Rural Hospitals – Resources
Selected recent or important resources focusing on Rural Hospitals.
Trends in Hospital Administrative Costs: Urban–Rural Disparities, Barriers, and Reduction Strategies
Compares Medicare cost report data from 2011 and 2022 for over 4,400 rural and urban short-term acute care hospitals to identify shifts in administrative and general (A&G) spending. Discusses 3 themes related to cost growth, barriers in reporting, and strategies to manage and reduce costs. Describes implications for hospital policy.
Author(s): Lauree Handlon, Kit Simpson, Larry Leaming, Dunc Williams
Citation: Health Affairs Scholar, 3(8)
Date: 08/2025
view details
Compares Medicare cost report data from 2011 and 2022 for over 4,400 rural and urban short-term acute care hospitals to identify shifts in administrative and general (A&G) spending. Discusses 3 themes related to cost growth, barriers in reporting, and strategies to manage and reduce costs. Describes implications for hospital policy.
Author(s): Lauree Handlon, Kit Simpson, Larry Leaming, Dunc Williams
Citation: Health Affairs Scholar, 3(8)
Date: 08/2025
view details
The Impact of Rural Hospital Closures and Mergers on Health System Ecologies: A Scoping Review
Examines 46 studies on rural hospital closures and mergers between 2010 to 2023, with a focus on understanding health system impacts, finances, workforce, utilization, access to facilities and services, and community and economic well-being.
Author(s): Alison Coates, Janice Probst, Kanika Sarwal, Suhaib Riaz, Agnes Grudniewicz
Citation: Medical Care Research and Review, 82(5)
Date: 07/2025
view details
Examines 46 studies on rural hospital closures and mergers between 2010 to 2023, with a focus on understanding health system impacts, finances, workforce, utilization, access to facilities and services, and community and economic well-being.
Author(s): Alison Coates, Janice Probst, Kanika Sarwal, Suhaib Riaz, Agnes Grudniewicz
Citation: Medical Care Research and Review, 82(5)
Date: 07/2025
view details
AHEAD CMS-Designed Medicare FFS HGB Calculator Tool for Acute Care Hospitals Demonstration
Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool, which aims to support fee-for-service acute care hospitals in understanding the HGB financial methodology for the AHEAD Model. Discusses how an AHEAD Medicare Fee-for-Service Hospital Global Budget is constructed.
Additional links: AHEAD Model CMS-Designed Medicare FFS Acute Care Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Acute Care Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool, which aims to support fee-for-service acute care hospitals in understanding the HGB financial methodology for the AHEAD Model. Discusses how an AHEAD Medicare Fee-for-Service Hospital Global Budget is constructed.
Additional links: AHEAD Model CMS-Designed Medicare FFS Acute Care Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Acute Care Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
FY 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule — CMS-1833-F
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the Medicare Promoting Interoperability Program and the discontinuation of the low-wage index hospital policy for FY 2026 and subsequent years.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the Medicare Promoting Interoperability Program and the discontinuation of the low-wage index hospital policy for FY 2026 and subsequent years.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Variation, Overlap, and Stability in Defining Safety Net Hospitals
Results of a study examining the extent to which safety net hospitals overlap, change over time, and represent similar types of healthcare facilities. Features statistics with breakdowns including rural location and Critical Access Hospital designation.
Author(s): Paula Chatterjee, Joshua M. Liao, Kano Amagai, et al.
Citation: JAMA Network Open, 8(7), e2523923
Date: 07/2025
view details
Results of a study examining the extent to which safety net hospitals overlap, change over time, and represent similar types of healthcare facilities. Features statistics with breakdowns including rural location and Critical Access Hospital designation.
Author(s): Paula Chatterjee, Joshua M. Liao, Kano Amagai, et al.
