Tools
AHA Issues: Rural Community Hospital Demonstration Program
Web site
Description of the Rural Community Hospital (RCH) Demonstration Program, which examines the use of RCHs to provide Medicare covered inpatient hospital services in rural areas. Includes links to program transmittals and regulations.
AHA Issues: Rural Health Care
Web site
Information on American Hospital Association (AHA) advocacy activities related to rural hospitals. Includes news, resources, and more.
AHA Quality Center
Web site
A resource of the AHA to help hospitals accelerate their quality and performance improvement processes.
AHA Section for Small or Rural Hospitals
Web site
Information on American Hospital Association (AHA) advocacy activities on behalf of small and rural hospitals. Includes information about the Section, advocacy activities, publications, and other resources.
AHAData.com
Web site
Provides customized reports (for a fee) about U.S. hospitals, health care systems, and networks.
Balanced Scorecard Tools and Resources
Web site
Resources for the implementation of the Balanced Scorecard (BSc) in health care organizations.
CMS Hospitals Center
Web site
Contains Medicare manuals, forms, and regulations for hospitals.
CMS Recovery Audit Contractor (RAC)
Web site
Provides information on the Recovery Audit Contractor (RAC) project, implementation strategies, who the RACs are, RAC jurisdictions, RAC expansion and provider outreach schedules, and FAQs.
Eligible ZIP Codes for Enhanced Medicare Rural Ambulance and Lab Reimbursement
Web site
A national fee schedule for ambulance services, effective for claims with dates of service on or after April 1, 2002. Applies to all ambulance services, including volunteer, municipal, private, independent, and institutional providers, such as hospitals, critical access hospitals (except when it is the only ambulance service within 35 miles), and skilled nursing facilities.
HCUPnet
Database
Online query tool for accessing Healthcare Cost and Utilization Project data. Provides access to health statistics and information on hospital stays at the national, regional, and State level. Includes data on rural hospital diagnoses and procedures.
HealthCare Volunteer
Database
Searchable database of health care volunteering opportunities in the United States and abroad. Individuals can search for volunteer opportunities and organizations can use the site to seek health care volunteers.
Innovators' Guide to Navigating CMS
Web site
Assist stakeholders in understanding the processes used to determine coverage, coding, and payment for new technologies under the Medicare fee-for-service program. Guide is intended as a general summary.
Medicare Contracting Reform
Web site
Information and resources concerning the Part A/Part B Medicare Administrative Contractors (MACs), which will replace the current fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Preparedness Resources for Healthcare Facilities
Web site
Serves as an online resource center designed to help hospitals and health care facilities improve preparedness for disasters and large-scale emergencies.
Rural Health Research: Hospitals and clinics
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of hospitals and clinics, produced by the Office of Rural Health Policy's funded rural health research centers.
Rural Hospital Performance Improvement Education and Training Gateway
Web site
Lists distance and web-based educational resources for rural hospitals.
TeamSTEPPS Tools and Materials
Web site
Is an evidence-based teamwork system aimed at optimizing patient outcomes by improving teamwork skills among health care professionals. It includes a comprehensive set of ready-to-use materials and training curricula necessary to integrate teamwork principles successfully into your health care system.
UND Center for Rural Health Communication Toolkit
Web site
Provides resources and guidance to help rural health care facilities and organizations promote their services and organizations through the media.
Regulations, Forms & Other Useful Documents
2008 Rural Hospital Renovation Study
Author(s): Bill Wilson
Summarizes the results of a survey on the impact of community hospital renovations on health care delivery and recruiting.
Date: 10 / 2008
340B Drug Pricing Program: Results of a Survey of Eligible but Non-Participating Rural Hospitals
Author(s): Andrea Radford, Rebecca Slifkin, Marianne Baernholdt, Claudia Schur, Karen Cheung
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Summarizes the results of a survey of pharmacy directors at rural hospitals eligible to participate in the 340B program but identified as not participating at the time of the survey. The purpose of this study was to understand why rural hospitals that are eligible for the program are not participating and to determine whether there are specific program features that present barriers to participation.
