A Research & Policy Brief is available from the Rural Telehealth Research Center.

To address the many challenges in treating behavioral health in rural areas, the Federal Office of Rural Health Policy (FORHP) in the Health Resources and Services Administration (HRSA) established the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) in 2018, funding 14 grantees, and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) in 2017, funding 3 grantees. Concurrently, the Rural Telehealth Research Center (RTRC) worked cooperatively with FORHP to establish data collection protocols and tools on a set of measures that could be used for a cross-grantee evaluation of behavioral health services over their funding periods. This brief details multi-project work to identify the standardized set of measures appropriate to behavioral health, create an Excel-based tool – termed the Behavioral-Telehealth Evidence Collection (B-TEC) Tool- and begin to systematically collect data from the grantees.

Please click here to read the brief.

Rural hospital executives are tasked with broader and more general functions than urban hospital executives who have greater resources to employ area-specific specialists. As such, rural hospital executives have developed and fine-tuned a different skill set than urban hospital executives. This study found four major themes from the many identified skill sets of the Critical Access Hospital (CAH) CEOs interviewed. These “best practices” likely helped contribute to the positive status of the CAHs interviewed and could also be a resource from which other CAHs could find utility.

For this study, the Flex Monitoring Team interviewed 14 CAH CEOs about their perspectives and experiences leading CAHs with a low risk of financial distress despite their operating environment. CEOs described their experiences with financial and quality issues, leadership roles, performance measurement, policy challenges, and community health.

This brief summarizes best practices related to tasks of daily operation, forecasting, and community health outcomes and to craft advice for other CAH CEOs.

This paper may be accessed here or on the Flex Monitoring Team website.

By Brian Whitacre and Roberto Gallardo 

A new dataset gives researchers a different way to measure internet use. What they’ve found is that when the number of “online ventures” goes up, so does the county’s prosperity.

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A new series of policy briefs coauthored by National Rural Health Association member George Pink examines the geographic variability in profitability of urban and rural hospitals; rural hospitals with long-term unprofitability; profitability of urban and rural hospitals by Medicare payment classification; and the broader context of rural hospitals and profitability. Another policy brief coauthored by NRHA members Xi Zhu and Keith Mueller looks at rural hospital participation in Medicare accountable care organizations, summarizing national and regional rates of rural hospital participation and identifying factors associated with ACO participation. Finally, new research coauthored by NRHA member Mark Holmes examines patterns of hospital bypass and inpatient care seeking by rural residents, as hospital bypass, or the tendency of local rural residents to not seek care at their closest hospital, is thought to be a contributing factor for rural hospital closure.

The Flex Monitoring Team has released a new policy brief, Impact of CAH Participation in Flex Financial and Operations Improvement Activities on Hospital Financial Indicators.

Under the Medicare Rural Hospital Flexibility (Flex) Program, states with Critical Access Hospitals (CAHs) are eligible to receive federal funds to support hospital improvement. In this brief, the Flex Monitoring Team explores the impact of participation in financial and operational improvement activities on key hospital financial indicators. Key findings include:

• Compared to CAHs with no participation, CAHs with two years of participation and three years of participation showed increases in total margin of 1.60 and 3.95 percentage points, respectively.
• Compared to CAHs with no participation, CAHs with three years of participation showed a 3.16 percentage point increase in operating margin.
• We found no evidence that one year of participation improved profitability indicators, suggesting that continued participation may be necessary to see changes in financial indicators.
• Because interventions were not randomly assigned, we were unable to determine whether there was a causal relationship between participation and financial performance. Results were sensitive to model specification and should be interpreted with caution.

This paper may be accessed via the link below or on the Flex Monitoring Team website.

The Flex Monitoring Team has released a new policy brief, CAH Medicaid Payer Mix in Expansion vs. Non-Expansion States. In this brief, we compare Medicaid payer mix in 2018 versus 2013 for CAHs in states that have and have not expanded Medicaid.

Since the Affordable Care Act’s (ACA) enactment of Medicaid expansion in 2014, 36 states have decided to expand Medicaid.  The larger number of Medicaid patients has resulted in a substantial increase in Medicaid payer mix (the proportion of a hospital’s net patient revenue provided by Medicaid).  Previous studies have found an association between Medicaid expansion and payer mix among patients hospitalized for certain conditions. This study finds a similar relationship among CAHs in expansion versus non-expansion states. CAHs with the greatest positive changes in Medicaid payer mix are located in expansion states. CAHs with the smallest or negative changes in Medicaid payer mix tend to be located in non-expansion states.

This paper may be accessed here or on the Flex Monitoring Team website.