Kim Young H, Reiter Kristin L, Thompson Kristie W, Pink George H
Department of Health Policy and Management, UNC Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA.
North Carolina Rural Health Research Program, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Rural Health. 2025 Jan;41(1):e12905. doi: 10.1111/jrh.12905.
This study compares 2018-2023 Medicare Advantage (MA) days as a percentage of total Medicare days in rural and urban hospitals, describes 2022-2023 operating profitability of rural and urban hospitals by quartiles of MA days as a percentage of total Medicare days, and explores hospital characteristics that may be important for understanding the relationship between MA and profitability of rural hospitals.
Financial and hospital data were obtained from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) for the years 2018 to 2023. Hospitals were assigned to quartiles based on MA days as a percentage of total Medicare days. Descriptive analyses were conducted to compare hospital characteristics and financial performance across quartiles.
Between 2018-2019 and 2022-2023, the median percentage of total Medicare days from MA grew from 11.3% to 28.0% for rural hospitals. The 2022-2023 median operating margin varied from 0.0% for rural hospitals in Q1 (lowest MA days as a percentage of total Medicare days) to 3.4% for hospitals in Q4 (highest MA days as a percentage of total Medicare days).
Among rural hospitals, higher MA days as a percentage of total Medicare days was found to be associated with higher operating margin. However, results suggest that MA is not randomly distributed: rural hospitals with higher MA days as a percentage of total Medicare days exhibit distinct characteristics. This non-random distribution suggests that descriptive analysis may not fully capture the actual financial impact of MA on rural hospitals. Future research should recognize these complexities.
本研究比较了2018 - 2023年农村和城市医院中医疗保险优势（MA）天数占医疗保险总天数的百分比，按MA天数占医疗保险总天数的四分位数描述了2022 - 2023年农村和城市医院的运营盈利能力，并探讨了对于理解MA与农村医院盈利能力之间关系可能重要的医院特征。
从医疗保险和医疗补助服务中心（CMS）的医疗保健成本报告信息系统（HCRIS）获取了2018年至2023年的财务和医院数据。根据MA天数占医疗保险总天数的比例将医院分为四分位数。进行描述性分析以比较各四分位数之间的医院特征和财务表现。
在2018 - 2019年至2022 - 2023年期间，农村医院中MA天数占医疗保险总天数的中位数百分比从11.3%增长到了28.0%。2022 - 2023年的运营利润率中位数从第一四分位数（MA天数占医疗保险总天数比例最低）的农村医院的0.0%到第四四分位数（MA天数占医疗保险总天数比例最高）的医院的3.4%不等。
在农村医院中，发现MA天数占医疗保险总天数的比例越高，运营利润率越高。然而，结果表明MA并非随机分布：MA天数占医疗保险总天数比例较高的农村医院呈现出明显的特征。这种非随机分布表明描述性分析可能无法完全捕捉MA对农村医院的实际财务影响。未来的研究应认识到这些复杂性。
