care Act is impacting reimbursement and financial performance of rural hospitals, allowing the Office of Rural Health Policy to identify emerging challenges and develop strategies or policy changes needed to deal with any unintended consequences.
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Health reform, Hospitals and clinics, Private health insurance, Uninsured and underinsured
How Medicare Payment Standardization Affects the Perceived "Cost" of Post-Acute Care Provided in Critical Access Hospital Swing Beds
Medicare-allowed charges are adjusted for geographic cost differences and payments that support larger Medicare program goals. This study aimed to identify the effects of the payment standardization method on the perceived "cost" of post-acute care provided in Critical Access Hospital swing beds.
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Medicare, Post-acute care
Rural-Urban Variation in CMS Hierarchical Condition Categories (HCC) Risk Scores
CMS uses hierarchical condition categories (HCC) to risk-adjust Medicare beneficiaries for multiple conditions. This adjustment is used for multiple programs, but it's unknown whether the adjustment works similarly in rural and urban areas. This project investigated the distribution of beneficiaries' and providers' HCC risk scores across rurality.
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topic: Medicare

Publications - (19)

2024

Differences in Measurement of Operating Margin: An Update
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
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

Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
Journal Article
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
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.

2022

Key Considerations for a Rural Hospital Assessing Conversion to Rural Emergency Hospital
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2022
Based on findings from a literature review and consultation with practitioners, a conceptual framework and checklist were developed to organize and guide conversations about key considerations for conversion to a Rural Emergency Hospital.
Small Rural Hospitals with Low-Volume Emergency Departments That May Convert to a Rural Emergency Hospital (REH)
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2022
This study profiles rural hospitals eligible to convert to Rural Emergency Hospitals. The objective is to characterize rural hospitals with very low emergency department volume to inform the clinical and operational decisions that will be required to implement this new provider model.

2021

The Effect of Medicare Payment Standardization Methods on the Perceived Cost of Post-Acute Swing Bed Care in Critical Access Hospitals
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2021
The purpose of this study is to describe the effects of current Medicare payment standardization methods on the perceived cost of Critical Access Hospital swing bed care as it relates to the Medicare Spending per Beneficiary measure.

2020

Association of CMS‐HCC Risk Scores With Health Care Utilization Among Rural and Urban Medicare Beneficiaries
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 12/2020
The study examines the relationship between Centers for Medicare & Medicaid Services Hierarchical Condition Categories risk scores and future healthcare utilization among rural and urban Medicare beneficiaries.
CMS Hierarchical Condition Category 2014 Risk Scores Are Lower for Rural Medicare Beneficiaries Than for Urban Beneficiaries
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 12/2020
The study investigates potential differences in rural and urban Centers for Medicare & Medicaid Services Hierarchical Condition Category risk scores by rurality, census region, and beneficiary race or ethnicity.
Estimated Reduction in CAH Proﬁtability From Loss of Cost‐Based Reimbursement for Swing Beds
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 05/2020
The purpose of this study was to estimate the impact of potential loss of cost-based reimbursement for swing beds on Critical Access Hospital (CAH) profitability and to examine the characteristics of CAHs that would be most affected by such a change in reimbursement.

2019

Characteristics of Communities Served by Rural Hospitals Predicted to Be at High Risk of Financial Distress in 2019
Policy Brief
Rapid Response to Requests for Rural Data Analysis
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
Rapid Response to Requests for Rural Data Analysis
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
Rapid Response to Requests for Rural Data Analysis
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.

2018

Average Beneficiary CMS Hierarchical Condition Category (HCC) Risk Scores for Rural and Urban Providers
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2018
This brief investigates potential differences in urban and rural Centers for Medicare & Medicaid Services (CMS) hierarchical condition category (HCC) risk scores at the provider's patient panel level.
Telestroke Adoption Among Community Hospitals in North Carolina: A Cross-Sectional Study
Journal Article
Rural Telehealth Research Center
Date: 05/2018
This study identifies community and hospital characteristics associated with the adoption of telestroke among acute care hospitals in North Carolina.

2017

CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars Is the Problem
Policy Brief
Rapid Response to Requests for Rural Data Analysis
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.

2016

Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2016
Views on how the implementation of the Affordable Care Act's (ACA) expanded insurance coverage is affecting the financial performance of rural hospitals. The study found that while respondents believe the expanded insurance coverage was the right thing to do for patients, they worried coverage may not be adequate to ensure access to care.

2015

Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 11/2015
Examines characteristics of rural hospitals that have merged or were acquired during 2005 and 2012. Also compares the change is rural hospital finances, staffing, or services after the merger or acquisition.
Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2015
Explores the differences of rural hospitals in states with Medicaid expansion and those with nonexpansion, in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013.

2014

Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward?
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2014
A brief from the North Carolina Rural Health Research and Policy Analysis Center examines the implications of mergers and acquisitions for small rural hospitals. The brief addresses the characteristics of rural hospitals that merged and the changes in hospital financial performance, staffing, or services following a merger.

2013

Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2013
This brief is a preliminary assessment of uncompensated care data quality included in Medicare Cost Report Worksheet S-10 for critical access hospitals and other rural hospitals to identify data quality issue implications for research and policy decisions. Worksheet S-10 data were collected from the Healthcare Cost Reporting Information System.