Date: 01 / 2007
340B Drug Pricing Program: Results of a Survey of Participating Hospitals
Author(s): Claudia Schur, Karen Cheung, Andrea Radford, Rebecca Slifkin, Marianne Baernholdt
Presents the results of a survey of pharmacy directors at rural hospitals currently buying discounted outpatient drugs through the 340B program. The purpose was to understand the perspectives of pharmacy directors on the 340B program in general, the financial impact of the program, and which specific program features presented barriers to its broader implementation. A joint paper from the NORC Walsh Center for Rural Health Analysis and North Carolina Rural Health Research & Policy Analysis Center.
Date: 05 / 2007
Acute Inpatient Prospective Payment System: Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides general information about the Acute Inpatient Prospective Payment System (IPPS) including IPPS payment rates and how IPPS payment rates are set.
Date: 01 / 2009
Assessing the Financial Effect of Medicare Payment on Rural Hospitals: Does the Source of Data Change the Results?
Author(s): Li-Wu Chen, Susan Puumala, Keith J. Mueller, Liyan Xu, Kathy Minikus, Catherine Makhanu,
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Describes how predictions of changes
in hospital financial performance as a result of change in Medicare payment differ when comparing results using data from the Medicare Cost Report (MCR) to results using data from the audited hospital financial statement.
Date: 11 / 2005
Balanced Scorecards for Small Rural Hospitals: Concept Overview and Implementation Guidance
Sponsoring organization: Health Resources and Services Administration
Describes the process of implementing a Balanced Scorecard (BSC) initiative in a small rural hospital setting. Includes a Balanced Scorecard example. Lists common terminology with definitions.
Date: 2005
Beyond Health Care: The Economic Contribution of Hospitals
Sponsoring organization: American Hospital Association
Discusses economic impact of hospitals to communities, including rural communities.
Date: 04 / 2008
CEO Recruitment Guide: Practical Step-by-Step Information for Recruiting a Hospital Administrator
Author(s): Linda Powell, Dave Berk, Rural Health Financial Services
Provides practical advice and tools
to recruit a qualified hospital administrator or chief executive officer.
Date: 2001
Community Leader's Guide to Hospital Finance: Evaluating How a Hospital Gets and Spends Its Money
Author(s): Sarah Gunther Lane, Elizabeth Longstreth, Victoria Nixon
Sponsoring organization: Harvard School of Public Health
A guide to hospital finance that provides: a vocabulary to help you understand information about a hospital's financial performance; tools that can be used to evaluate a hospital's charitable commitment to the community; and,
tips on how groups can engage hospital leadership
in meaningful discussions of hospital financial performance.
Date: 2001
Conducting Hospital Employee Satisfaction Surveys: Practical Step-by-Step Information for Assessing Employee Perceptions
Author(s): Linda Powell, Mountain States Group
Overview of how to conduct a hospital employee satisfaction survey. Includes a sample survey and discusses how to administer the survey and report the results.
Date: 2001
Corporate Responsibility and Health Care Quality: A Resource for Health Care Boards of Directors
Author(s): Arianne N. Callender, Douglas A. Hastings, Michael C. Hemsley, Lewis Morris, Michael W. Peregrine
Sponsoring organization: U.S. Department of Health and Human Services
Resource guide designed to help health care organization boards ask appropriate questions related to health care quality requirements, measurement tools, and reporting requirements.
Date: 2007
Cracks in the Foundation - Averting a Crisis in America's Hospitals
Sponsoring organization: American Hospital Association
Discusses a number of critical issues affecting hospitals including: worker shortages, emergency department overcrowding, regulatory burdens, rapidly rising costs, growing number of uninsured people, and payment shortfalls for Medicare and Medicaid government programs.
Date: 08 / 2002
Critical Access Hospital Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information about Critical Access Hospital (CAH) providers; CAH designation; CAH payments; reasonable cost payment principles that do not apply to CAHs; election of Standard Payment Method or Optional (Elective) Payment Method; Medicare Rural Pass-Through funding for certain anesthesia services; Health Professional Shortage Area Incentive payments; Physician Scarcity Area Bonus payments; Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provisions that impact CAHs; and grants to states under the Medicare Rural Hospital Flexibility Program.
