Health Affairs

The financial viability of rural hospitals has been a matter of serious concern, with ongoing closures affecting rural residents’ access to medical services. We examined the financial viability of 1,004 US rural hospitals that had consistent rural status in 2011–17. The median overall profit margin improved for nonprofit critical access hospitals (from 2.5 percent to 3.2 percent) but declined for other hospitals (from 3.0 percent to 2.6 percent for nonprofit non–critical access hospitals, from 3.2 percent to 0.4 percent for for-profit critical access hospitals, and from 5.7 percent to 1.6 percent for for-profit non–critical access hospitals). Occupancy rate and charge markup were positively associated with overall margins: In 2017 hospitals with low versus high occupancy rates had median overall profit margins of 0.1 percent versus 4.7 percent, and hospitals with low versus high charge markups had median overall margins of 1.8 percent versus 3.5 percent. Rural hospital financial viability deteriorated in states that did not expand eligibility for Medicaid and was lower in the South. Rural hospitals that closed during the study period had a median overall profit margin of −3.2 percent in their final year before closure. Policy makers should compare the incremental cost of providing essential services between hospitals and other settings to balance access and efficiency.

Access the full article here.

Substance use is a significant public health issue in rural communities. Despite this fact, substance use treatment services are limited in rural areas and residents suffer from significant barriers to care. Critical Access Hospitals (CAHs), frequently the hubs of local systems of care, can play an important role in addressing substance use disorders. To develop a coordinated response to community substance use issues, CAHs must identify and prioritize local needs, mobilize local resources and partnerships, build local capacity, and screen for substance use among their patients. These activities provide a foundation upon which CAHs and their community partners can address identified local needs by selecting and implementing initiatives to minimize the onset of substance use and related harms (prevention), treat substance use disorders, and help individuals reclaim their lives (recovery).

This brief makes the case for why CAHs should address substance use, provides a framework to support CAHs in doing so, describes examples of substance use activities undertaken by CAHs to substantiate the framework, and identifies resources that can be used by State Flex Programs to support CAHs in addressing this important public and population health problem.

The report may accessed here or on the Flex Monitoring Team website.

TRIP is a nonprofit organization researching and evaluating economic and technical data on surface transportation issues.  For this report focused on rural America, TRIP examines deficiencies and identifies needed improvements.  Read the report here.

Feeding America is a national nonprofit researching and responding to insufficient food resources.  In this annual report, the organization provides rates of food insecurity among Americans age 60 or older, with data breakdowns by metropolitan and nonmetropolitan settings.  Read the report here.  A separate report examines food insecurity among adults aged 50-59.

This Issue Brief summarizes the second annual meeting of the CMS Innovation Center AHC Model participants, where they had an opportunity to network and discuss challenges and strategies to address HRSNs.  Highlighted in the brief are challenges and strategies in serving rural communities to address health-related social needs (HRSNs). Read more here.

This brief from the North Carolina Rural Health Research and Policy Analysis Center estimates the impact of potential loss of cost-based reimbursement for swing beds on profitability for Critical Access Hospitals (CAHs) and examines the characteristics of CAHs that would be most affected by such a change in reimbursement. Read more here.

Researchers at the Maine Rural Health Research Center used data from the National Health Interview Survey and national death certificate data, finding that the risk of death at any point in time was 10% higher for rural residents as compared with urban residents. Read more here.

The Flex Monitoring Team has released a new report on the community impact and benefit activities of Critical Access Hospitals (CAHs), rural non-CAHs, and urban hospitals. The report enables State Flex Programs and CAH administrators to compare the community impact and benefit profiles of CAHs nationally to the performance of CAHs in their state.

The report may be found in the link below. Pages 1-5 provide national data with key findings, and pages 6-95 provide state-specific tables. Shortcut links to each state’s tables are at the bottom of page 5.

The report may accessed here or on the Flex Monitoring Team website.

Mochamad Nataliansyah, MD, MPH; Abiodun Salako, PhD; Fred Ullrich, BA; and Keith Mueller, PhD

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created the Medicare Part D outpatient prescription drug program allowing Medicare beneficiaries to add prescription drugs to their Medicare coverage. Within Medicare, beneficiaries can select either a stand-alone Part D Plan (PDP) or Medicare Advantage plan that provides prescription drug coverage (MA-PD plan). Those plans offer an array of payment options and provided benefits. PDPs must offer the same design throughout the region in which they operate so minimal differences across types of counties were found. MA-PD plans were offered in lower numbers in noncore counties (compared to metropolitan and micropolitan counties), were found to have higher monthly premiums and were less likely to offer enhanced benefits. Of most concern, the brief shows that 10.6 percent of noncore counties have no MA-PD plans available, and 8.7 percent have only one plan offered.

 

Please click here to read the brief.