The Walsh Center for Rural Health Analysis was established in 1996 by Project HOPE to study policy issues affecting health care in rural America. The Walsh Center was transferred to NORC in 2003. The Walsh Center focuses primarily on the impact of Medicare policies on rural communities, but the Center's work also addresses other topics relevant to rural health. Walsh Center projects are conducted in the areas of (click to advance to area of interest):
Walsh Center researchers conduct both quantitative and qualitative research and analysis, using primary data collection as well as data from public sources, including Medicare administrative data, such as claims and hospital cost reports, federally-collected survey data, and hospital discharge data. The Walsh Center is funded through the Rural Health Research Center Program in the Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services.
Walsh Center Projects and Products
New or recently-developed products
Migrant and Seasonal Farm Worker Emergency Preparedness Planning Guide, September 2009 [LINK]
Emergency Preparedness Planning: Modeling the Impact of Urban Evacuation on Surrounding and Rural Communities, July 2009 [LINK]
Satisfaction with Practice and Decision to Relocate: An Examination of Rural Physicians, May 2009 [FINAL REPORT]
Achieving Success in QIO and Rural Hospital Partnerships, February 2009 [FINAL REPORT]
Urban to Rural Evacuation Planning Toolkit, including Urban to Rural Evacuation Planning Tool [LINK]
Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services, October 2008 [Policy Analysis Brief]
Urban to Rural Evacuation: Planning for Rural Population Surge, August 2008 [FINAL REPORT]
Impact of CAH Conversion on Hospital Finances and Mix of Services, August 2008 [FINAL REPORT]
An Analysis of Mental Health and Substance Abuse Disparities & Access to Treatment Services in the Appalachian Region [LINK]
Rural Preparedness Planning Guide: Planning for Population Surge Following Urban Disasters [PRINTABLE PDF]
Rural Public Health Financing: The Relationship Between Infrastructure and Local Program Funding, June 2008 [Policy Analysis Brief]
Financing Rural Public Health Activities in Prevention and Health Promotion, June 2008 [FINAL REPORT]
Challenges, Opportunities, and Strategies for Rural Public Health Agencies Seeking Accreditation, June 2008 [Policy Analysis Brief]
Rural Public Health Agency Accreditation, June 2008 [FINAL REPORT]
Critical Access Hospitals' Experience with Medicare Advantage Plans, March 2008 [Policy Analysis Brief]
Medicare Payment Policy
The Impact of the Elimination of Medicare Bad Debt on Rural Prospective Payment System (PPS) Hospitals (2007)
This study explored the potential impacts of the elimination of Medicare bad debt reimbursement on rural prospective payment system (PPS) hospitals by simulating the financial impacts using the 2005 Medicare Cost Reports and the 2005 Hospital Inpatient PPS Payment Impact File and by interviewing hospital executives.
Options for Structuring Disproportionate Share (DSH) Payments to Account for Uncompensated Care: Impact on Rural Hospitals (2004)
This study identified options for development of an equitable DSH payment adjustment that accounts for hospital uncompensated care costs and determined the financial impact of each of these proposals on rural hospitals, using simulations with data from Washington, West Virginia, Texas, and Iowa.
Medicare Payment for Post-Acute Care Transfers (2003)
This study examines the expansion of Medicare's post-acute care (PAC) transfer payment policy from the perspective of rural hospitals.
Access to Care
Use of Emergency Departments and Inpatient Care for Conditions Related to Poor Oral Health in Rural Areas (Current)
This study is investigating the extent to which EDs and inpatient settings are used to treat problems related to poor oral health, the charges for such care, and variations in the use of these services by patient and area characteristics.
Analysis of Substance Abuse and Mental Health Disparities in the Appalachian Region and Access to Treatment Services (2008)
This project is using both quantitative and qualitative methods to analyze substance abuse and mental health issues within the Appalachian region, as well as between Appalachia and the broader United States.
The Effect of Travel Distances on Access to Obstetric Care and Birth Outcomes in Rural Communities (Current)
This study is assessing whether the availability of obstetric providers in rural areas is sufficient to meet the need for obstetric care by measuring the distance patients must travel to obtain prenatal care and delivery and by examining health outcomes related to labor and delivery.
Impact of CAH Conversion on Hospital Costs and Mix of Services (2008)
This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
Rural Hospital Participation in the 340B Drug Discount Program (2007)
(Joint with North Carolina Rural Health & Policy Analysis Center)
The 340B drug discount program enables certain types of safety net organizations to obtain deeply discounted medications, at prices below the 'best price' typically offered to Medicaid agencies. This study used telephone interviews and mail surveys to explore the experiences that rural hospitals have had in seeking 340B eligibility status.
Declining Access to Hospital-based Obstetric Services in Rural Areas: Causes and Impact (2007)
This study examined the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. It examined potential causes for this trend and explored the effects of medical malpractice reforms.
