Bourne, Donald
(2024)
Impacts of Rural Hospital Payment Reform: Evidence from the Pennsylvania Rural Health Model.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Rural hospitals have long faced financial challenges, which increase the risk of service reductions or closures. The Pennsylvania Rural Health Model (PARHM) is a unique payment model tailored for rural hospitals. Developed through collaboration between the Center for Medicare & Medicaid Innovation and the Commonwealth of Pennsylvania, it started in 2019 with plans to continue through 2024. PARHM aims to assess if global budgets for hospitals—a fixed payment amount covering all services—combined with hospital-specific transformation plans, can sustain rural patient care access, enhance care quality, and boost financial stability for rural Pennsylvania hospitals. Sixty-five hospitals were eligible, with cohorts joining in 2019 (5 hospitals), 2020 (8 hospitals), and 2021 (5 hospitals), forming a natural policy experiment to investigate the ability of payment reform to sustain hospital services in rural areas.
This study evaluates PARHM’s impact on potentially avoidable utilization of inpatient hospital services, access to and utilization of low-margin service lines (e.g., obstetrics care), and rural hospital bypass for elective surgeries (e.g., total knee replacement). Employing a difference-in-differences approach with multiple time periods, we compare relative changes between PARHM-participating and non-participating eligible hospitals. Data sources include the Pennsylvania Health Care Cost Containment Council Database for hospitalizations, the American Community Survey for demographic data, and the American Hospital Association Annual Survey for hospital characteristics.
Overall, key study outcomes did not change differentially between participating and non-participating hospitals when pooled across cohorts. However, heterogeneous treatment effects were observed among individual PARHM cohorts. For example, we found a statistically significant differential decrease in potentially avoidable admissions among hospital service areas served by Cohort 2 hospitals. In our analysis of low-margin service lines, we found a statistically significant differential increase in substance use disorder care among Cohort 1 hospitals. Finally, we found a statistically significant differential increase in the risk of bypass of the rural hospital in a patient’s local hospital service area among patients from areas served by critical access hospitals. Our results underscore the role of rigorous evaluations in understanding state-level health policies such as PARHM, and inform the design and implementation of future alternative payment models in rural settings.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
26 June 2024 |
| Date Type: |
Publication |
| Defense Date: |
5 June 2024 |
| Approval Date: |
26 June 2024 |
| Submission Date: |
17 June 2024 |
| Access Restriction: |
1 year -- Restrict access to University of Pittsburgh for a period of 1 year. |
| Number of Pages: |
161 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Health Policy & Management |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
alternative payment models, difference-in-differences, comparative interrupted times series |
| Date Deposited: |
26 Jun 2024 19:25 |
| Last Modified: |
26 Jun 2024 19:25 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46565 |
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