New Projects
1. Role of CAHs in Addressing Long Term Care Needs
Lead Center: University of Southern Maine
Principal Investigators: Andrew F. Coburn, Ph.D. 207-780-4435 or andyc@usm.maine.edu
Contact Person: John A. Gale, M.S. 207-228-8246 or
jgale@usm.maine.edu
This project will profile trends in CAH ownership/involvement in the provision of skilled nursing facility (SNF), nursing facility (NF), home health agency (HHA), and other long term care (LTC) services in order to understand the financial, staffing, and market factors that have enabled some CAHs to maintain SNF services and led others to drop them over the past three years. There are two main components to this study. The first involves using data from the American Hospital Association Annual Hospital Survey, the Medicare Provider of Services File, and Medicare Hospital Cost reports to describe trends in the provision of SNF, NF, HHA, and other LTC services by CAHs over the past three years, including establishing rates of CAH-owned SNF, NF, HHA, and other LTC closures. In the second component of the study, we will use the FMT’s financial performance data to examine key financial performance indicators related to profitability In the second component of the study, we will select samples of CAHs that have closed and those that have maintained their SNFs to examine in more detail the factors that have led CAHs to either close or maintain these services.
2. Health Information Technology Diffusion and Its Effect on Quality in Critical Access Hospitals
Lead Center: University of Minnesota Rural Health Research Center
Principal Investigators: Ira Moscovice, Ph.D., 612-624-8618 or mosco001@umn.edu
Contact Person: Ira Moscovice, Ph.D., 612-624-8618 or mosco001@umn.edu
The purpose of this project is to: 1) describe critical access hospital (CAH) health information technology (HIT) diffusion through 2008; 2) identify areas in which CAH HIT adoption lags behind other hospitals; 3) measure the effect of HIT on clinical data reporting by CAHs; and 4) estimate the effect of HIT on CAH quality. Data for the project will come from an analysis of secondary data on CAHs from the Healthcare Information and Management Systems Society (HIMSS) Analytics Database, the American Hospital Association Annual Survey and CMS Hospital Compare. HIT holds the promise of both improved quality and reduced costs. An integrated HIT system is also crucial for efficient clinical information reporting for ongoing initiatives such as Hospital Compare and for any future pay-for-performance programs. CAHs lag other hospitals in HIT and may fall further behind under new HIT policy initiatives. It is thus crucial that HIT diffusion be carefully monitored. We will address this issue by continuing to measure CAH HIT diffusion and building a framework for measuring diffusion under new HIT policies. We will then study the role of HIT in reporting Hospital Compare data. Finally, we will estimate the effect of HIT on quality.
3. Measuring the Performance of State Flex Programs
Lead Center: University of Southern Maine
Principal Investigators: Andrew F. Coburn, Ph.D. 207-780-4435 or andyc@usm.maine.edu
Contact Person: John A. Gale, M.S. 207-228-8246 or
jgale@usm.maine.edu
This program will provide input and guidance to the Office of Rural Health Policy in developing performance measures for State Flex programs and in developing its strategic plans for future Flex Program goals, objectives, and activities. We will work with key stakeholders, including ORHP, State Flex Program representatives, and TASC to collect information to inform ORHP's planning efforts. We will also work with these stakeholders to develop measures that can be used to document and report on the achievement of new and revised State Flex Program goals and objectives.
4. Change in Obstetrical Services in Critical Access Hospitals
Lead Center: University of North Carolina Rural Health Research & Policy Analysis Center
Principal Investigators: Mark Holmes, Ph.D., 919-966-9694 or holmes@schsr.unc.edu
Contact Person: George Pink, Ph.D. 919-966-5541 or gpink@schsr.unc.edu
Previous FMT surveys have found that obstetrical services are one of the most common lines of services to be dropped due to overhead costs. In response to recent queries from CAH administrators, we performed preliminary analyses to determine the extent to which this trend is continuing. The results suggest a sharp and continuing drop in provision of OB, but do not provide either an explanation for why this trend is occurring or the consequences to the community and the CAH. The purpose of this project is to document the change in access to obstetrical (OB) services among communities served by CAHs. This project will have four components: 1) Description of changes in OB services in CAHs: We will present descriptive statistics on the trends over time in the number of CAHs that have always offered OB, offered it at one time but have recently dropped the service, and have recently added the service. 2) Understanding causes when OB services are dropped: We will model the probability of dropping OB as a function of size (revenue), years since conversion, nearby competition (distance to next closest hospital or next larger hospital with OB), market characteristics (e.g. percent in poverty and/or on Medicaid), physician supply, the trend in obstetrical services provided by the hospital (i.e., whether there has been a secular decrease in OB services or whether the closing was "abrupt"), measures of the malpractice environment in a state, and state-level controls (proxy for differences in Medicaid reimbursement for OB). 3) Access and implications for nearby CAHs: for communities where the local CAH has dropped OB, we will describe the distance to the next closest hospital that still offers the service. 4) Financial implications: For those that have dropped OB services, how have financial performance measures, such as profitability measures, changed?