Policy implications of fixed-to-total-cost ratio variation across rural and urban hospitals
© 2023 National Rural Health Association..
PURPOSE: Hospitals with lower fixed-to-total-cost ratios may be better positioned to remain financially viable when reducing service volumes required by many value-based payment systems. We assessed whether hospitals in rural areas have higher fixed-to-total-cost ratios, which would tend to create a systematic disadvantage in such an environment.
METHODS: Our observational study used a mixed-effects, repeated-measures model to analyze Medicare Hospital Cost Report Information System data for 2011-2020. We included all 4,953 nonfederal, short-term acute hospitals in the United States that are present in these years. After estimating the relationship between volume (measured in adjusted patient days) and patient-care costs in a model that controlled for a small number of hospital characteristics, we calculated fixed-to-total-cost ratios based on our model's estimates.
FINDINGS: We found that nonmetropolitan hospitals tend to have higher average fixed-to-total-cost ratios (0.85-0.95) than metropolitan hospitals (0.73-0.78). Moreover, the degree of rurality matters; hospitals in micropolitan counties have lower ratios (0.85-0.87) than hospitals in noncore counties (0.91-0.95). While the Critical Access Hospital (CAH) designation is associated with higher average fixed-to-total-cost ratios, high fixed-to-total-cost ratios are not exclusive to CAHs.
CONCLUSIONS: Overall, these results suggest that hospital payment policy and payment model development should consider hospital fixed-to-total-cost ratios particularly in settings where economies of scale are unattainable, and where the hospital provides a sense of security to the community it serves.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
|---|---|
| Enthalten in: |
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association - 39(2023), 4 vom: 19. Sept., Seite 737-745 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Barker, Abigail R [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Costs |
|---|
| Anmerkungen: |
Date Completed 20.09.2023 Date Revised 20.09.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/jrh.12767 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM357061217 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM357061217 | ||
| 003 | DE-627 | ||
| 005 | 20231226071800.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/jrh.12767 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1190.xml |
| 035 | |a (DE-627)NLM357061217 | ||
| 035 | |a (NLM)37203592 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Barker, Abigail R |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Policy implications of fixed-to-total-cost ratio variation across rural and urban hospitals |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 20.09.2023 | ||
| 500 | |a Date Revised 20.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 National Rural Health Association. | ||
| 520 | |a PURPOSE: Hospitals with lower fixed-to-total-cost ratios may be better positioned to remain financially viable when reducing service volumes required by many value-based payment systems. We assessed whether hospitals in rural areas have higher fixed-to-total-cost ratios, which would tend to create a systematic disadvantage in such an environment | ||
| 520 | |a METHODS: Our observational study used a mixed-effects, repeated-measures model to analyze Medicare Hospital Cost Report Information System data for 2011-2020. We included all 4,953 nonfederal, short-term acute hospitals in the United States that are present in these years. After estimating the relationship between volume (measured in adjusted patient days) and patient-care costs in a model that controlled for a small number of hospital characteristics, we calculated fixed-to-total-cost ratios based on our model's estimates | ||
| 520 | |a FINDINGS: We found that nonmetropolitan hospitals tend to have higher average fixed-to-total-cost ratios (0.85-0.95) than metropolitan hospitals (0.73-0.78). Moreover, the degree of rurality matters; hospitals in micropolitan counties have lower ratios (0.85-0.87) than hospitals in noncore counties (0.91-0.95). While the Critical Access Hospital (CAH) designation is associated with higher average fixed-to-total-cost ratios, high fixed-to-total-cost ratios are not exclusive to CAHs | ||
| 520 | |a CONCLUSIONS: Overall, these results suggest that hospital payment policy and payment model development should consider hospital fixed-to-total-cost ratios particularly in settings where economies of scale are unattainable, and where the hospital provides a sense of security to the community it serves | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Critical Access Hospitals | |
| 650 | 4 | |a costs | |
| 650 | 4 | |a health care financing | |
| 650 | 4 | |a hospitals | |
| 650 | 4 | |a rural health policy | |
| 700 | 1 | |a MacKinney, A Clinton |e verfasserin |4 aut | |
| 700 | 1 | |a McBride, Timothy D |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association |d 1985 |g 39(2023), 4 vom: 19. Sept., Seite 737-745 |w (DE-627)NLM036315915 |x 1748-0361 |7 nnns |
| 773 | 1 | 8 | |g volume:39 |g year:2023 |g number:4 |g day:19 |g month:09 |g pages:737-745 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/jrh.12767 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 39 |j 2023 |e 4 |b 19 |c 09 |h 737-745 | ||