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.

This report examines trends in emergency department (ED) discharge opioid prescribing for adults from 2006–2007 through 2016–2017. It provides data by selected patient and hospital characteristics and the type of opioids prescribed. Table 1 includes data on the percent of ED patients prescribed an opioid at discharge by location of patient residence for metropolitan and nonmetropolitan areas. Read more here.

This resource is a mapping and data analysis focused on rural communities. It includes a gallery of maps addressing various issues, including maps currently in beta focused on rural healthcare trends, hospital closures, and rural definitions. Find more information here.

This report details the Federal Transit Administration’s (FTA) efforts in improving rural public transit coordination and identifies areas for improvement. It highlights some of the challenges affecting the FTA’s ability to effectively coordinate transportation for rural and tribal areas. Read the overview here. Read the full report here: Full Report

This report provides results from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for calendar year 2018. It summarizes reporting rates and performance among all U.S. Critical Access Hospitals (CAHs). It includes detailed tables that allow state-by-state comparison of response rates and overall CAH performance. Read more here.

This report focuses on the shortcomings of the federal nutrition guidelines in meeting the nutritional needs of older adults. Bases recommendations on interviews with older adults in both rural and urban areas. Read an overview here. Read the full report here: Full Report

This resource provides access to data and digital content from the U.S. Census Bureau. It includes the American Community Survey (ACS) with socioeconomic and demographic data and the ability to narrow to rural data. Find more information here. Historical U.S. Census data is available on American Factfinder.

This article presents results of a cross-sectional county-level study using all reported direct-to-physician pharmaceutical payments from manufacturers of opioid use disorder medications from 2014-2017, as well as demographic and economic data from 3,140 counties. It features statistics with breakdowns by metropolitan, micropolitan, and rural areas. Read more here.