Citation: JAMA Network Open, 8(7), e2523923
Date: 07/2025
view details
Emergency Department Visits among Rural and Urban Older Adults: Disparities in Ambulatory and Emergency Care Sensitive Conditions
Compares emergency department (ED) utilization for ambulatory care sensitive conditions (ACSCs) and emergency care sensitive conditions (ECSCs) among rural and urban Medicare beneficiaries. Presents findings from a pooled cross-sectional analysis of 2016–2020 Medicare Current Beneficiary Survey data.
Author(s): Cameron J. Gettel, Courtney Kitchen, Craig Rothenberg, et al.
Citation: BMC Health Services Research, 25, 275
Date: 07/2025
view details
Compares emergency department (ED) utilization for ambulatory care sensitive conditions (ACSCs) and emergency care sensitive conditions (ECSCs) among rural and urban Medicare beneficiaries. Presents findings from a pooled cross-sectional analysis of 2016–2020 Medicare Current Beneficiary Survey data.
Author(s): Cameron J. Gettel, Courtney Kitchen, Craig Rothenberg, et al.
Citation: BMC Health Services Research, 25, 275
Date: 07/2025
view details
MedPAC Data Book: Health Care Spending and the Medicare Program, 2025
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures and Rural Emergency Hospital conversions.
Date: 07/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures and Rural Emergency Hospital conversions.
Date: 07/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
Obstetric Care Access Declined in Rural and Urban Hospitals Across US States, 2010–22
Examines the number and proportion of hospitals located in rural and urban counties in each state that lost hospital-based obstetric services between 2010 and 2022. Describes the proportion of hospitals without obstetric services for any reason by 2022.
Author(s): Katy Backes Kozhimannil, Julia D. Interrante, Caitlin Carroll, et al.
Citation: Health Affairs, 44(7), 806-811
Date: 07/2025
view details
Examines the number and proportion of hospitals located in rural and urban counties in each state that lost hospital-based obstetric services between 2010 and 2022. Describes the proportion of hospitals without obstetric services for any reason by 2022.
Author(s): Katy Backes Kozhimannil, Julia D. Interrante, Caitlin Carroll, et al.
Citation: Health Affairs, 44(7), 806-811
Date: 07/2025
view details
The Impact of High Hospital Fixed-Cost Ratios on Rural Populations
Explores how rurality relates to hospital cost structures as categorized by Urban Influence Codes (UICs). Describes the characteristics of hospitals at different fixed-to-total-cost ratio levels, the demographics associated with hospitals at different ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or Low-Volume Hospital (LVH) designations. Discusses how findings could be used to refine hospital payment policies.
Author(s): Abigail Barker, Eliot Jost, Timothy McBride, Keith Mueller
Date: 06/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
view details
Explores how rurality relates to hospital cost structures as categorized by Urban Influence Codes (UICs). Describes the characteristics of hospitals at different fixed-to-total-cost ratio levels, the demographics associated with hospitals at different ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or Low-Volume Hospital (LVH) designations. Discusses how findings could be used to refine hospital payment policies.
Author(s): Abigail Barker, Eliot Jost, Timothy McBride, Keith Mueller
Date: 06/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
view details
MedPAC Comment on CMS's Proposed Rule on Inpatient Prospective Payment System for FY 2026
Comments on an April 30, 2025, Federal Register proposed rule revising the hospital inpatient and long-term care hospital (LTCH) prospective payment systems (PPS). Discusses proposals to update inpatient prospective payment systems (IPPS) payment rates, update wage index values and policies, modify the Transforming Episode Accountability Model (TEAM), and remove the proposed health-equity adjustment from the Hospital Value-Based Purchasing (VBP) Program.
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
Comments on an April 30, 2025, Federal Register proposed rule revising the hospital inpatient and long-term care hospital (LTCH) prospective payment systems (PPS). Discusses proposals to update inpatient prospective payment systems (IPPS) payment rates, update wage index values and policies, modify the Transforming Episode Accountability Model (TEAM), and remove the proposed health-equity adjustment from the Hospital Value-Based Purchasing (VBP) Program.
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
view details
Additional resources are available related to this guide. See the full list of resources by topic for:
Last Updated: 9/8/2025