Post-Acute Care: A Rural and Urban Comparison (2005)
This multi-phase analysis examines whether discharge patterns for and use of post-acute care services by rural and urban hospitalized Medicare beneficiaries differ and, if they do, what are the sources of these different patterns.
Quality
Exploring the Black Box: Design and Implementation Issues of Pay-for-Performance for Rural Physicians (Current)
This study is exploring issues related to the design and implementation of P4P systems by CMS and private health care delivery systems, including quality measures and measurement, linking quality measurement to payments, dissemination of information, and the implications of P4P for rural physicians.
Delivering the U.S. Preventive Services Task Force (USPSTF) Recommendations in a Rural Health Plan (2007)
Using interview data from a larger project conducted for the Agency for Healthcare Research and Quality, this analysis studied challenges faced by a hybrid health plan in delivering the USPSTF recommendations to a large rural population.
Home Health Care
Medicare Beneficiary Outcomes in Rural and Urban Home Health Agencies (2006)
This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes, and to ascertain whether there are agency characteristics that are associated with better or worse outcomes.
Impact of the Home Health PPS on Access in Rural America (2005)
This study was designed to help policymakers understand whether patterns of home care use in rural communities have been affected by the PPS. Analyses provide information on the characteristics of the patients served, the number and mix of services rendered, and quality of care.
Home Care in Rural America (2002)
This study looked at the characteristics of rural Medicare beneficiaries served by urban home health agencies as compared with those served by rural agencies.
Public Health Infrastructure
Financing Rural Public Health Activities in Chronic Disease Prevention and Health Promotion (2008)
This study examined federal funding streams and state pass through funds for selected local public health activities in the area of chronic disease prevention and health promotion and assessed potential barriers to program implementation in less populated, rural areas of a state.
Challenges and Opportunities for Rural Health Departments Seeking Accreditation (2008)
This project investigated opportunities and challenges related to public health agency accreditation among rural health departments.
Emergency Preparedness and Resiliency
Migrant and Seasonal Farm Worker Emergency Preparedness Planning Guide (2009)
This guide addresses community planning issues related to migrant and seasonal workers in the event of an emergency. The guide stresses all hazard preparedness, as disasters of different kinds present varying challenges and necessitate varying responses. the guide provides a set of actionable steps that can be taken by public health and preparedness professionals pre-event, during the event, and post-event, taking into account how the type of emergency will impact the response.
Emergency Preparedness Planning: Modeling the Impact of Urban Evacuation on Surrounding and Rural Communities (2008)
This project has developed a prototype web-based tool for emergency planners to address the issue of post-event population surge following an urban disaster. The tool will provide estimated numbers of evacuees following various types of disasters, as well as local and regional planning resources, with the intent of stimulating rural emergency planning efforts.
Predicting Rural Population Surge Following Urban Disasters (2007)
NORC is developing a tool to predict post-event rural population surge following public health emergencies. To enhance predictive accuracy of this tool and to more generally inform rural preparedness efforts, this project gathered information using key informant interviews and a national survey of urban residents.
Involvement of State Offices of Rural Health in Emergency Preparedness Activities (2006)
This project followed up with the state offices of rural health (SORH) to identify their current involvement with preparedness in rural areas, particularly in the use of funds earmarked to bioterrorism preparedness.
Understanding the Roles of Rural Hospitals in Responding to Bioterrorist Attacks and Other Emergencies (2004)
The purpose of this study was to improve our understanding of rural Emergency Room (ER) capacity and the nature of constraints in expanding capacity in response to demand surge caused by emergencies, including acts of terrorism or bioterrorism.
Workforce Issues
Stay or Leave: Evidence from a Cohort of Young Rural Physicians (2009)
This project helps to improve understanding of the dynamics of physician practice location decision making by examining and analyzing changes in practice locations for a sample of rural physicians.
Health Information Technology
Investments in Health Information Technology by Rural Hospitals (2007)
This study involved a national survey of rural hospitals conducted in late spring 2006 to gather data about readiness to adopt health IT, current use of different technologies, perceptions about the benefits and barriers to health IT adoption, future implementation plans, use of Federal programs designed to facilitate IT adoption, and interest in various health IT policy options.
Roadmap for the Adoption of Health Information Technology in Rural Communities (2006)
This project developed a resource document intended to help rural health care providers of all types as they think about whether an investment in health information technology makes sense for them and work through various implementation issues. The document was distributed at the September 2006 conference entitled "Health Information Technology: A Rural Provider's Roadmap to Quality," sponsored by ORHP.
Other Topics
Effective Strategies for Achieving HIPAA Compliance Among Rural Hospitals (2003)
This project examines the impact of HIPAA transactions and privacy standards on rural hospitals
For information on projects or publications prior to 2004, please contact Michael Meit at (301) 634-9324 or meit-michael@norc.org.