Decline in Inpatient Volume at Rural Hospitals.
inpatient volume
rural health care
rural hospital
Journal
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
ISSN: 1748-0361
Titre abrégé: J Rural Health
Pays: England
ID NLM: 8508122
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
pubmed:
1
1
2021
medline:
19
8
2021
entrez:
31
12
2020
Statut:
ppublish
Résumé
To investigate (1) all-payer inpatient volume changes at rural hospitals and (2) whether trends in inpatient volume differ by organizational and geographic characteristics of the hospital and characteristics of the patient population. We used a retrospective, longitudinal study design. Our study sample consisted of rural hospitals between 2011 and 2017. Inpatient volume was measured as inpatient average daily census (ADC). Additional measured hospital characteristics included census region, Medicare payment type, ownership type, number of beds, local competition, total margin, and whether the hospital was located in a Medicaid expansion state. Measured characteristics of the local patient population included total population size, percent of population aged 65 years or older, and percent of population in poverty. To identify predictors of inpatient volume trends, we fit a linear multiple regression model using generalized estimating equations. Rural hospitals experienced an average change in ADC of -13% between 2011 and 2017. We found that hospital characteristics (eg, census region, Medicare payment type, ownership type, total margin, whether the hospital was located in a Medicaid expansion state) and patient population characteristics (eg, percent of population in poverty) were significant predictors of inpatient volume trends. Trends in inpatient volume differ by organizational and geographic characteristics of the hospital and characteristics of the patient population. Researchers and policy makers should continue to explore the causal mechanisms of inpatient volume decline and its role in the financial viability of rural hospitals.
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
347-352Informations de copyright
© 2020 National Rural Health Association.
Références
Medicare Payment Advisory Commission. Chapter 3: Hospital Inpatient and Outpatient Services. Report to the Congress: Medicare payment policy, (p.65-94). March 2019.
Bai G, Anderson GF. A more detailed understanding of factors associated with hospital profitability. Health Aff. 2016;35(5):889-897.
Pink GH, Holmes GM, Thompson RE, Slifkin RT. Variations in financial performance among peer groups of critical access hospitals. J Rural Health. 2007;23(4):299-305.
North Carolina Rural Health Research Program. 174 rural hospital closures: January 2005-Present (132 since 2010) [Internet]. n.d. [cited 2020 October 17]. Available from: https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/
Holmes GM, Kaufman BG, Pink GH. Predicting financial distress and closure in rural hospitals. J Rural Health. 2016;33(3):239-249.
Kaufman BG, Thomas SR, Randolph RK, et al. The rising rate of rural hospital closures. J Rural Health. 2015;32(1):35-43.
Newkirk V, Damico A. The Affordable Care Act and Insurance Coverage in Rural Areas [Internet]. San Francisco, CA: Kaiser Family Foundation; 2014 [cited 2020 Apr 16]. Available from: https://www.kff.org/uninsured/issue-brief/the-affordable-care-act-and-insurance-coverage-in-rural-areas/
Meit M, Knudson A, & Gilbert T, et al. Chapter 5: Health Care Access and Use. The 2014 Update of the Rural-Urban Chartbook, (p.52-65). Bethesda, MD: Rural Health Reform Policy Research Center; 2014.
United States Department of Health and Human Services, Centers for Medicare & Medicaid Services. Healthcare Cost Report Information System (HCRIS) data file for Hospitals for the 1st, 2nd, 3rd, and 4th Quarters of Years 2011-2017. 2011-2018.
Health Resources and Services Administration. Defining rural population [Internet]. 2018 [cited 2020 Apr 16]. Available from: hrsa.gov/rural-health/about-us/definition/index.html
Centers for Medicare & Medicaid Services. Cost reports [Internet]. 2020 [cited 2020 Apr 16]. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports
Mazurenko O, Balio CP, Agarwal R, Carroll, AE, Menachemi N. The effects of medicaid expansion under the ACA: a systematic review. Health Aff. 2018;37(6):944-950.
United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. Area Health Resource File (AHRF); 2019 Available from: https://data.hrsa.gov/data/download.
Halekoh U, Højsgaard S, Yan J. The R package geepack for generalized estimating equations. J Stat Softw. 2006;15(2). 10.18637/jss.v015.i02.1.11.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2019. Available from: https://www.R-project.org
Freeman V, Thompson K, Howard H, Randolph R, Holmes GM. The 21st Century Rural Hospital: A Chart Book. Chapel Hill, NC: North Carolina Rural Health Research Program; 2015.
Medicare Payment Advisory Commission. Chapter 3: Hospital Inpatient and Outpatient Services. Report to the Congress: Medicare payment policy, (p.55-90). March 2016.
United States Government Accountability Office. Number and characteristics of affected hospitals and contributing factors [Internet]. 2018 [cited 2020 June 16]. Available from: gao.gov/assets/700/694125.pdf
Colla CH, Lewis VA, Tierney E, Muhlestein DB. Hospitals participating in ACOs tend to be large and urban, allowing access to capital and data. Health Aff. 2016;35(3):431-439.
Schulz J, DeCamp M, Berkowitz SA. Regional cost and experience, not size or hospital inclusion, helps predict ACO success. Medicine. 2017;96(24): e7209.
Abrams K, Balan-Cohen A, Durbha P. Growth in outpatient care: the role of quality and value incentives [Internet]. 2018 [cited 2020 June 16]. Available from: https://www2.deloitte.com/us/en/insights/industry/health-care/outpatient-hospital-services-medicare-incentives-value-quality.html
Kacik A. Nearly a quarter of rural hospitals are on the brink of closure. Modern Healthcare [cited 2020 April 30]. Available from: https://www.modernhealthcare.com/article/20190220/NEWS/190229999/nearly-a-quarter-ofrural-hospitals-are-on-the-brink-of-closure; 2019.
Medicare Payment Advisory Commission. Payment basics: critical access hospitals payment system, (p.1-4). October 2020.
Medicare Payment Advisory Commission. Chapter 7: Improving Efficiency and Preserving Access to Emergency Care in Rural Areas. Report to the Congress: Medicare Payment Policy, (p.203-225). June 2016.