This brief explores the current trend in hospital affiliation from a rural perspective and offers guidance to rural hospital leaders in navigating a potential affiliation. With an understanding of the rural context and challenges facing rural hospitals, risks and opportunities across key areas for consideration are presented, including costs, quality, service delivery and system finances. The brief offers an overview of the affiliation process and how to assess success.

Rural hospitals are anchor institutions in their communities and are the hubs for a host of healthcare services such as emergency care, outpatient care, long term care, and primary care in provider-based rural health clinics. However, rural hospitals are affected by an amalgam of factors which may lead them to consider alternative organizational structures such as participating in local rural health networks and affiliating with large regional health systems.

Read the full report.

Principal Authors: Joel M. James, MPH, Guest Author and Keith J. Mueller, PhD, Chair
Contributing Author: Dan M. Shane, PhD
Prepared by the RUPRI Health Panel: Alva O. Ferdinand, DrPh, JD; Alana D. Knudson, PhD; Jennifer P, Lundblad, PhD, MBA; A. Clinton MacKinney, MD, MS; and Timothy D. McBride, PhD

This work was supported by the Leona M. and Harry B. Helmsley Charitable Trust.

This policy brief used American Hospital Association (AHA) survey data to examine partnerships between hospitals and external organizations to address social needs. Hospitals were stratified by rurality (metropolitan or non-metropolitan) and type—prospective payment system (PPS) or critical access hospital (CAH) as well as by region, ownership status and accountable care organization (ACO) participation. We calculated a partnership score for all hospitals reflective of the number of types of partnerships and the number of ways that hospital partner to address social needs with scores ranging from 0 to 48. We also assessed what types of specific partnerships hospitals indicated.  Key findings are noted below:

• The highest mean community partnership scores were seen in metropolitan PPS hospitals (24.0), followed by non-metropolitan PPS hospitals (20.4) and CAHs (16.8).
• Except for non-metropolitan PPS hospitals in the West, the Northeast had the highest mean partnerships across hospital types.
• Regardless of geography or type (CAH or PPS), non-profit hospitals and those participating in ACOs had higher mean partnership scores.

Most hospitals had partnerships with state and local agencies, though compared to other types of hospitals, a higher proportion of metropolitan PPS hospitals had partnerships with organizations that address specific social needs (e.g., food insecurity).

Authors:  Whitney E. Zahnd, PhD; Khyathi Gadag, MHA; Kristin D. Wilson, PhD, MHA; Keith J. Mueller, PhD

Contact Information: Lead Author: Whitney Zahnd, PhD; whitney-zahnd@uiowa.edu

From Becker’s CFO Report

There are about 418 rural hospitals at risk of closure, according to a new report from Chartis, a healthcare advisory services firm.

The organization analyzed 16 vulnerability indicators and found nine were statistically significant in predicting hospital closures, including: case mix index, Medicaid expansion, average daily census swing, occupancy, government control status and years of negative operating margin. The hospital’s average length of stay and change in net patient revenue also factored into its risk of closure.

States in the Southeast region of the country had the highest percentage of rural hospitals at risk of closure, followed by the Great Plains. The states with the most hospitals vulnerable to closures include:

1. Texas: 45
2. Kansas: 38
3. Nebraska: 29
4. Oklahoma: 22
5. North Carolina: 19
6. Georgia: 18
7. Mississippi: 18

The percentage of rural hospitals at risk of closure by state is as follows:

More than 41% of hospitals
Florida
Tennessee
Nebraska

31% to 40%
Utah
South Dakota
Kansas
Oklahoma
Alabama
North Carolina
South Carolina

26% to 30%
Wyoming
Texas
Louisiana
Arkansas
Mississippi
Georgia

21% to 25%
Missouri
Illinois

16% to 20%
Wisconsin
New York
Massachusetts
Hawaii

10% to 15%
California
Idaho
North Dakota
New Mexico
Indiana
Pennsylvania
Virginia

0% to 9%
Oregon
Montana
Arizona
Alaska
Colorado
Minnesota
Iowa
Michigan
Ohio
Kentucky
West Virginia
Maryland
Rhode Island
Delaware
Connecticut
New Hampshire
Maine
Vermont
Nevada
Washington
New Jersey

For health care professionals, it’s maddening. The technology needed to stop colorectal cancer before it turns deadly has never been better.

