Medicaid Expansion Affects Rural And Urban Hospitals Differently

Kaufman, Brystana G.; Reiter, Kristin L.; Pink, George H.; Holmes, George M.

doi:10.1377/hlthaff.2016.0357

Cited by 48 publications

(55 citation statements)

References 12 publications

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“… 50 Further, states with large rural populations have generally been reluctant to expand Medicaid, which may be related to most rural hospital closures occurring in those states. 51 This may be reflected in the proportion of visits to rural EDs by patients without insurance, which experienced only a 5% decrease compared with a 9% decrease that occurred in urban EDs. In response to these cumulative financial pressures on rural hospitals, some states are experimenting with an alternative payment model of global rural health care budgets.…”

Section: Discussionmentioning

confidence: 99%

Trends in Emergency Department Use by Rural and Urban Populations in the United States

2019

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Key Points Question How do payer status and patient demographic characteristics differ between urban and rural emergency department (ED) visits? Findings In this cross-sectional study of National Hospital Ambulatory Medical Care Survey data, rural ED visit rates increased by more than 50%, from 36.5 to 64.5 per 100 persons, outpacing urban ED visit rates, which increased from 40.2 to 42.8 visits per 100 persons. Rural ED use increased for those aged 18 to 64 years, non-Hispanic white patients, Medicaid beneficiaries, and patients without insurance, with a larger proportion of rural EDs categorized as safety-net EDs. Meaning Rural EDs experienced greater growth in ED use simultaneous with increased pressure as safety-net hospitals.

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Section: Discussionmentioning

confidence: 99%

Trends in Emergency Department Use by Rural and Urban Populations in the United States

2019

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“…In that context, then, programs like BSPAN might struggle to secure local provider participation in their network, as many providers consider Medicaid reimbursement inadequate to cover operational expenses of providing clinical procedures for underserved women. Future research should monitor how such healthcare developments may impact rural regions and affect delivery of care to indigent populations (Allen, Ballweg, Cosgrove, Engle, Robinson, et al, 2013; Kaufman, Reiter, Pink, & Holmes, 2016). …”

Section: Discussionmentioning

confidence: 99%

Assessing local capacity to expand rural breast cancer screening and patient navigation: An iterative mixed-method tool

Inrig

Higashi

Tiro

et al. 2017

Evaluation and Program Planning

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Background Despite federal funding for breast cancer screening, fragmented infrastructure and limited organizational capacity hinder access to the full continuum of breast cancer screening and clinical follow-up procedures among rural-residing women. We proposed a regional hub-and-spoke model, partnering with local providers to expand access across North Texas. We describe development and application of an iterative, mixed-method tool to assess county capacity to conduct community outreach and/or patient navigation in a partnership model. Methods Our tool combined publicly-available quantitative data with qualitative assessments during site visits and semi-structured interviews. Results Application of our tool resulted in shifts in capacity designation in 10 of 17 county partners: 8 implemented local outreach with hub navigation; 9 relied on the hub for both outreach and navigation. Key factors influencing capacity: (1) formal linkages between partner organizations; (2) inter-organizational relationships; (3) existing clinical service protocols; (4) underserved populations. Qualitative data elucidate how our tool captured these capacity changes. Conclusions Our capacity assessment tool enabled the hub to establish partnerships with county organizations by tailoring support to local capacity and needs. Absent a vertically integrated provider network for preventive services in these rural counties, our tool facilitated a virtually integrated regional network to extend access to breast cancer screening to underserved women.

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“… 48 Population controlled for market size. 61 Unemployment rate controlled for local economic conditions 61 and the average community member’s likelihood to seek and ability to pay for health care services. 13 , 30 Region controlled for potential unobserved geographic differences.…”

Section: Methodsmentioning

confidence: 99%

Rural Hospital Mergers Increased Between 2005 and 2016—What Did Those Hospitals Look Like?

Williams

Reiter

Pink

et al. 2020

INQUIRY

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The objective of this study is to determine whether key hospital-level financial and market characteristics are associated with whether rural hospitals merge. Hospital merger status was derived from proprietary Irving Levin Associates data for 2005 through 2016 and hospital-level characteristics from HCRIS, CMS Impact File Hospital Inpatient Prospective Payment System, Hospital MSA file, AHRF, and U.S. Census data for 2004 through 2016. A discrete-time hazard analysis using generalized estimating equations was used to determine whether factors were associated with merging between 2005 and 2016. Factors included measures of profitability, operational efficiency, capital structure, utilization, and market competitiveness. Between 2005 and 2016, 11% (n = 326) of rural hospitals were involved in at least one merger. Rural hospital mergers have increased in recent years, with more than two-thirds (n = 261) occurring after 2011. The types of rural hospitals that merged during the sample period differed from nonmerged rural hospitals. Rural hospitals with higher odds of merging were less profitable, for-profit, larger, and were less likely to be able to cover current debt. Additional factors associated with higher odds of merging were reporting older plant age, not providing obstetrics, being closer to the nearest large hospital, and not being in the West region. By quantifying the hazard of characteristics associated with whether rural hospitals merged between 2005 and 2016, these findings suggest it is possible to determine leading indicators of rural mergers. This work may serve as a foundation for future research to determine the impact of mergers on rural hospitals.

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Medicaid Expansion Affects Rural And Urban Hospitals Differently

Cited by 48 publications

References 12 publications

Trends in Emergency Department Use by Rural and Urban Populations in the United States

Trends in Emergency Department Use by Rural and Urban Populations in the United States

Assessing local capacity to expand rural breast cancer screening and patient navigation: An iterative mixed-method tool

Rural Hospital Mergers Increased Between 2005 and 2016—What Did Those Hospitals Look Like?

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