Focusing the Lens: Understanding the Rural Hospital Landscape

Contributing authors:  Bolin, JN., Bruining, H., Hutchison, L.

The Center for Optimizing Rural Health (CORH)’s primary purpose is to provide an extensive range of technical assistance services that help rural hospitals adjust and respond to the challenges associated with providing health care in rural areas. Over the last three years, CORH has worked with more than 130 hospitals representing 30 states across the country.

While each rural hospital is unique, with its own challenges and priorities, several key characteristics have emerged that enable the CORH to deliver client focused, need driven, technical assistance offerings.

Geographic distribution. More than half of CORH’s hospitals are located in the Northeast, West, and Midwest. These regions largely consist of states that have adopted federal Medicaid expansion. Through the expansion of Medicaid, these states have been able to provide greater access to health care services and reduce the health coverage gap for a number of individuals. Figures 1 and 2 display the breakdown of hospitals by U.S. census region and Medicaid expansion states.

Payment Type. Each type of hospital––whether Prospective Payment System (PPS) or Critical Access Hospital (CAH)––engages local communities by providing resources, sharing knowledge, and making other significant contributions to increase overall access to health care services. PPSs utilize a method of reimbursement in which payment made by the Centers for Medicare and Medicaid Services (CMS) is based on a predetermined, fixed amount. CAHs receive certain benefits, such as cost-based reimbursement for Medicare Services, in order to provide more predictability in financial income, reduce the financial vulnerability of rural hospitals, and improve access to health care in rural communities. More than half of CORH’s participating hospitals are classified as CAHs, as shown in Figure 3. CAHs are generally geographically remote and maintain a relatively small number of acute care beds (no more than 25 acute care beds are allowed for CAHs), despite the size of the population they serve.

Key Priorities. Rural hospitals across the country face common challenges that influence the health of their local communities and force them to modify their structure, such as reduced patient volumes and access to care. CORH seeks to understand the top priorities of all hospitals it works with in order to best deploy its experts and resources, and Figure 4 highlights the top priorities identified by participating hospitals.

Priorities related to learning and growth were most frequently identified, and recruitment and retention strategies are a main component of this priority. Rural hospitals often struggle to maintain an adequate workforce, which can strain patient care or staffing requirements. By identifying and implementing successful recruitment and retention practices, rural hospitals can improve the quality of care delivered and ensure continuity of care.

COVID-19 Pandemic Response. The new challenges brought on by the COVID-19 pandemic have prompted health care systems across the United States to seek financial and technical assistance. Hospitals participating in the CORH program this year were met with these unfamiliar circumstances beginning in March 2020. As shown in Figure 5, more than half of these hospitals identified a priority related to the impact of COVID-19, including guidance on how to use federal assistance and stimulus funding.

Although rural hospitals face often overwhelming and unique challenges, they have distinct opportunities to serve their respective communities. By effectively managing challenges and utilizing opportunities for growth, rural hospitals can impact health outcomes in their local communities.

We would appreciate hearing your unique COVID-19 challenges in your rural region, and how you have approached them. Please share your insights and questions with us at info@optimizingruralhealth.org.