Yet in 2024, the American Cancer Society expects it to cause 106,590 new cases and 53,010 deaths. In Pennsylvania, about 34% of those diagnosed with colorectal cancer die from the disease. Though rates have decreased overall, they’re increasing among adults younger than 55.

And in a time when information can circle the globe in nanoseconds, barriers like geography still get between doctors and patients.

Health care professionals are finding higher rates of advanced colorectal cancer in rural areas compared with urban centers, said Dr. Karen Kim, dean of Penn State College of Medicine and Dorothy Foehr Huck and J. Lloyd Huck Chair in Rural Health Research. Also, mortality rates related to the disease are higher in less populated areas “largely because people there tend to be diagnosed in the later stages,” she said.

As a clinician, Kim knows the heartbreak and frustration firsthand. With multiple choices for colorectal cancer screening available, she explained, medical science can stop and prevent this fatal disease. But barriers get between her and some of her patients who need it most.

“Unlike some cancers where we think about early detection, with colon cancer it’s really about finding premalignant lesions before they even become cancer,” she said. “It’s so difficult as a gastroenterologist to continue to watch people die from this preventable disease.”

Kim discussed why people in less populated areas are seeing colon cancer more often than people living in cities, and what you can do to help protect your own health.

Read more.

This new policy brief describes differences in unsubsidized and net-of-subsidy premiums between nonmetropolitan and metropolitan counties in plan design and availability in 2022. Consistent with previous reports of health insurance marketplace (HIM) activity, we report enrollment-weighted plan selection by metal level and premiums paid by number of issuers and by Medicaid expansion status.

Authors: Abigail Barker, PhD; Ayushi Shrivastava, MPH; Eliot Jost, MBA, MPH; Timothy McBride, PhD; Keith Mueller, PhD

Read the full report.

The Heterogeneous Influences of Online Health Information Seeking on Aspirin Use for Cardiovascular Disease Prevention

Authors: Jingrong Zhu, PhD; Yunfeng Shi, PhD; Yi Cui, PhD; Wei Yan, Ph.D., Penn State

Making decisions related to health and healthcare is an important part of life for most consumers. As sources of health information have expanded explosively, consumers’ information seeking and processing in the context of health decision making have also become increasingly complicated.

Previous research has shown that online health information seeking is associated with medication adherence. However, less is known about the factors that moderate such a relationship. This study examines four different sources of health information jointly and their interactive roles in consumers’ decisions on using aspirin for cardiovascular disease (CVD) prevention: the advice from health care providers, prior CVD diagnosis, CVD risk factors due to co-morbidities, and online health information.

Our results indicated that online health information seeking had heterogeneous influences on aspirin use for CVD prevention, depending on other factors such as provider advice, prior CVD diagnoses, and CVD risk factors, and potentially leading to both overuse and underuse.

Find more details about the article here.

America’s rural health safety net has been in crisis mode since 2010. Rural hospital closures, decreasing reimbursements, declining operating margins, and staffing shortages have all coalesced to undermine the delivery of care in communities whose populations are older, less healthy, and less affluent. The mission of the safety net to serve under-resourced communities is unraveling.

The latest research conducted by the Chartis Center for Rural Health points to a startling new phase of this crisis as rural hospitals fall deeper into the red, “care deserts” widen throughout rural communities, and the increasing penetration of Medicare Advantage could further disrupt rural hospital revenue.

Click here to read the report.

A new report shows banking deserts — neighborhoods with no bank branches nearby — are on the rise. From 2019 to 2023, the total number of U.S. bank branches declined by 5.6 percent, the number of banking deserts increased by 217, and the number of Americans living in banking deserts grew by 760,000.

Despite the overall trend toward online banking, older, disabled, and lower-income communities often rely on in-person banking. For people facing other barriers to banking services, having no bank branches nearby could limit opportunities to foster financial health and build wealth.

The report also examines how financial institutions in some communities are working to address the decline of retail bank branches.

Read the report.