Medicare Advantage and rural hospital profitability.

Purpose: This study compares 2018-2023 Medicare Advantage (MA) days as a percentage of total Medicare days in rural and urban hospitals, describes 2022-2023 operating profitability of rural and urban hospitals by quartiles of MA days as a percentage of total Medicare days, and explores hospital characteristics that may be important for understanding the relationship between MA and profitability of rural hospitals.

Methods: Financial and hospital data were obtained from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) for the years 2018 to 2023. Hospitals were assigned to quartiles based on MA days as a percentage of total Medicare days.

Capital Expenditures Increased at Rural Hospitals That Merged Between 2012 and 2015.

The number of rural hospital mergers has increased substantially in recent years. A commonly reported reason for merging is to increase access to capital. However, no empirical evidence exists to show whether capital expenditures increased at rural hospitals after a merger.

Rural Hospital Mergers Increased Between 2005 and 2016-What Did Those Hospitals Look Like?

The objective of this study is to determine whether key hospital-level financial and market characteristics are associated with whether rural hospitals merge. Hospital merger status was derived from proprietary Irving Levin Associates data for 2005 through 2016 and hospital-level characteristics from HCRIS, CMS Impact File Hospital Inpatient Prospective Payment System, Hospital MSA file, AHRF, and U.S.

For Rural Hospitals That Merged, Inpatient Charges Decreased and Outpatient Charges Increased: A Pre-/Post-Comparison of Rural Hospitals That Merged and Rural Hospitals That Did Not Merge Between 2005 and 2015.

Purpose: To determine whether inpatient and outpatient charges changed at rural hospitals after a merger.

Methods: Hospital mergers were derived from proprietary Irving Levin Associates data through manual review and validation. Hospital-level characteristics were derived from HCRIS, CMS Impact File Hospital Inpatient Prospective Payment System, Hospital MSA file, AHRF, and US Census data.

The Effect of the Magnet Recognition Signal on Hospital Financial Performance.

The objective of this study was to investigate the effect of the Magnet Recognition (MR) signal on hospital financial performance. MR is a quality designation granted by the American Nurses Credentialing Center (ANCC). Growing evidence shows that MR hospitals are associated with various interrelated positive outcomes that have been theorized to affect hospital financial performance.

Telestroke Adoption Among Community Hospitals in North Carolina: A Cross-Sectional Study.

Objective: This study identifies community and hospital characteristics associated with adoption of telestroke among acute care hospitals in North Carolina (NC).

Methods: Our sample included 107 hospitals located in NC. Our analytic dataset included variables from the American Hospital Association (AHA) annual survey, AHA Health IT supplement, Healthcare Cost Report Information System, and Centers for Disease Control and Prevention's WONDER online database.

Contextual factors that influence quality improvement implementation in primary care: The role of organizations, teams, and individuals.

Background: Recent emphasis on value-based health care has highlighted the importance of quality improvement (QI) in primary care settings. QI efforts, which require providers and staff to work in cross-functional teams, may be implemented with varying levels of success, with implementation being affected by factors at the organizational, teamwork, and individual levels.

Purpose: The purpose of our study was to (a) identify contextual factors (organizational, teamwork, and individual) that affect implementation effectiveness of QI interventions in primary care settings and (b) compare perspectives about these factors across roles (health care administrators, physician and nonphysician clinicians, and administrative staff).

High-Tech Versus High-Touch: Components of Hospital Costs Vary Widely.

The recent release by the Centers for Medicare & Medicaid Services of hospital charge and payment data to the public has renewed a national dialogue on hospital costs and prices. However, to better understand the driving force of hospital pricing and to develop strategies for controlling expenditures, it is important to understand the underlying costs of providing hospital services. We use Medicare Provider and Analysis Review inpatient claims data and Medicare cost report data for fiscal years 2008 and 2012 to examine variations in the contribution of "high-tech" resources (i.

Medicaid Expansion Affects Rural And Urban Hospitals Differently.

Rural hospitals differ from urban hospitals in many ways. For example, rural hospitals are more reliant on public payers and have lower operating margins. In addition, enrollment in the health insurance Marketplaces of the Affordable Care Act (ACA) has varied across rural and urban areas.

Measuring Mortality Performance: How Did Safety-Net Hospitals Compare With Other Hospitals?

Background: Safety-net hospitals (SNHs) tend to be weaker in financial condition than other hospitals, leading to a concern about how the quality of care at these hospitals would compare to other hospitals.

Objectives: To assess mortality performance of SNHs using all-payer databases and measures for a broad range of conditions and procedures.

Design: Longitudinal analysis of hospitals from 2006 through 2011 with data from the Healthcare Cost and Utilization Project State Inpatient Databases, the American Hospital Association Annual Survey, and the Area Health Resources File.

Quality improvement teams, super-users, and nurse champions: a recipe for meaningful use?

Objective: This study assessed whether having an electronic health record (EHR) super-user, nurse champion for meaningful use (MU), and quality improvement (QI) team leading MU implementation is positively associated with MU Stage 1 demonstration.

Methods: Data on MU demonstration of 596 providers in 37 ambulatory care clinics came from the clinical data warehouse and administrative systems of UNC Health Care. We surveyed the 37 clinics about champions, super-users, and QI teams.

Associations Between Practice Characteristics and Demonstration of Stage 1 Meaningful Use for the Electronic Health Record Incentive Program.