Date: 04 / 2009
Does Hospital Size Affect Our Ability to Accurately Identify High Quality Care in Pay-for-Performance Programs?
Sponsoring organization: Upper Midwest Rural Health Research Center
Discusses the issue that smaller hospitals experience much greater variability in performance scores as a result of statistical sampling characteristics than larger hospitals.
Date: 05 / 2007
Economic Crisis: The Toll on the Patients and Communities Hospitals Serve
Author(s): American Hospital Association
Sponsoring organization: American Hospital Association
Interprets the results of an AHA survey of 1,078 U.S. community hospitals conducted in March 2009 about the effects of the economic downturn on patients and providers.
Date: 04 / 2009
Far From the City: Community Orientation and Responsiveness of Rural Hospitals
Sponsoring organization: Upper Midwest Rural Health Research Center
Reports the findings of a national study focused on variation in hospital community orientation and responsiveness across differing rural contexts.
Date: 05 / 2008
Financing Facilities During Today's Credit Crisis
Sponsoring organization: Safety Net Hospitals for Pharmaceutical Access
Describes how rural healthcare entities can improve their chance of successfully
securing financing for construction, expansion or remodeling projects during the current economic crisis.
Date: 2009
Focus on Health Care Finance White Paper II: Financing Options for Nonprofit Small and Rural Hospitals
Author(s): Thomas R. Green
Sponsoring organization: Lancaster Pollard
Outlines several programs and financial options available to non-profit community and rural hospitals. Discusses a hospital's strategic plan for future and financial operations.
Date: 05 / 2009
Health Care Leader Action Guide to Reduce Avoidable Readmissions
Author(s): Osei-Anto A, Joshi M, Audet AM, Berman A, Jencks S
Sponsoring organization: Health Research & Educational Trust
Serves as a starting point for hospital leaders to assess, prioritize, implement, and monitor strategies to reduce avoidable readmissions.
Date: 01 / 2010
Hospital Language Services for Patients With Limited English Proficiency: Results From a National Survey
Author(s): Romana Hasnain-Wynia, Julie Yonek, Debra Pierce, Ray Kang, Cynthia Hedges Greising
This report describes current practices, common
barriers, and the specific resources and tools
needed to provide language services to patients
with LEP. The results of the survey will inform
federal policymakers, practitioners, providers, and others of the issues and potential solutions facing hospitals as they work to improve language
services for all patients with LEP.
Date: 10 / 2006
Hospital Outpatient Prospective Payment System
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides general information about the Hospital Outpatient Prospective Payment System, ambulatory payment classifications, and how payment rates are set.
Date: 01 / 2009
Hospital Quality Improvement: Strategies and Lessons From U.S. Hospitals
Author(s): S. Silow-Carroll, T. Alteras, J. A. Meyer
Sponsoring organization: Commonwealth Fund
Focuses on the dynamics of hospital performance: how hospitals achieve and sustain improvements over time.
Date: 04 / 2007
Hospital Size, Uncertainty and Pay-for-Performance
Author(s): Gestur Davidson, Ira Moscovice, Denise Remus
Sponsoring organization: Upper Midwest Rural Health Research Center
Discusses hospital quality issues, hospital size, and pay-for-performance.
Date: 02 / 2007
How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
Author(s): Janet P. Sutton, Alene Kennedy, Lucia Hammer, Grace Yang
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Policy brief examining the financial effect that changes in current Medicare bad debt payment policy, as proposed in the FY2007 budget, might have
on rural hospitals.
Date: 07 / 2007
Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project
Author(s): Walter Gregg, Ira Moscovice, Denise Remus
Sponsoring organization: Upper Midwest Rural Health Research Center
Reports the findings of a national study designed to identify institutional, organizational, and environmental factors that influence the experience of rural hospitals in the Hospital Quality Incentive Demonstration Project.
