Medicare Uncompensated Care Payment Adjustments Reported by Rural and Urban Prospective Payment System Hospitals between 2014-15 and 2023-24

Hospital wages are a major component of operating costs and play an important role in workforce recruitment, retention, and financial stability. Wage levels vary across hospital types and geographic areas, reflecting differences in labor markets, payment policy, and financial capacity. The NC Rural Health Resaerch Program, in it’s brief, , examines trends in average salary… Read more »

Geographic Variation in Average Salary Expense Among Rural Hospitals Nationwide Before and During COVID-19, 2018–2022

Rural hospitals face persistent workforce shortages and limited financial flexibility, making labor costs a critical component of their economic sustainability. Labor expenses increased substantially during the COVID‑19 pandemic, although the magnitude of these changes varied across geographic and policy contexts. This brief, examines geographic variation in average salary expense per full‑time equivalent (FTE) employee among… Read more »

Average Salary Expense in Rural and Urban Hospitals in 2022 Compared with 2018, by Hospital Characteristics

Rural hospitals face persistent workforce shortages and limited financial flexibility, making labor costs a critical component of their economic sustainability. Labor expenses increased substantially during the COVID‑19 pandemic, although the magnitude of these changes varied across geographic and policy contexts. This brief, , examines geographic variation in average salary expense per full‑time equivalent (FTE) employee… Read more »

Average Salary Expense in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022

Rural hospitals face persistent workforce shortages and limited financial flexibility, making labor costs a critical component of their economic sustainability. Labor expenses increased substantially during the COVID‑19 pandemic, although the magnitude of these changes varied across geographic and policy contexts. This brief, examines geographic variation in average salary expense per full‑time equivalent (FTE) employee among… Read more »

Usual Source of Care for Rural Medicare Fee-for-Service Beneficiaries in 2021

Having a regular place to go for health care—often called a usual source of care (USC)—is important because it helps people get timely and consistent medical attention. In this brief, , the NC Rural Health Research Program describes where rural Medicare fee‑for‑service beneficiaries received their routine care in 2021 and which groups were most likely… Read more »

A Comparison of Independent and System-Affiliated Rural Hospitals

Rural hospitals play a critical role in ensuring that people living in small towns and remote areas can access essential health care. However, many rural hospitals face ongoing financial pressures, staffing shortages, and declining patient volumes, all of which increase the risk of service cuts or closure. In the brief, , the NC Rural Health… Read more »

Changes in Bed-Based Measures of Surge Capacity from 2018 to 2022 among Rural and Urban Hospitals

The COVID-19 pandemic showed that hospital closures and other reductions in inpatient capacity can limit a hospital’s ability to respond to sudden surges in demand. To help policymakers and stakeholders consider trade-offs between cost-saving reductions and emergency preparedness, the NC Rural Health Research Program describes how rural inpatient capacity has changed over time in the… Read more »

Do Changes in Hospital Ownership Affect Staffing?

In the brief, the NC Rural Health Research Program examines whether hospital ownership changes—specifically transitions between government or nonprofit ownership and for-profit status—are associated with differences in staffing levels, an important indicator of care quality and local economic impact. Using CMS HCRIS data from 2011–2023, we analyzed 1,917 hospital-year observations from 162 rural hospitals that… Read more »

Financial Distress Index: Relative Risk in 2025

The NC Rural Health Research Prorgram released the The Financial Distress Index (FDI) uses historical data about hospital financial performance, government reimbursement, organizational characteristics, and market characteristics to predict the probability of rural hospital financial distress within two years. The model assigns every rural hospital to one of four financial risk categories: highest, mid-highest, mid-lowest,… Read more »

News Media Coverage of Rural Hospital Closures and the Causes

The NC Rural Health Research Program wrote the brief, . to augment previous research with findings from a structured framework of attributed causes of closures through the analysis of news media reports. Media reports of closures offer a qualitative dimension that goes beyond numbers, allowing us to understand the deeper context surrounding a hospital closure…. Read more »

The Low-Volume Hospital Adjustment Before and During COVID-19

The NC Rural Health Research Program has been tracking the Low Volume Hospital (LVH) adjustment’s impact on rural hospitals. As policy makers consider legislation to maintain or alter the LVH adjustment before its expiration on December 31, 2024, the impact on more vulnerable communities is a relevant consideration.  Read our July 2024 brief, . The… Read more »

2018-23 Profitability of Rural Hospitals by Ownership and System Affiliation

Access to care in many communities has been reduced by rural hospital closures. The causes of rural hospital closures are complex and multifaceted, but unprofitability has been identified as a major contributor. In this study, the NC Rural Health Research Program focuses on system affiliation and ownership as additional contributing factors. Using hospital cost report… Read more »