Background: The Medicare and Medicaid meaningful use (MU) incentive programs promote adoption and "meaningful use" of certified electronic health records among hospitals and eligible providers in outpatient settings, with a goal of improving the quality of patient care. Despite the potential importance of MU for providers and patients, little is currently known about the practice characteristics that facilitate providers' demonstration of MU. This study examined whether selected practice characteristics were associated with providers' meeting Stage 1 MU objectives at the end of 1 year in a single large North Carolina integrated delivery system.

Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?

The number of stand-alone rural hospitals has been shrinking as larger health systems target these hospitals for mergers and acquisitions (M and As). However, little research has focused specifically on rural hospital M and A transactions. Using data from Irving Levin Associates' Healthcare M and A Report and Medicare Cost Reports from 2005 to 2012, we examined two research questions: (1) What were the characteristics of rural hospitals that merged or were acquired, and (2) were there changes in rural hospital financial performance, staffing, or services after an M and A transaction? We used logistic regression to identify factors predictive of merger, and we used multiple regression to examine various hospital measures after an M or A.

Uncompensated Care Burden May Mean Financial Vulnerability For Rural Hospitals In States That Did Not Expand Medicaid.

The implementation of the Affordable Care Act has led to a large decrease in the number of uninsured people. Yet uncompensated care will still occur, particularly in states where eligibility for Medicaid is not expanded. We compared rural hospitals in Medicaid expansion and nonexpansion states in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013.

The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention.

Objective: To measure the return on investment (ROI) for a pediatric asthma pay-for-reporting intervention initiated by a Medicaid managed care plan in New York State.

Design: Practice-level, randomized prospective evaluation.

Setting: Twenty-five primary care practices providing care to children enrolled in the Monroe Plan for Medical Care (the Monroe Plan).

Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system.

Background: Meaningful Use (MU) provides financial incentives for electronic health record (EHR) implementation. EHR implementation holds promise for improving healthcare delivery, but also requires substantial changes for providers and staff. Establishing readiness for these changes may be important for realizing potential EHR benefits.

Facing the recession: how did safety-net hospitals fare financially compared with their peers?

Objective: To examine the effect of the recession on the financial performance of safety-net versus non-safety-net hospitals.

Data Sources/study Setting: Agency for Healthcare Research and Quality Hospital Cost and Utilization Project State Inpatient Databases, Medicare Cost Reports, American Hospital Association Annual Survey, InterStudy, and Area Health Resource File.

Study Design: Retrospective, longitudinal panel of hospitals, 2007-2011.

Costs and benefits of transforming primary care practices: a qualitative study of North Carolina's Improving Performance in Practice.

Primary care organizations must transform care delivery to realize the Institute for Healthcare Improvement's Triple Aim of better healthcare, better health, and lower healthcare costs. However, few studies have considered the financial implications for primary care practices engaged in transformation. In this qualitative, comparative case study, we examine the practice-level personnel and nonpersonnel costs and the benefits involved in transformational change among 12 primary care practices participating in North Carolina's Improving Performance in Practice (IPIP) program.

Colorectal cancer surgery outcomes for vulnerable patients in safety-net versus non-safety-net hospitals.

Extensive research documents disparities in health outcomes for vulnerable populations. Safety-net hospitals-those that serve a greater proportion of vulnerable patients with Medicaid or no insurance-may yield better outcomes for these vulnerable patients because of their expertise with this population. National Inpatient Sample data from 2005-2007 show that predicted rates of complications following colorectal cancer surgery are approximately 20% lower for vulnerable patients in safety-net than in non-safety-net hospitals (0.

The role of non-operating income in community benefit provision by not-for-profit hospitals.

Not-for-profit hospitals are under increased public scrutiny for providing what some view as insufficient levels of community benefit compared to their tax-exempt benefits. One potential driver of community benefit is financial surplus, which arises from both patient care (operating) activities and non-patient care (non-operating) activities. This study addresses the effect of hospitals' non-operating income on not-for-profit hospitals' provision of community benefit.

Hospital capital budgeting in an era of transformation.

The Patient Protection and Affordable Care Act (PPACA), signed into law in 2010, is transforming the health care marketplace. This transformation requires health system leaders and health finance scholars to re-examine hospital capital budgeting practices in the context of new delivery models. Within the context of accountable care organizations (ACOs), this article discusses the components of the hospital capital budgeting process, identifies current practices that may require new methods or approaches, and suggests areas where existing or future research can inform capital budgeting going forward.

Challenges and facilitators of community clinical oncology program participation: a qualitative study.

Successful participation in the National Cancer Institute's Community Clinical Oncology Program (CCOP) can expand access to clinical trials and promote cancer treatment innovations for patients and communities without access to major cancer centers. Yet CCOP participation involves administrative, financial, and organizational challenges that can affect hospital and provider participants. This study was designed to improve our understanding of challenges associated with CCOP participation from the perspectives of involved providers and to learn about opportunities to overcome these challenges.

Assessing organizational capacity for achieving meaningful use of electronic health records.

Background: Health care institutions are scrambling to manage the complex organizational change required for achieving meaningful use (MU) of electronic health records (EHR). Assessing baseline organizational capacity for the change can be a useful step toward effective planning and resource allocation.

Purpose: The aim of this article is to describe an adaptable method and tool for assessing organizational capacity for achieving MU of EHR.