- Last year was the worst for rural hospitals closures since a crisis for their stability began in 2010 as 19 rural facilities closed, bringing the number that have shuttered in the past 10 years to 120, according to a report from The Chartis Center for Rural Health.
- The analysis found that 453 rural hospitals out of 1,844 open rural hospitals are vulnerable to closure based on their performance levels, about half of which are most vulnerable with the other half labeled "at risk." CCRH, an arm of advisory and analytics firm The Chartis Group, works with iVantage Health Analytics to track the data.
- The states with the highest number of closures in the past 10 years are Texas at 20 and Tennessee at 12, followed by Oklahoma and Georgia with seven each. Those states also had the highest levels of hospitals vulnerable to closure, according to the report.
The decade long crisis of rural hospital closures has had a number of impacts. Losing a community hospital cuts access options for people nearby and means lost jobs in the area. All of that leads to worse health outcomes for rural residents — a frequently documented occurrence.
The new analysis identified nine variables as most relevant to probability a rural hospital will close. Facilities were less likely to shutter when they had a broad array of service lines and higher occupancy rates. Financially, a higher percentage of capital efficiency (net patient income in relation to total patient revenue) was key, along with positive change in total revenue.
Also, more stable are hospitals with government control status (and thus additional funding and access to resources), those with larger system affiliation and facilities in Medicaid expansion states.
CMS has made some efforts to boost rural facilities as the closure crisis continues. In a final rule last year, the agency increased the wage index for hospitals below the 25th percentile for at least four years starting in fiscal year 2020. CMS Administrator Seema Verma told reporters then that with the change, "low-wage and rural hospitals will be able to increase employee compensation and have sustainability."
The CCRH report found that shuttered hospitals had notable financial struggles in their last three years of operation, with a particularly rapid decline in the last year. Rural hospitals that closed saw a 12.5% decrease in operating margin median in their last year of operation and total revenue dropped by $2.1 million over that time.
The 216 hospitals the analysis deemed most vulnerable to closing includes 97 that are critical access. The total group has median occupancy at about 20% and relies heavily on outpatient revenue. A greater ability to capture people in need of outpatient care — a more financially beneficial service line — is associated with more stability.