Physician Assistant Training Programs Producing Rural PA Research Brief Released

The proportion of physician assistant (PA) graduates who enter practice in rural settings has dropped over the last two decades, though PAs still continue to enter rural practice at a higher rate than primary care physicians. Between 2000 and 2012, 10% of PA training programs produced about 34% of rural PAs; those same programs produced only 14% of all the PAs graduating in the same period. This study identifies the PA training programs that produced high proportions and/or numbers of rural PAs and the program characteristics associated with that success.

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Pilot Testing a Rural Health Clinic Quality Measurement Reporting System Policy Brief Released

More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities, and are therefore an important source of primary care and other essential health services for rural residents. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data on the financial, operational, and quality performance of participating clinics. In light of the significant expansion of quality performance reporting and growing use of performance-based payment approaches, it is critically important that RHCs be able to compete in this changing healthcare market. To this end, we piloted the reporting and use of a small set of primary care-relevant quality measures by a geographically diverse sample of RHCs. This policy brief reports on the results of this pilot with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs.

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Geographic Variation in Risk of Financial Distress among Rural Hospitals Research Brief Released

From 2005 to 2015, 112 rural hospital closures have been identified (North Carolina Rural Health Research Program, 2015). Although six of these closed hospitals have since reopened, the remaining closures impact millions of rural residents in communities that are typically older and poorer, more dependent on public insurance programs, and in worse health than residents in urban communities.

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Prediction of Financial Distress among Rural Hospitals Research Brief Released

From 2005 through 2015, more than 100 rural hospitals have closed their doors to patients in need of inpatient services. To better understand factors affecting rural hospital financial distress and to develop an early warning system to identify hospitals at risk of distress, the North Carolina Rural Health Research Program developed the Financial Distress Index (FDI). The FDI model forecasts the risk of distress in two years using the most currently available hospital financial performance, government reimbursement, organizational characteristics and market characteristics. The objective of the brief, Prediction of Financial Distress among Rural Hospitals, is to: 1) describe the ability of the FDI model to identify a group of rural hospitals facing an increased closure rate and 2) evaluate the potential impact drivers of the FDI model may have on the percent of hospitals at high risk of financial distress and closure.

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2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification

More Americans are now aware of the financial challenges faced by rural hospitals. Media coverage of the 66 rural hospital closures between January 2010 and January 2016 has highlighted the health care access and economic challenges facing rural America. Rural hospital closures are not a new phenomenon – hundreds of rural hospitals closed in the 1980s and 1990s. Recognizing that many rural hospitals are the only health care facility in their community and that their survival is vital to ensure access to health care, federal policymakers created four classifications of rural hospitals that qualify for special payment provisions under Medicare: Critical Access Hospitals (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), and Rural Referral Centers (RRCs). In this brief, the NC Rural Health Research Center compares the profitability of urban hospitals to that of rural hospitals for fiscal years 2012-2014 based on size and rural Medicare payment classifications.

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Geographic Variation in the Profitability of Urban and Rural Hospitals

Between January 2010 and January 2016, 66 rural hospitals have closed, a majority of them in the South. Understanding where some hospitals are succeeding, compared to those that are not, is important as policy makers try to craft sustainable models of health care for rural areas. To help policy makers, researchers, and communities understand which hospitals are likely to be less profitable, the North Carolina Rural Health Research Program’s brief, Geographic Variation in the Profitability of Urban and Rural Hospitals, describes the current geographic variability of hospital profitability by comparing the 2014 profitability of CAHs, other rural hospitals (Medicare Dependent Hospitals, Sole Community Hospitals, and rural PPS hospitals, denoted as “ORHs”) and urban hospitals by census region, census division, and state.

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How Could Nurse Practitioners and Physician Assistants Be Deployed to Provide Rural Primary Care?

New (2014) rural enrollees in the insurance plans available on federal and state exchanges—platinum, gold, silver, bronze and catastrophic plans—are expected to generate about 1.39 million primary care visits per year. At a national level, it would require 345 full-time equivalent (FTE) physicians to provide those visits to new rural enrollees. This study uses data on rural insurance uptake, expected utilization and productivity of physicians, physician assistants (PAs), and nurse practitioners (NPs) to examine how different mixes of physicians, PAs and NPs might be able meet expanding population requirements for care. There is substantial regional variation in the need for providers to meet the needs of new enrollees, with high levels of need found in East North Central, West North Central and South Atlantic Census divisions.

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Quality Measures and Sociodemographic Risk Factors: The Rural Context

Researchers and policymakers have publicly discussed and debated whether or not to adjust provider quality measures for differences in patient characteristics. Lacking in this discussion, however, is a nuanced understanding of how adjustment should be conducted within a rural context and what impact it might have on patients and providers when quality measures are used for benchmarking and payment.

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Graduates of Rural-Centric Family Medicine Residencies: Determinants of Rural and Urban Practice

The researchers surveyed graduates of family medicine residencies with a mission to produce rural physicians to understand physician characteristics, experiences, and attitudes that affected their practice location choices. Influential factors included partner or spouse characteristics, residency experiences, and practice community amenities. Some physicians are clearly self-selected into rural practice, but much needs to be done, particularly during and after residency training, to sustain their interests and to encourage other physicians to embark on rural careers.

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