The Financial Importance of the Sole Community Hospital Payment Designation

In 1983, Congress created the Sole Community Hospital (SCH) program to support small rural hospitals for which “by reason of factors such as isolated location, weather conditions, travel conditions, or absence of other hospitals, is the sole source of inpatient hospital services reasonably available in a geographic area to Medicare beneficiaries.” As such, Medicare SCH… Read more »

The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals

Thanks to a temporary, but substantial expansion of the Centers for Medicare & Medicaid Services (CMS) Low Volume Hospital (LVH) Program, around 500 rural hospitals benefit from LVH payment adjustment. When it was originally implemented in 2005 only five rural hospitals qualified. Under the program, CMS provides an additional payment to qualifying hospitals for the higher costs associated with… Read more »

Trends in Risk of Financial Distress among Rural Hospitals

From January 2005 to July 2016, 118 rural hospitals have closed permanently, not including seven others that closed and subsequently reopened. The number of closures has increased each year since 2010, and in the first half of 2016, the closure rate surpassed two closures per month. Hospital closures impact millions of rural residents in communities… Read more »

Profitability of Rural and Urban Hospitals (Infographic)

More Americans are now aware of the financial challenges faced by rural hospitals. Media coverage of the 76 rural hospital closures between January 2010 and July 2016 has highlighted the health care access and economic challenges facing rural America. Rural hospital closures are not a new phenomenon – hundreds of rural hospitals closed in the 1980s and… Read more »

Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?

The implementation of the Patient Protection and Affordable Care Act (ACA) is changing hospital reimbursement in important ways.  The most significant changes stem from increasing access to health insurance coverage for previously uninsured or under-insured populations. Since rural residents are more likely than urban residents to be uninsured, increased access to health insurance should, in… Read more »

Characteristics of Medicaid Beneficiaries Who Use Rural Health Clinics

For almost four decades, Rural Health Clinics (RHCs) (currently numbering about 4,100) have served patients from underserved rural areas. Although Medicaid is an important payer for RHCs, little is known about Medicaid patients and the services provided to them partly because of the complexity of identifying claims generated from RHCs in Medicaid claims data sources…. Read more »

Identifying Rural Health Clinics in Medicaid Data

In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. RHCs must be located in non-urban areas with documented health care shortages. There are currently more than 4,100 RHCs across the U.S. Some RHCs operate as independent medical practices, while others are part of… Read more »

Geographic Variation in the Profitability of Urban and Rural Hospitals

The popular business quote “No margin, no mission” succinctly states the importance of profitability. The notion that if a hospital doesn’t make enough money to keep its doors open, its higher purpose is moot may be a simplistic view, but historic and recent evidence suggest that unprofitability can reduce hospital services and quality, or worse,… Read more »

Geographic Variation in Risk of Financial Distress among Rural Hospitals

From 2005 to 2015, 112 rural hospital closures have been identified (North Carolina Rural Health Research Program, 2015). Although six of these closed hospitals have since reopened, the remaining closures impact millions of rural residents in communities that are typically older and poorer, more dependent on public insurance programs, and in worse health than residents… Read more »

Prediction of Financial Distress among Rural Hospitals

From 2005 through 2015, more than 100 rural hospitals have closed their doors to patients in need of inpatient services. Though a handful of these closed hospitals have since reopened, the remaining closures leave millions of rural residents at greater risk of negative health and economic hardship due to the loss of local acute care services.  Policymakers,… Read more »

Estimated Costs of Rural Freestanding Emergency Departments

Since 2005, more than 100 rural hospitals have closed and more are at risk. Rural hospital closures jeopardize access to emergency services in the affected communities. As communities react to and/or prepare for closures, providers and policy makers seek a viable alternative for emergency services provided in a rural hospital setting. A rural freestanding emergency… Read more »