The Rural Hospital

Join Our Mailing List

Understanding Hospital Types

By Calvin W. Wiese; MBA, CPA


According to Healthcare Organizations [Financial Management Strategies], the parameters of rural hospitals are determined based on distance

A Distance Definition

A rural hospital is defined as a hospital serving a geographic area ten or more miles from the nexus of a population center of 30,000 or more

More specifically, a rural hospital means an entity characterized by one of the following:

·Type A Rural Hospital — small and remote, has fewer than 50 beds, and is more than 30 miles from the nearest hospital.

·Type B Rural Hospital — small and rural, has fewer than 50 beds, and is 30 miles or less from the nearest hospital.

·Type C Rural Hospital — considered rural and has 50 or more beds.


Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.


Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact:


Product DetailsProduct Details

7 Responses

  1. Re-Defining the “Rural” Hospital

    The Hill reports that Sen. Ben Nelson (D-Neb.) has asked the Federal Communications Commission to reconsider a 2004 decision that narrowed the definition of a rural hospital to a facility that serves no more than 25,000 people from a previous classification that included service areas of up to 50,000 people.

    In a letter to the agency, Nelson said that the rule change will make four hospitals in his home state ineligible for $230,000 a year in federal funding to install and maintain broadband networks.

    So Calvin, I guess it all depends on what the definition of “rural” is!



  2. Areas Rural Hospitals are Delivering Value

    • Rural hospitals charge 63% less than their urban counterparts.
    • Spending per beneficiary for rural hospitals could save $6.8 billion if adopted by all.
    • Quality, patient safety, outcomes and satisfaction are equal, while price and efficiency in the emergency department are better.
    • Patients’ total time in the rural emergency department is 56 minutes faster than in urban facilities. Fifty percent of those ED visits occurred during normal business hours and are for low acuity cases.

    Source: iVantage Health Analytics


  3. Rural and Urban Hospitals’ Role in Providing Inpatient Care

    In 2010, 12% of the 35 million U.S. hospitalizations were in rural hospitals. A higher percentage of inpatients in rural hospitals were aged 65 and over (51%) compared with inpatients in urban hospitals (37%).

    The average number of diagnoses for rural and urban inpatients was similar, as was the average length of stay. Sixty-four percent of rural hospital inpatients, compared with 38% of urban hospital inpatients, had no procedures performed while in the hospital.

    Following their hospitalization, a higher percentage of rural inpatients (7%) than urban inpatients (3%) were transferred to other short-term hospitals, and a higher percentage of rural (14%) than urban (11%) inpatients were discharged to long-term care institutions.

    Source: CDC/National Center for Health Statistics


  4. Rural hospitals close as healthcare system changes

    Small, rural hospitals have always struggled to remain viable, but things are getting worse.

    Now, the Affordable Care Act is bringing additional pressure.



  5. 283 Rural US Hospitals are in Danger of Closing

    Pew Charitable Trusts recently published an article on the predicament of rural hospitals in the US. Here are some key findings from the report:

    • There are 2,322 rural hospitals in the U.S., with a majority in the Midwest and the South.
    • 56 rural hospitals that have closed since 2010.
    • Currently, 283 rural hospitals are in danger of closing.
    • From 1983 to 1998, 440 rural hospitals closed in the U.S.
    • Rural hospitals have an average of 50 beds per hospital, compared to 234 at urban hospitals.
    • 7 inpatients are served on average per day at rural hospitals, versus 102 at urban hospitals.

    Source: Pew Charitable Trusts, August 17, 2015


  6. A Sense of Alarm as Rural Hospitals Keep Closing

    The following originally appeared on The Upshot (copyright 2018, The New York Times Company).

    Hospitals are often thought of as the hubs of our health care system. But hospital closings are rising, particularly in some communities.

    “Options are dwindling for many rural families, and remote communities are hardest hit,” said Katy Kozhimannil, an associate professor and health researcher at the University of Minnesota.

    Beyond the potential health consequences for the people living nearby, hospital closings can exact an economic toll, and are associated with some states’ decisions not to expand Medicaid as part of the Affordable Care Act.

    Since 2010, nearly 90 rural hospitals have shut their doors. By one estimate, hundreds of other rural hospitals are at risk of doing so.

    In its June report to Congress, the Medicare Payment Advisory Commission found that of the 67 rural hospitals that closed since 2013, about one-third were more than 20 miles from the next closest hospital.

