Evaluation of the grant program for rural health care transition : 1995 annual progress report

95 Pages·1995·3.4 MB·English

by  Mazumdar, Siddhartha

Evaluation ofthe Grant Program for
Rural Health Care Transition
1995 Annual Progress Report
CMSLibrary
Ba7l5t0i0maSreec,uMriDty2Bl1v2d4.4
Report to Congress
1995
U.S.DepartmentofHealthandHumanServices
HealthCareFinancingAdministration
OfficeofResearchandDemonstrations
ACKNOWLEDGMENTS
Thisreportcouldnothavebeenwrittenwithoutthehelpofmanypeople. Staffofthe
hospitalsintheRuralHealthCareTransitiongrantsprogramcompletedourdetailedforms
thoroughly and participated in telephone interviews candidly. Without their help, our
understandingoftheirgrantprojects,environments,andoperationswouldbeminimal.'The
staffofNationalBiosystemsandHCFAalsoprovideduswithinformationabouttheapplicants
aMnPdRgrapnrtoeveisdetdhatthweeiwnofuorlmdatniootnhaavnedbgeueindaanbcleettoocmolalkecetothuirsserlveepso.rtFiunsaelfluyl,,sreevaedraablles,tafafnadt
interesting. LaraineSchwartzandotherstaffprovidedtechnicalassistancetothegranteesin
completingthemonitoringformsandcodedtheformsforourdatasets. MonaShahproduced
manyofthe tablesfor thisreportand investigatedvariablesfromyear toyeartoensure
comparability. CraigThorntonandValerieChehprovidedcontinualguidanceandinsight.
JudithWooldridgereviewedthereport,whichhasbenefitedfromherextensiveexperiencein
ruralhealthissues. JoannePfleiderereditedthereport,andMarjorieMitchellandMonica
Capizziproducedit.
iii
CONTENTS
Chapter Page
EXECUTIVESUMMARY
xiil
INTRODUCTION
I ,
A. LEGISLATIVEHISTORYANDPURPOSEOFTHE
GRANTPROGRAM
j
B. THENUMBERANDDISTRIBUTIONOF
GRANTEES
4
II CHARACTERISTICSOFGRANTEESATAWARD, 1989
THROUGH1993 7
A. MANAGEMENTCHARACTERISTICS 8
B. GRANTEEFINANCES 10
C. STAFFING 14
D. SERVICEAREACHARACTERISTICS 18
E. HOSPITALSERVICES 21
F. POTENTIALFORCONVERSION,CONSOLIDATION,OR
CLOSURE
24
III SELF-REPORTEDPROGRESSOF1992GRANTEES 27
A STATUSOF1992GRANTEES 27
B. PROGRESSOF1992GRANTEES 27
C. PROJECTMODIFICATIONSANDPROBLEMS 31
D. GRANTEXPENDITURES 32
V
CONTENTS(continued)
Chapter
IV SELF-REPORTEDPROGRESSOF1993GRANTEES
A. STATUSOF1993GRANTEES
B. GRANTEEOBJECTIVES
C. PROGRESSOF1993GRANTEES
D. PROJECTMODIFICATIONS
.
E. GRANTEXPENDITURES
V 1994GRANTSOLICITATIONPROCESSAND
APPLICANTCHARACTERISTICS
A. SOLICITINGANDSCORINGTHEAPPLICATIONS
ANDSELECTINGGRANTEES
B. GEOGRAPHICDISTRIBUTIONOFTHE
APPLICANTS
C. FEDERALANDEXTERNALFUNDINGAND
LOCALCOOPERATION
1. FederalFunding
2. ExternalFunding
D. COMPARISONOFAPPLICANTSFROM1989
THROUGH1994
E. COMPARISONOFGRANTEESFROM1989
THROUGH1994
VI
CONTENTS(continued)
Chapter P„age
VI DOESALOW-INCOMELOCATIONAFFECT
HOSPITALS'FINANCIALSTABILrTY?
65
A. CHARACTERISTICSOFLOCALECONOMIES 66
B. CHARACTERISTICSOFTHEGRANTEE
HOSPITALSINLOW-INCOMECOUNTIES 67
1. HospitalSizeandManagement 67
2. PayerTypesandDegreeofUncompensatedCare 67
3. FinancialStatus 6g
C. HOWDOTHESEHOSPITALSSURVIVE
FINANCIALLY?
69
1. SourcesofFinancialandOtherSupport 69
D. GRANTPROJECT
71
REFERENCES
75
APPENDIXA: FIRST-YEARFUNDINGUNDERTHE
GRANTPROGRAMFORRURAL
HEALTHCARETRANSITION,1994 77
APPENDIXB: SCOREADJUSTMENTPROCESS 85
vii
TABLES
Page
•- GRANTEESTATUS ^
DISTRIBUTIONBYMANAGEMENT
CHARACTERISTICSATTIMEOFAWARD
(1989THROUGH1993GRANTEES) 9
FINANCIALCHARACTERISTICS
ATTIMEOFAWARD
(1989THROUGH1993GRANTEES) 12
STAFFINGATTIMEOFAWARD
(1989THROUGH1993GRANTEES) 15
STAFFVACANCIESATTIMEOFAWARD
(1989THROUGH1993GRANTEES) 17
SERVICEAREACHARACTERISTICSATTIME
OFAWARD(1989THROUGH1993GRANTEES) 19
SERVICESPROVIDEDATAWARD(1989THROUGH1993
GRANTEES)
22
CONSIDERATIONOFCONVERSION,CONSOLIDATION
ORCLOSURE: 1989AND1993GRANTEES '.... 25
1992GRANTEESTATUS 28
PROJECTPROGRESSAFTER21MONTHS,