Date: 09 / 2006
Implementing A New USDA Rural Development Program Targeting Small Rural Hospitals and Their Communities: Recommendations of the RUPRI Health Panel
Author(s): Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Lists recommendations for implementing a new USDA
Rural Development program, included in the Senate Farm Bill proposal, should it be enacted into law. The goal of this program is to strengthen rural health care delivery systems, to provide necessary health care services to rural residents in a cost-effective manner.
Date: 03 / 2008
Inpatient Stays in Rural Hospitals, 2007
Author(s): Elizabeth Stranges, Laurel Holmquist, Roxanne M. Andrews
Sponsoring organization: Agency for Healthcare Research and Quality
Presents data from the Healthcare Cost and Utilization Project (HCUP) on rural hospital stays in 2007.
Date: 01 / 2010
Market Survey Construction Kit: Practical Step-by-Step Information for Assessing Community Perceptions About Local Health Care Services
Author(s): Linda Powell, Mountain States Group
Guide for conducting a market survey of local residents' utilization of, attitudes toward
and satisfaction with local hospital and health care services. Includes a sample survey and guidelines for conducting and reporting the results from the survey.
Date: 2000
Measuring Efficiency: The Association of Hospital Costs and Quality of Care
Author(s): Ashish K. Jha, E. John Orav, Allen Dobson, Robert A. Book, Arnold M. Epstein
Sponsoring organization: Commonwealth Fund
Reviews a study exploring the relationship between cost and quality of care in more than 3,700 U.S. hospitals, including rural hospitals, treating Medicare patients.
Date: 05 / 2009
Measuring Regional Variation in Service Use
Sponsoring organization: Medicare Payment Advisory Commission
A report to Congress that presents data on the difference between regional variation in Medicare spending and regional variation in the use of Medicare-covered services. Date used was adjusted due to differences in small rural hospital and critical access hospital Medicare payment rates.
Date: 12 / 2009
Medicare Dependent Hospital Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Describes this type of rural hospital in terms of bed size and the percentage of its patients that are beneficiaries of Medicare Part A.
Date: 04 / 2009
Medicare Disproportionate Share Hospital Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Overviews the Medicare Disproportionate Share
Hospital adjustment provision and lists how a hospital can qualify to receive it.
Date: 04 / 2009
Medicare Payment Basics: Hospital Acute Inpatient Services Payment System
Sponsoring organization: Medicare Payment Advisory Commission
Overview of Medicare payments to hospitals for acute inpatient care. Include information on Medicare payments for medical education, payments to disproportionate share (DSH) hospitals, and special payments for rural hospitals.
Date: 10 / 2008
Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Final Rule
Sponsoring organization: Centers for Medicare and Medicaid Services
Revises the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs. Implements
certain provisions made by the Deficit Reduction Act of 2005 (Pub. L. 109–171), the Medicare Improvements and Extension Act under Division B, Title I of the Tax Relief and Health Care Act of
2006 (Pub. L. 109–432), and the Pandemic and All Hazards Preparedness Act (Pub. L. 109–417). In the Addendum to this final rule with comment period, describes changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs.
Journal citation: Federal Register Volume 72 Issue 162 Pages: 47129-48175
Date: 08 / 2007
National Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
Author(s): Li-Wu Chen, Wanqing Zhang, Junfeng Sun, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Documents the national magnitude of charges associated with hospitalizations
due to ambulatory care sensitive conditions in rural hospitals.
Date: 12 / 2007
New Hospital Information Technology: Is it Helping to Improve Quality?
Author(s): Suzanne Felt-Lisk
Sponsoring organization: Mathematica Policy Research, Inc.
Study included a nationally representative survey of hospitals that asked senior hospital executives whether clinicians use six specific types of information technology (IT). The survey also assessed whether IT had advanced quality of care, and if so, the most important ways in which it had done so.
Date: 05 / 2006
Performance Management: Improving and Sustaining Performance in Rural Hospitals
Author(s): Terry J. Hill
Sponsoring organization: Center for Rural Policy and Development
Outlines strategies and frameworks for overcoming obstacles in order to maintain financial stability for small rural hospitals and to establish sustainable health systems for the future.
