Background In response to the widening gap between rural and urban hospital profitability margins, the Medicare Payment Advisory Commission (MedPAC) asserted that Medicare payment policies penalized small-scale hospital operations and recommended that Congress authorize a Low Volume Hospital (LVH) payment adjustment.1 This designation and payment adjustment was created in the Medicare Prescription Drug, Improvement and… Read more »

BACKGROUND 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.”1 A hospital qualifies… Read more »

Abstract From January 2005 through December 2015, 105 rural hospitals closed. This study examined associations between community characteristics and rural hospital closure. Compared with other rural hospitals that were at high risk of financial distress but remained open over the same time period, closed rural hospitals had a smaller market share (p < .0001) despite… Read more »

OVERVIEW Since 2005, more than 100 rural hospitals have closed and more are at risk.1,2 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… Read more »

Abstract The number of stand-alone rural hospitals has been shrinking as larger health systems target these hospitals for mergers and acquisitions (M and As). However, little research has focused specifically on rural hospital M and A transactions. Using data from Irving Levin Associates’ Healthcare M and A Report and Medicare Cost Reports from 2005 to… Read more »

Background As the Federally Facilitated Marketplace (FFM) enters its third open enrollment period, focus is shifting toward examining which communities have lower uptake in coverage and how to increase enrollment. In national analysis of the first open enrollment period, Holmes and colleagues found that rural areas had lower rates of plan selections.1 However, these estimates… Read more »

Abstract Background: Hospitals are focused on improving postdischarge services for older adults, such as early follow-up care after hospitalization to reduce readmissions and unnecessary emergency department (ED) use. Rural Medicare beneficiaries face many barriers to receiving quality care, but little is known about their postdischarge care and outcomes. We hypothesize that rural Medicare beneficiaries compared with… Read more »

Abstract   OBJECTIVE: The purpose of this research study is to determine the effect of surgery on the profitability of rural hospitals. BACKGROUND: Small rural hospitals are often the sole health care provider in their communities and the only source of care for many people.  The provision of surgery in rural hospitals saves the lives… Read more »

Abstract Since the inception of the Medicare Rural Hospital Flexibility Program in 1997, over 1,300 rural hospitals have converted to critical-access hospitals, which entitles them to Medicare cost-based reimbursement instead of reimbursement based on the hospital prospective payment system (PPS). Several changes to eligibility for critical-access status have recently been proposed. Most of the changes… Read more »

Abstract Purpose: This study assessed the association between homicide rates in northern Mexico and potentially avoidable use of emergency departments (ED) in the US-Mexico border region. The border region is largely rural and underserved, making the identification and correction of potential barriers to access crucial. Methods: We used secondary data from state inpatient and ED discharge databases… Read more »

Abstract Rural hospitals serve as major sources of health care and employment for their communities, but recently they have been under increased financial stress. What are the causes of this stress, and how have hospitals and their communities responded?

BACKGROUND From 2010 through 2014, 47 rural hospitals,1 ceased providing inpatient services in 23 states across the country (“closed”2 ). Among the 47 closed hospitals, 26 hospitals no longer provide any health care services (“abandoned”), and 21 continue to provide a mix of health services but no inpatient care (“converted”).3 These closures have affected approximately… Read more »

Purpose In March 2015, the Office of the Inspector General (OIG) issued a report on Medicare’s expenditures on swing beds in Critical Access Hospitals (“Medicare Could Have Saved Billions At Critical Access Hospitals If Swing Bed Services Were Reimbursed Using The Skilled Nursing Facility Prospective Payment System Rates.” Department of Health and Human Services, Office… Read more »

Read the PDF.