BYOBJECTIVE: 1992GRANTEES 29
1993GRANTEESTATUS 36
PROJECTPROGRESSAFTER6MONTHS,
BYOBJECTIVE: 1993GRANTEES 39
PERCENTAGEOFFIRST-YEARFUNDING
SPENTDURINGFIRST6MONTHS,BY
GRANTOBJECTIVES 47
tx
GRANTPROGRAMFORRURALHEALTHCARE
TRANSITION: 1994ELIGIBLEHOSPITALS,
PROPOSALSRECEIVED,ANDAWARDS
EXTERNALFINANCINGOFFUNDEDAND
NONFUNDEDPROPOSALS, 1994APPLICANTS
DISTRIBUTIONOFGRANTAPPLICANTS,
BYREGION: 1989THROUGH1994
COMPARISONOFAWARDS,BYREGION:
1989THROUGH 1994GRANTEES
FIGURES
Figure Page
LI -NUMBERANDPERCENTAGEOFELIGIBLE
HOSPITALSAWARDEDRURALHEALTHCARE
TRANSITIONGRANTSBETWEEN 1989AND
1994,BYSTATE 5
XI
EXECUTIVESUMMARY
CongresschargedtheHealthCareFinancingAdministration(HCFA)withimplementing
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HCFAimplementedtheprograminSeptember1989with184granteehospitals;additional
Rh1o9Hs9p3Ci,tTaalngsdrarne1tc2se9ihviaenvde19gb9re4a.netnsNaeiwnaarreldayecd4h:5spu1eb8rs4ceeqinnute1n9ot8f9,Sthe2ep1ts2emmaibnlel1r9.r9u0r,aSli1n8hco7espintith1ael9s9p1ri,ong1t6rh3aemiUnnb1ei9gt9ae2nd,,'S1t17a.8t0e5is3n
havereceivedprogramgrants,andCongresshasauthorized$117millioningrantprogram
fundingduringthepast6years.
The 1989, 1990,and 1991 granteescompletedtheirgrantprojectsinSeptember 1992,
September 1993, and September 1994, respectively. Currently, 444active grantees are
progressingwiththeirprojectsoverthe3-yeargrantperiod.
Current legislation mandates that the HCFA administrator report on the program's
progresstoCongressannually. Here,wefocusontwotopics: (1)comparingcharacteristics
oifnc1o9m9e3lgorcaanttieoensafaftecatwsagrrdanwtietehftihnoansceiaolfsetaabrilliietry.coWhoertasl;soanddesc(r2)ibuentdheersptraongdriensgsohfotwhea1l9o9w2-
granteesafter21months,the1993granteesafter6months,andtheselectionof1994grantees.
1993 GRANTEE CHARACTERISTICS COMPARED WITH THOSE OF EARLIER
COHORTS
Thecharacteristicsofparticipantsinanestablished,ongoingprogrammaydifferfromthe
characteristicsofparticipantsinanewandunfamiliarprogram. Overtime,newprogramsmay
gainpublicityfromprogramsuccessorfromtheword-of-mouthofparticipants. Thisprogram
validationbyearlyparticipantsmayconvincelesswillingorlessableparticipantstoapplyto
theprogram. Asaresult,wemightexpectparticipantsinthelateryearsofanewprogram
tohave,forexample,smallerstaffsormoretenuousfinancialperformancethanparticipants
inthefirstfewyearsofanewprogram. Wecomparedthecharacteristicsatawardofgrantees
from 1989through 1993toexaminewhetherthecharacteristicsofgranteesataward have
changed.
'OmnibusBudgetReconciliationActof1987: P.L. 100-203.
xiii
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tHhpmnrriohaeinaeeydvatpeansleliolmietonrlpcfvnth^aieclewmaloHCodiinlhPydlipoeeinarerrtaisatmCphcsrcspsreieit.solszTietleeotaimSdyinfepepoiteh.rcnmslnroo,eooagsvrPntpyismdiiedpoat,edhn^asyrytlusosbshc.afieehwccPtRipicw1aturao*sehronuleant*pilntahhfseey^Hs2frseia1oaisbartcitliailatotinanhnthtndiissoe;Casf2lsc4iosihbnifnayisfdcpntusehalg,1nplyeS9t-eswus9tinh,ib3icdni,msieieceanntqhn1tewuo9lqaoeeryusnmdsi-wptpievoaelslrapyrytolesc,atey.rneontalntmsattqiFreuaridgdanrerlelsgdreeRitivp,fupsteoyrhtrhlraueoottslrppshe,erepoHddaiirlerctetantaddicuillooltmsrtiniisohnnsoneirgnsceCoeeslefrisdshanogIosirsnstcauposRnic1utmthTh9reaiah8alear9yelsess
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Disproportionatesharehospitalsserveadisproportionateshareoflow-incomepatients
relativetootherhospitalsinthecountry. Medicareprovideshigherreimbursementsfor
inpatientservicesprovidedbyhospitalswitheitherofthesespecialdesignations. Medicaid
makesadditionalpaymentstohospitalswithdisproportionatesharestatus.
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