title: The financial performance of rural hospitals and implications for elimination of the Critical Access Hospital program.
abstract: OBJECTIVE
  To compare the financial performance of rural hospitals with Medicare payment provisions to those paid under prospective payment and to estimate the financial consequences of elimination of the Critical Access Hospital (CAH) program.
  
  
  METHODS
  Financial data for 2004-2010 were collected from the Healthcare Cost Reporting Information System (HCRIS) for rural hospitals. HCRIS data were used to calculate measures of the profitability, liquidity, capital structure, and financial strength of rural hospitals. Linear mixed models accounted for the method of Medicare reimbursement, time trends, hospital, and market characteristics. Simulations were used to estimate profitability of CAHs if they reverted to prospective payment.
  
  
  RESULTS
  CAHs generally had lower unadjusted financial performance than other types of rural hospitals, but after adjustment for hospital characteristics, CAHs had generally higher financial performance.
  
  
  CONCLUSIONS
  Special payment provisions by Medicare to rural hospitals are important determinants of financial performance. In particular, the financial condition of CAHs would be worse if they were paid under prospective payment.
authors.affiliation: North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. mark_holmes@unc.edu
authors.forename: George M
authors.initials: GM
authors.lastname: Holmes
authors.forename: George H
authors.initials: GH
authors.lastname: Pink
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Friedman
mesh_terms: D003198:Computer Simulation; D005377:Financial Management, Hospital / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics; D006780:Hospitals, Rural / Q000191:economics*; D006801:Humans; D006278:Medicare / Q000191:economics / Q000458:organization & administration*; D018803:Models, Economic; D011445:Prospective Payment System / Q000191:economics*; D013997:Time Factors; D014481:United States