Rural Health
Research Gateway

Tyler Malone, PhD

North Carolina Rural Health Research and Policy Analysis Center

Phone: 919.996.9484
Email: tmalone@email.unc.edu

Cecil G. Sheps Center for Health Services Research
725 MLK Jr. Blvd
Chapel Hill, NC 27516

Current Projects - (2)

  • 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
  • Long-term Implications of Declining Inpatient Revenue on Bed Surge Capacity and Emergency Preparedness
    Inpatient use and key health care services offered at rural hospitals have declined over the past decade. Has the quest for efficiency in hospitals led to a dangerously low surge capacity and ability to effectively handle public health emergencies?
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Hospitals and clinics, Medicare

Publications - (16)

2024

  • An Updated Model of Rural Hospital Financial Distress
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2024
    In fall 2024, the North Carolina Rural Health Research Program completed a study modeling financial distress among rural hospitals, "An Updated Model of Rural Hospital Financial Distress." The model updates a 2016 version, by adding recent changes in the operating environment.
  • Using the Updated Financial Distress Index to Describe Relative Risk of Hospital Financial Distress
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2024
    Using a recent revision of the Financial Distress Index (FDI) model, this study aimed to describe the relative risk of experiencing financial distress for rural hospitals and selected urban hospitals.

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

  • Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2022
    This study examines differences between patients discharged to swing beds versus skilled nursing facilities, stratifying by admitting hospital type (i.e., rural Critical Access Hospital versus rural Prospective Payment System 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.
  • Predictors of Hospital Bypass for Rural Residents Seeking Common Elective Surgery
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    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.
  • Association Between Rural Hospital Service Changes and Community Demographics
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2022
    Research has shown that among rural communities, those with a larger percentage of Black or Hispanic residents were more likely to experience a local hospital closure. This brief explores possible associations between the proportion of a rural community belonging to a AHRQ-identified priority population and local hospital service changes.
  • Trends in Revenue Sources Among Rural Hospitals
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2022
    Possible issues with existing rural hospital financing models suggest that outpatient-centric payment methods may be more effective in providing financial relief to rural hospitals. Given this, we explored the financial importance of outpatient care to rural hospitals by estimating changes in outpatient care as a source of revenue.
  • Predictors of Hospital Choice Among Rural Patients Seeking Elective Surgery: A Scoping Review
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
    Date: 04/2022
    The purpose of this scoping review was to identify literature describing determinants of hospital choice among rural patients seeking elective surgery.
  • The Economic Effects of Rural Hospital Closures
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2022
    This study updates previous research (Holmes, et al. 2006) on the economic effects of rural hospital closures by measuring the economic changes over time among U.S. rural counties that had a hospital closure from 2001-2018.

2021

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.
  • Decline in Inpatient Volume at Rural Hospitals
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 12/2020
    This study examined inpatient volume in rural hospitals between 2011 and 2017. Patient population and the organizational and geographic characteristics of hospitals that were significant predictors of inpatient volume included census region, Medicare payment type, ownership type, total margin, and percent of the population in poverty.
  • Changes in Care-Seeking After Rural Hospitals Merge
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 07/2020
    Rural hospital mergers have increased significantly since 2010. Enhanced financial performance and improved quality are often cited as benefits, but hospital mergers can also lead to changes in the services provided by acquired hospitals. This brief estimates the use of inpatient services delivered by acquired rural hospitals following a merger.
  • Patterns of Hospital Bypass and Inpatient Care-Seeking by Rural Residents
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2020
    Hospital bypass, the tendency of local rural residents to not seek care at their closest hospital, is thought to be a contributing factor for rural hospital closure. The purpose of this brief is to update the knowledge base of determinants of bypass behavior by analyzing state inpatient data from 2014-2016.