US Rural Hospitals

Ongoing closures threaten access to health care for millions of Americans.

Read how telehealth and telemedicine can buck the trend.

Closures

Nearly 20% of Americans live in rural areas, and many no longer have local access to acute care services. According to GetReferralMD.com, 43 rural hospitals have closed their doors since 2010. The causes range from not expanding Medicaid to inability to meet new electronic health record standards, physician shortages, and reduced reimbursement.[1] From 2013 through 2014, 24 closures occurred in 12 states: Alabama, Georgia, Kentucky, Mississippi, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, and Virginia.[2]

Success Stories

Some US rural hospitals are beating the closure trend. AMD Global Telemedicine describes how Baystate Health supports three community hospitals through improved connectivity to specialists at Baystate Medical Center (Springfield). With 11,500 employees, Baystate Health serves more than 750,000 residents in Western Massachusetts. Telemedicine is the key to providing cardiology, critical care, geriatric, infectious disease, neurology, and psychology consults.[3]

Oregon could be another state facing rural hospital closures if actions aren’t taken to prevent them. By 2030, projections suggest that the number of primary care providers throughout Oregon will fall 20% short of the ideal goal of 6,500. Nearly 25% of Oregon’s population is rural, but only 10% of the state’s physicians serve those residents.[4] On the Oregon coast, one coastal community is expanding capacity to meet rising demand for medical services. Curry General Hospital is a Level IV trauma center that has been recertified through February 2017. The project has generated controversy, however, because the hospital site is located in an area that could be adversely affected if there’s a large earthquake in or across the Pacific Ocean. Construction is taking that possibility into account. Gold Beach city administrators note that the new Curry General Hospital is “designed to the highest earthquake standards, even more so than what the building codes require” and is the first in the United States to address tsunami impacts.

2017 Update

Cumulative figures are grim: 80 rural hospital closures between 2010 and 2016. The problem is publicized, and impacts are evaluated by the Federal Office of Rural Health Policy (FORHP), Health Resources & Services Administration (HSRA), Medicare Rural Hospital Flexibility Program (Flex), and State Offices of Rural Health.[5]

An independent analysis published in 2016 identified key factors and trends. For example, rural hospitals have closed in 20 states, but a total of 673 facilities are “vulnerable” in 43 states. As also noted by the HSRA, a significant portion are Critical Access Hospitals -- the only facilities in a 35-mile radius. States that do no have expanded Medicaid programs face more extreme financial pressure. While rural residents lose access to health care, closures also eliminate jobs and economic support for local communities.[6]

[1] “Rural Hospital Closures: How Telemedicine Could Provide Relief,” GetReferralMD.com, February 2015.

[2] “The Rural Hospital Landscape: Current Trends & Policies,” National Rural Health Association, August 20, 2015. [2015PolicyInstituteAskDRCredits.pdf]

[3] “Baystate Health Brings ‘Big-city’ Specialist Access To Two Community Hospitals Using AGNES™ Software From AMD Global Telemedicine,” AMD Global Telemedicine Baystate Health Success Story

[4] “Replace The General,” