States with the most rural hospitals at risk of closing
Rural hospitals serve 60 million people, approximately one in every five Americans. These hospitals provide remote communities with critical care ranging from primary care services like health maintenance and patient education to long-term care and emergency services. Besides medical care, rural hospitals serve as major local economic drivers by providing jobs and attracting other businesses to the area. New businesses are less likely to choose a location that doesn’t have the health care infrastructure in place to care for their employees.
But as people have flocked to urban areas, rural populations have declined. This is putting some rural hospitals in vulnerable financial situations, which has led to hospital cuts and closures, with many more on the horizon. COVID-19 has put additional stress on already understaffed rural hospitals, spelling trouble for spikes in cases we are now seeing all across the United States.
To determine which states have the most at-risk rural hospitals, Stacker consulted a 2019 study from Navigant, a consulting firm acquired by the healthcare firm Guidehouse. Navigant analyzed the financial viability of about 2,000 hospitals in rural parts of the U.S., based on the hospitals' operating margins, cash on hand, and debt-to-capitalization ratios. Delaware, New Jersey, and Rhode Island did not have any qualifying rural hospitals, and so are not included in this story.
Populations served by rural hospitals are often in great need of care. In fact, rural populations have a lower average life expectancy (76.8 years) than urban populations (78.8 years), according to a 2015 brief by the National Advisory Committee on Rural Health and Human Services. Access to providers and hospitals can be a major obstacle in receiving the appropriate, affordable, and effective health care that rural communities need. Costly, unreliable, or difficult-to-access transportation can be especially challenging for patients who need treatments every week. Even if a hospital is accessible in the community, cash-strapped hospitals in many states often cut services, particularly labor and delivery units, to prevent total closures.
But even with cost-cutting measures, rural hospitals can still face closures. In Navigant’s analysis, 21%, or 430 hospitals across 43 states, are at high risk for closure without changes to improve their finances. If these hospitals were to close their doors, they would take away 21,547 staffed beds, 707,000 annual discharges, 150,000 jobs, and $21.2 billion in total patient revenue.
Keep reading to learn which states have the most at-risk hospitals.
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#44. Utah (tie)
- Rural hospitals at high risk: 0 out of 17 qualifying hospitals (0%)
In 2018, four rural Utah hospitals were nationally recognized for care quality and patient outcomes. One of the hospitals was honored for providing quality care in an affordable, safe, and effective manner. The other three hospitals received recognition for the impact of health care service or intervention on the health status of patients.
#44. Vermont (tie)
- Rural hospitals at high risk: 0 out of 13 qualifying hospitals (0%)
The Green Mountain Care Board regulates hospital budgets in Vermont, the only state to have such regulation. In order to protect rural hospitals from bankruptcy, the board wants some hospitals to create sustainability plans and check in with the board periodically, according to a 2019 report by VTDigger.
#44. Massachusetts (tie)
- Rural hospitals at high risk: 0 out of 6 qualifying hospitals (0%)
Although classified as a rural hospital, Nantucket Cottage Hospital is located on a wealthy island, which means higher wages for its staff. Since Medicare must reimburse employee wages at urban hospitals at least as much as it reimburses rural hospitals in Massachusetts, Nantucket Cottage Hospital sets a higher-than-typical floor for Medicare reimbursement across the state.
#44. Maryland (tie)
- Rural hospitals at high risk: 0 out of 5 qualifying hospitals (0%)
Maryland created a total patient revenue program to help rural hospitals manage rising costs. The state’s Health Services Cost Review Commission sets the amount of revenue the hospitals will get each year based on each hospital’s patient mix and services. The program creates a financial incentive to improve quality of care while reducing unnecessary testing and readmissions.
- Rural hospitals at high risk: 1 out of 28 qualifying hospitals (3.6%)
The Oregon Office of Rural Health noted disparities between statewide and rural health care in its August 2020 report. The 2017-2019 average preventable hospitalization rate across Oregon is 7.3 per 1,000 people per year, while in rural parts of the state the three-year average is 9.0. Statewide, it takes a patient about 13 minutes to travel to a Patient-Centered Primary Care Home (a health care clinic recognized for patient-centered care), but in rural areas, the average travel time is almost double, at 25 minutes.
- Rural hospitals at high risk: 1 out of 22 qualifying hospitals (4.5%)
When Pioneer Community Hospital closed in 2017, Patrick County was left without any hospitals. The closure meant the unemployment of over 100 people, longer trips for rescue teams to the next-nearest hospital, and difficulties in attracting new businesses to the area, according to the Associated Press. Officials have largely given up on reopening the hospital, which has a $5 million price tag, but are considering adding medical personnel to fire and rescue stations.
- Rural hospitals at high risk: 1 out of 21 qualifying hospitals (4.8%)
With an established telehealth program in place nearly two years before COVID-19 hit, St. John’s Health in Jackson was better prepared to continue caring for its rural community. The hospital was able to focus on treating patients instead of scrambling to build telehealth systems and educate patients on how to use them, as other hospitals needed to do during the early months of the pandemic.
- Rural hospitals at high risk: 1 out of 13 qualifying hospitals (7.7%)
Nevada hospitals face a physician shortage, with the state ranking 45th in the U.S. in active physicians per 100,000 people, 48th in primary care physicians, and 50th in general surgeons, according to a January 2020 report by the Nevada Health Workforce Research Center. Although the state ranks 25th in the nation in the number of undergraduate medical students per 100,000 people, Nevada’s ranking plummets to 44th in terms of residents and fellows, indicating a challenge in keeping medical students in the state.
- Rural hospitals at high risk: 4 out of 50 qualifying hospitals (8%)
In 2018, Sonoma Valley Hospital closed its obstetrics department and home care service. Cost-cutting measures like these and the building of a new diagnostic hub (so doctors won’t have to refer patients to outside providers) has the California hospital hoping it can stave off closure, according to the North Bay Business Journal.
- Rural hospitals at high risk: 12 out of 50 qualifying hospitals (9.4%)
Sixteen rural hospitals in Texas have closed for at least a period of time, if not permanently, over the four years preceding a February 2017 fact sheet prepared by the Texas Organization of Rural & Community Hospitals. The organization cites cuts and underpayments by Medicare and Medicaid costing $120 million annually as the main reason for the closures.
[Pictured: Dr. Ed Garner is the only doctor for 11,000 square miles of territory in West Texas. He practices out of Culberson Hospital, the only hospital available to serve three counties in and around Van Horn, Texas.]