Rural Health
Resources by Topic: Hospitals
Determinants of Rural Hospital Closures or Conversions in the United States
Examines determinants leading to rural hospital closures or conversion to outpatient-only facilities. Provides data on hospital closures and conversions from 2012 to 2023 and analyzes potential determinants such as inpatient occupancy rates, ownership type, proximity to an urban county, profit margin, and more.
Author(s): Eden Volkov, Kaushik Ghosh, Steven Sheingold, Ge Bai
Date: 05/2026
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Examines determinants leading to rural hospital closures or conversion to outpatient-only facilities. Provides data on hospital closures and conversions from 2012 to 2023 and analyzes potential determinants such as inpatient occupancy rates, ownership type, proximity to an urban county, profit margin, and more.
Author(s): Eden Volkov, Kaushik Ghosh, Steven Sheingold, Ge Bai
Date: 05/2026
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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REH: Key Staffing Considerations
Describes key considerations to developing staffing plans for Rural Emergency Hospitals that balance operational needs and workforce stability.
Date: 05/2026
Sponsoring organization: Rural Health Redesign Center
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Describes key considerations to developing staffing plans for Rural Emergency Hospitals that balance operational needs and workforce stability.
Date: 05/2026
Sponsoring organization: Rural Health Redesign Center
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The Economic Impact of North Carolina's Hospitals
Reports on the statewide and regional economic contributions of 113 hospitals across North Carolina. Features statistics including number of hospitals by county designation and number of beds, with breakdowns by nonmetropolitan, micropolitan, and metropolitan areas.
Additional links: Infographic, Technical Documentation
Author(s): Sara Nienow, Carly Dotson
Date: 05/2026
Sponsoring organization: North Carolina Healthcare Association
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Reports on the statewide and regional economic contributions of 113 hospitals across North Carolina. Features statistics including number of hospitals by county designation and number of beds, with breakdowns by nonmetropolitan, micropolitan, and metropolitan areas.
Additional links: Infographic, Technical Documentation
Author(s): Sara Nienow, Carly Dotson
Date: 05/2026
Sponsoring organization: North Carolina Healthcare Association
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State-Level Medicaid Expansion and Hospital, Federally Qualified Health Center, and Rural Health Clinic Availability
Explores the association between state Medicaid expansion and the availability of hospitals, Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs) in states that expanded Medicaid between 2014-2016. Examines the presence of hospitals, FQHCs, and RHCs in urban and rural counties between 2010-2019.
Author(s): Elliott Paintsil, Sebastian Linde
Citation: Journal of Rural Health, 42(2), e70159
Date: 05/2026
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Explores the association between state Medicaid expansion and the availability of hospitals, Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs) in states that expanded Medicaid between 2014-2016. Examines the presence of hospitals, FQHCs, and RHCs in urban and rural counties between 2010-2019.
Author(s): Elliott Paintsil, Sebastian Linde
Citation: Journal of Rural Health, 42(2), e70159
Date: 05/2026
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CAH Financial Indicators Report: Summary of Indicator Medians by State
Presents state and national median values of 30 financial indicators included in the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS). Provides an overview of each measurement and reports median values by state. Indicators represent seven areas of financial performance: profitability, liquidity, capital structure, revenue, cost, utilization, and other.
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Presents state and national median values of 30 financial indicators included in the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS). Provides an overview of each measurement and reports median values by state. Indicators represent seven areas of financial performance: profitability, liquidity, capital structure, revenue, cost, utilization, and other.
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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MedPAC Comment on CMS's Proposed Rule on Inpatient Rehabilitation Facility for FY 2027
Comments on an April 6, 2026, Federal Register proposed rule addressing updates to the prospective payment system for inpatient rehabilitation facilities (IRFs) for fiscal year 2026. Includes comments on the potential creation of an IRF-specific wage index and refinements to the IRF payment system, such as changes to IRF patient clinical classification. Includes rural considerations throughout.
Date: 04/2026
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on an April 6, 2026, Federal Register proposed rule addressing updates to the prospective payment system for inpatient rehabilitation facilities (IRFs) for fiscal year 2026. Includes comments on the potential creation of an IRF-specific wage index and refinements to the IRF payment system, such as changes to IRF patient clinical classification. Includes rural considerations throughout.
Date: 04/2026
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment for Rural or Geographically Isolated Hospitals, 2026
Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2026
Sponsoring organization: Congressional Research Service
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Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2026
Sponsoring organization: Congressional Research Service
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Payer Mix Shifts and Profitability at Critical Access Hospitals, 2011 to 2023
Analyzes 1,384 Critical Access Hospitals between 2011 and 2023 to determine the impact of changes in commercial, Medicare, Medicaid, and uncompensated care on their finances. Discusses reimbursement policy based on study findings.
Author(s): Yusheng Jia, Yue Li, Xueya Cai, Samuel J. Enumah
Citation: Health Affairs Scholar, 4(4)
Date: 04/2026
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Analyzes 1,384 Critical Access Hospitals between 2011 and 2023 to determine the impact of changes in commercial, Medicare, Medicaid, and uncompensated care on their finances. Discusses reimbursement policy based on study findings.
Author(s): Yusheng Jia, Yue Li, Xueya Cai, Samuel J. Enumah
Citation: Health Affairs Scholar, 4(4)
Date: 04/2026
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Medicare Wage Index Trends in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Provides an overview of the wage index and its role in hospital reimbursement and financial stability. Describes the pattern of wage index values for rural and urban prospective payment system (PPS) hospitals from 2018 to 2022. Explores the impact of the low-wage index policy (LWIP), which was implemented in fiscal year 2020, and the potential implications of its discontinuation in fiscal year 2025.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Provides an overview of the wage index and its role in hospital reimbursement and financial stability. Describes the pattern of wage index values for rural and urban prospective payment system (PPS) hospitals from 2018 to 2022. Explores the impact of the low-wage index policy (LWIP), which was implemented in fiscal year 2020, and the potential implications of its discontinuation in fiscal year 2025.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Geographic Variation in Average Salary Expense Among Rural Hospitals Nationwide, 2018–2022
Examines the change in hospital wages between 2018–2019 and 2021–2022, with a focus on the geographic variation in these changes among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. Describes the variation in average salary expense per full-time equivalent (FTE) employee for rural hospitals from 2018 to 2022. Appendices include the median salary expense per FTE of rural hospitals each year by U.S. Census region, state Medicaid expansion status, Core-Based Statistical Area (CBSA), Frontier and Remote Area (FAR) code, and by state.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Examines the change in hospital wages between 2018–2019 and 2021–2022, with a focus on the geographic variation in these changes among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. Describes the variation in average salary expense per full-time equivalent (FTE) employee for rural hospitals from 2018 to 2022. Appendices include the median salary expense per FTE of rural hospitals each year by U.S. Census region, state Medicaid expansion status, Core-Based Statistical Area (CBSA), Frontier and Remote Area (FAR) code, and by state.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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