Journal citation: Rural Minnesota Journal Volume 2 Issue 2
Date: 2007
Potentially Preventable Readmissions in Rural Hospitals (Policy Brief)
Author(s): Marilyn G. Klug, Kyle Muus, Michelle Casey, Ira Moscovice
Sponsoring organization: Upper Midwest Rural Health Research Center
Examines potentially preventable readmission rates for rural and urban hospitals, and discusses the rural implications of policy initiatives to reduce readmission rates.
Date: 08 / 2009
Prevalence of Evidence-Based Safe Medication Practices in Small Rural Hospitals
Author(s): Gary Cochran, Katherine Jones, Liyan Xu, Keith Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Describes the prevalence of evidence-based safe medication practices, including the use of voluntary medication error reporting, in small rural hospitals.
Date: 04 / 2008
Primer on Interpreting Hospital Margins
Author(s): Kathleen Dalton, Rebecca Slifkin
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Explains the most commonly used measures of hospital profitability, and how they are used to inform policy changes. Particular emphasis on the different formulas as they impact rural versus urban hospital figures.
Date: 07 / 2003
Regional Variation in Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions
Author(s): Li-Wu Chen, Wanqing Zhang, Junfeng Sun, Keith J. Mueller
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Estimates and documents the regional magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals.
Date: 12 / 2007
Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program
Sponsoring organization: Centers for Medicare and Medicaid Services
Report focuses on Prospective Payment System (PPS) hospitals, lays out a framework for value-based purchasing programs and discusses rural challenges.
Date: 11 / 2007
Rural Hospitals' Strategies for Achieving Compliance with HIPAA Privacy Requirements
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Discusses a survey of hospital administrators in rural areas regarding the Health Insurance Portability and Accountability Act (HIPAA). Includes an overview of HIPAA compliance efforts in rural hospitals, as well as examples of specific strategies to meet HIPAA requirements.
Date: 03 / 2004
Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
Author(s): Curt Mueller, Keith Mueller, Janet Sutton
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Identifies sections of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) that might be of special concern to rural Medicare beneficiaries, medical care providers, and policymakers. Includes guidance regarding provisions in the Proposed Rule "Establishment of the Medicare Advantage Program," which implements Title II of the MMA, with a focus on its impact on rural health service delivery.
Date: 08 / 2004
Rural Referral Center Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
Overview of the Rural Referral Center (RCC) program, which supports high-volume rural
hospitals that treat a large number of complicated cases.
Date: 04 / 2009
Sole Community Hospital Fact Sheet
Sponsoring organization: Centers for Medicare and Medicaid Services
A general summary about Sole Community Hospitals that includes a list of helpful rural Health websites.
Date: 04 / 2009
Teaching Hospitals: Their Impact on Patients and the Future Health Care Workforce
Sponsoring organization: American Hospital Association
Provides details about the role America's teaching hospitals play in the nation's health care system, arguing that in addition to training future physicians and health professionals, teaching hospitals conduct lifesaving research and provide specialized services not offered at other facilities. Also argues that teaching hospitals are major economic engines in their communities, directly employing 2.7 million people and contributing more than $1 trillion to the economy in 2007.
Date: 09 / 2009
Transforming Hospitals: Designing for Safety and Quality
Sponsoring organization: Agency for Healthcare Research and Quality
Reviews the case for evidence-based hospital design and how it increases patient and staff satisfaction and safety, quality of care, and employee retention, and results in a positive return on investment.
Date: 09 / 2007
Understanding the Role of the Rural Hospital Emergency Department in Responding to Bioterrorist Attacks and Other Emergencies: A Review of the Literature and Guide to the Issues
Author(s): Claudia L. Schur
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Overview of bioterrorism preparedness issues facing rural hospitals, including physical capacity, sufficiency of health personnel, preparedness plans, disease surveillance systems, and communication/coordination. Detailed review of the literature, with discussion.
Date: 04 / 2004