    A study published last year in Health Affairs by researchers from the University of Minnesota found that over half of rural counties now lack obstetric services. Another study, published in Health Services Research, showed that such closures increase the distance pregnant women must travel for delivery.

    And another published earlier this year in JAMA found that higher-risk, preterm births are more likely in counties without obstetric units. (Some hospitals close obstetric units without closing the entire hospital.)

    Ms. Kozhimannil, a co-author of all three studies, said, “What’s left are maternity care deserts in some of the most vulnerable communities, putting pregnant women and their babies at risk.”

    In July, after The New York Times wrote about the struggles of rural hospitals, some doctors responded by noting that rising malpractice premiums had made it, as one put it, “economically infeasible nowadays to practice obstetrics in rural areas.”

    Many other types of specialists tend to cluster around hospitals. When a hospital leaves a community, so can many of those specialists. Care for mental health and substance use are among those most likely to be in short supply after rural hospital closures.

    The closure of trauma centers has also accelerated since 2001, and disproportionately in rural areas, according to a study in Health Affairs. The resulting increased travel time for trauma cases heightens the risk of adverse outcomes, including death.

    Another study found that greater travel time to hospitals is associated with higher mortality rates for coronary artery bypass graft patients.

    In many communities, hospitals are among the largest employers. They also draw other businesses to an area, including those within health care and others that support it (like laundry and food services, or construction).

    A study in Health Services Research found that when a community loses its only hospital, per capita income falls by about 4 percent, and the unemployment increases by 1.6 percentage points.

    Not all closures are problematic. Some are in areas with sufficient hospital capacity. Moreover, in many cases hospitals that close offer relatively poorer quality care than nearby ones that remain open. This forces patients into higher-quality facilities and may offset negative effects associated with the additional distance they must travel.

    Perhaps for these reasons, one study published in Health Affairs found no effect of hospital closures on mortality for Medicare patients. Because it focused on older patients, the study may have missed adverse effects on those younger than 65. Nevertheless, the study found that hospital closings were associated with reduced readmission rates, which is regarded as a sign of increased quality. So it seems consolidating services at larger hospitals can sometimes help, not harm, patients.

    “There are real trade-offs between consolidating expertise at larger centers versus maintaining access in local communities,” said Karen Joynt Maddox, a cardiologist and health researcher with the Washington University School of Medicine in St. Louis and an author of the study. “The problem is that we don’t have a systematic approach to determine which services are critical to provide locally, and which are best kept at referral centers.”

    Many factors can underlie the financial decision to close a hospital. Rural populations are shrinking, and the trend of hospital mergers and acquisitions can contribute to closures as services are consolidated.

    Another factor: Over the long term, we are using less hospital care as more services are shifted to outpatient settings and as inpatient care is performed more rapidly. In 1960, an average appendectomy required over six days in the hospital; today one to two days is the norm.

    Part of the story is political: the decision by many red states not to take advantage of federal funding to expand Medicaid as part of the Affordable Care Act. Some states cited fiscal concerns for their decisions, but ideological opposition to Obamacare was another factor.

    In rural areas, lower incomes and higher rates of uninsured people contribute to higher levels of uncompensated hospital care — meaning many people are unable to pay their hospital bills. Uncompensated care became less of a problem in hospitals in states that expanded Medicaid.

    In a Commonwealth Fund Issue Brief, researchers from Northwestern Kellogg School of Management found that hospitals in Medicaid expansion states saved $6.2 billion in uncompensated care, with the largest reductions in states with the highest proportion of low-income and uninsured patients. Consistent with these findings, the vast majority of recent hospital closings have been in states that have not expanded Medicaid.

    In every year since 2011, more hospitals have closed than opened. In 2016, for example, 21 hospitals closed, 15 of them in rural communities. This month, another rural hospital in Kansas announced it was closing, and next week people in Kansas, and in some other states, will vote in elections that could decide whether Medicaid is expanded.

    Richard Lindrooth, a professor at the University of Colorado School of Public Health, led a study in Health Affairs on the relationship between Medicaid expansion and hospitals’ financial health. Hospitals in nonexpansion states took a financial hit and were far more likely to close. In the continuing battle within some states about whether or not to expand Medicaid, “hospitals’ futures hang in the balance,” he said.


    via Ann Miller RN MHA


Leave a Reply

Please log in using one of these methods to post your comment: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: