A new report, A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership, demonstrates several key factors that contribute to rural hospital uncompensated care.  A summary of the key findings is highlighted below.

Uncompensated care are services provided that are never reimbursed, including charity care and unanticipated bad debt. High uncompensated care burden is a concern because it may contribute to smaller operating margins and rural hospital closures.

The purpose of this study is to better understand patterns of uncompensated care. It extends a 2018 study of geographic variation in uncompensated care between rural and urban hospitals. In the current study, researchers use 2017-2019 Medicare Cost Report data to study the association of uncompensated care with net patient revenue, system affiliation, and ownership among Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals.

Key Findings:

• Rural PPS hospitals had the highest uncompensated care median, and urban PPS hospitals had the lowest.
• Furthermore, rural PPS hospitals with less than $20 million in net patient revenue had the highest median uncompensated care, and urban PPS hospitals with less than $20 million had the lowest.
• Hospitals affiliated with a health system had higher median uncompensated care than hospitals not affiliated with a health system.
• Government-owned hospitals had the highest median uncompensated care for rural PPS and urban PPS, while a small number of for-profit CAHs had the highest median uncompensated care across all groups.

Findings suggest that changes to policies and reimbursement that affect uncompensated care could have a differential effect on hospitals, particularly related to Medicare payment designation, size (as measured by net patient revenue), and ownership.

Contact Information:

George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.966.5011
gpink@email.unc.edu

Additional Resources of Interest:

• Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
• Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
• Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
• More information about the North Carolina Rural Health Research and Policy Analysis Center

A new brief, titled Substance Use and Substance Use Disorders by Race and Ethnicity, 2015-2019, describes findings from an analysis of National Survey on Drug Use and Health data to assess whether and how rates of substance use and substance use disorder (SUD) among adults (ages 18 and older) differ by race and ethnicity.

United Health Foundation release of America’s Health Rankings 2023 Annual Report, shows eight chronic conditions have reached the highest prevalence in the report’s history. These include arthritis, asthma, cancer, cardiovascular diseases (CVDs), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), depression, and diabetes.

The report, produced in partnership with the American Public Health Association, provides the longest running state-by-state analysis of the nation’s health, providing a comprehensive look at the health of Americans across 87 measures of health from 28 data sources. The report found that between 2021 and 2022, for example, depression rates grew to 21.7%, impacting close to 54.2 million people. Similarly, prevalence of diabetes rose to 11.5%, or 31.9 million adults. The report also examines disparities, finding, for example, that emergency room visits caused by asthma were 2.5 higher among Black adults compared to white adults, that diabetic Black and Hispanic adults were also less likely than white adults to have their A1c levels under control, and that depression rates were 2.4 times higher among LGBTQ+ people compared to straight people.

A new report from Pennsylvania Partnerships for Children shows that the commonwealth is one of three states where the number of uninsured children increased in 2022 – with 145,000 uninsured children in the state, including nearly 6,000 in Allegheny County. Read more.

The Rural Health Value team is pleased to share a policy paper entitled Advancing Value-Based Payment Policies Relevant to Rural Areas – Continued Challenges and New Opportunities.

Building on RHV’s “How to Design Value-Based Care Models for Rural Participant Success: A Summit Findings Report,” this paper suggests potential Innovation Center and CMS policy opportunities to ensure that all fee-for-service Medicare beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030, and to ensure the inclusion of rural health care providers in CMS models, programs, and quality improvement initiatives.

Related resources on the Rural Health Value website:

• Catalog of Value-Based Initiatives for Rural Providers – Find federal Health and Human Services (HHS) value-based programs that might be appropriate for rural participation. (2023)
• How to Design Value-Based Care Models for Rural Participant Success: A Summit Findings Report – Based on the input from a two-day virtual summit of rural participants in value-based care models and programs, this report summarizes themes and actionable recommendations that can be used by those designing and supporting value-based care models to improve the viability, relevance, and likelihood of rural health care organization participation and success. (2020)

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released the results of their 2022 National Survey on Drug Use and Health and a companion infographic report (PDF). Findings include that more than 23% of adults aged 18 or older had any mental illness in the past year (59.3 million), with 6% suffering from serious mental illness (15.4 million). Among adolescents aged 12 to 17, nearly 20% (4.8 million) had a major depressive episode in the past year.

The 2018-2022 ACS Five-Year Estimates are now available from the U.S. Census Bureau. These estimates provide data for all Pennsylvania counties, municipalities, and other geographic areas regardless of population size. Our latest brief explores trends in language, poverty, and the foreign-born population. For instance, did you know that 50 percent or more of the population age 5 to 17 years old speak Spanish in twenty-two Pennsylvania counties? Click here to read the brief.

To read more about trends at the national level, click here to read the Bureau’s news release.

Additional Data Releases

The Census Bureau is set to release ACS, 5-year Public Use Microdata Sample (PUMS) files and Variance Replicate Estimate (VRE) tables on January 25, 2024. To view the complete release schedule, visit the data year 2022 release schedule. For more information on ACS topics, visit the Subjects Included in the Survey. To access the full set of statistics released today, visit data.census.gov.

Reminder: Proposed 2025 ACS and PRCS Content Changes 

The Census Bureau is inviting public feedback through a Federal Register notice on proposed changes to the 2025 American Community Survey (ACS) and Puerto Rico Community Survey (PRCS). The proposed content for the 2025 ACS and PRCS reflects changes to content and instructions that were recommended as a result of the 2022 Content Test. The Census Bureau periodically conducts tests of new and revised survey content to ensure the ACS and the PRCS meet the data needs of stakeholders.

The changes proposed for 2025 cover several topics: household roster, educational attainment, health insurance coverage, disability, and labor force questions. Additionally, three new questions are proposed to be added to the ACS and the PRCS on solar panels, electric vehicles, and sewage disposal.

The public may submit comments through 11:59pm ET on December 19, 2023.