Zachary Levinson Follow @zlevs100 on Twitter , Jamie Godwin , and Scott Hulver
Published: Feb 23, 2023

Policymakers have had ongoing concerns about the financial health of rural hospitals and the implications  for access to care and the local economy. Rural hospital finances improved during the COVID-19 pandemic as a result of government relief funds. However, industry reports suggest that the outlook for the hospital sector as a whole deteriorated in 2022 as these funds have gone away and due to ongoing effects of the pandemic (such as labor shortages), rising prices, and investment losses. Concerns about the viability of rural hospitals have been cited as one factor that could potentially motivate lawmakers to expand Medicaid in the eleven states that have not already done so. These non-expansion states collectively account for about one-third (34%) of rural hospitals, based on our analysis of 2021 hospital cost report data.

In this data note, we provide a background on rural hospital finances and use hospital cost report data to describe operating margins among rural hospitals before and during the COVID-19 pandemic (see Methods for details). We find that median operating margins among the rural hospitals in our analysis increased earlier in the COVID-19 pandemic, likely as a result of government relief funds, but that these facilities face renewed financial challenges, especially in states that have not expanded Medicaid (Figure 1). Among rural hospitals in non-expansion states, median operating margins were 2.1 percent during the July 2021-June 2022 period and were -0.7 percent when excluding documented relief funds. In Medicaid expansion states, median operating margins dropped, but remained positive even after excluding documented relief funds.

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A new Philadelphia Fed report finds that the loss rate of bank branches in the Third District states of Pennsylvania, New Jersey, and Delaware more than doubled during the pandemic. Here are some of the highlights from the study.

• The three states combined experienced a net loss of 627 branches and a significant increase in the number of banking deserts, census tracts without nearby bank branches, during the pandemic.
• The number of lower-income, non-White, or rural banking deserts increased from six to 11 from 2019 to 2022.
• The share of low- and moderate-income (LMI) individuals living in banking deserts increased by 30 percent.

Increasing bank branch closures are a cause for concern, as banking deserts can limit opportunities for lower-income residents to improve their financial health and accrue wealth.

Read the report.

Telehealth usage increased during the Public Health Emergency (PHE), and this has fueled discussions on the optimum use of telehealth in healthcare delivery. Based on experiences during the PHE, and new applications of telecommunications technologies, this report assesses potential improvements in rural health service delivery, as well as potential unintended consequences that could undermine goals to improve services for currently underserved populations. The assessment is guided by the over-arching framework of the high-performing rural health system (HPRHS), to understand the benefits of telehealth in improving health equity as affecting four pillars of the HPRHS – access, affordability, community health, and quality.

Click here to open the full document.

Principal Authors: Joel M. James, MPH and Keith J. Mueller, PhD (Panel Chair) 

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; Timothy D. McBride, PhD; Nancy E. Schoenberg, PhD

 

A new policy brief is available on the Flex Monitoring Team website: Patient Transfers to and from Critical Access Hospitals During the COVID-19 Pandemic. In this brief, the Flex Monitoring Team describes the volume, barriers, and facilitators of inbound and outbound patient transfers as found in a survey of Critical Access Hospital CEOs.

The Rural Health Value team has released the annual update of the Catalog of Value Based Initiatives for Rural Providers.  This is your “go to” resource for staying current on CMMI payment demos that are germane for rural health care organizations and clinicians. Please share this resource as appropriate with your networks and stakeholders:

Catalog of Value Based Initiatives for Rural Providers
One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).   (2023)

Link:    https://ruralhealthvalue.org/files/Catalog%20Value%20Based%20Initiatives%20for%20Rural%20Providers.pdf

Related resources on the Rural Health Value website:

• Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations – A summary of the changes made to the Medicare Shared Savings Program taking effect January 2023 and 2024. This Rural Health Value analysis outlines how the changes would reduce barriers to participation for potential or reentering ACOs that operate in rural contexts.
• 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, 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.
• Experience in the Pennsylvania Rural Health Model: Barnes-Kasson County Hospital – A critical access hospital in Susquehanna, PA provides insight into their experience participating in the Pennsylvania Rural Health Model, which includes a global budget and transforming care to address community health needs.

Contact information:

Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu

According to a new study, the number of undergraduate public health majors has increased significantly over the past two decades. The study analyzed the popularity of undergraduate public health majors, the demographics of those programs, and the careers their graduates pursue. The increased interest can partially be attributed to the COVID-19 pandemic.

Click here to read the study.

 According to a new report, interoperability – the ability of healthcare providers to exchange electronic health information – continues to improve among hospitals. As of 2021, 88 percent of hospitals engaged in sending and obtaining patient health information electronically.  The rate of availability of outside information at the point of care grew over 20 percent in 2021 reaching 62 percent nationwide.  For rural and small hospitals the rate grew by more than 26 percent, reaching a rate of 48 percent.  Additionally, usage of information received electronically from outside sources by rural and small hospitals increased at twice the rate of hospitals nationally (over 40% vs. over 20%) between 2017 and 2021. The report concludes these less-resourced hospitals are still not on par with their counterparts, indicating the need to continue addressing challenges with having full access to electronic information from external sources.

Among the findings in this policy brief from the RUPRI Center for Rural Health Analysis: gains in services occurred more frequently in hospitals that left healthcare systems, while the majority of service losses occurred in hospitals that joined systems.

 Among the key findings in this study from the Center for Economic Analysis of Rural Health: among rural hospitals at risk of financial distress, closures disproportionately took place in communities with specific sociodemographic characteristics: lower incomes, a lower percentage of college graduates, larger populations, lower percentages of the White population, higher percentages of the Black population, higher child poverty, higher unemployment rates, higher uninsurance rates for those younger than 65, a higher percentage of adults reporting fair or poor health, higher obesity levels, and higher rates of smoking.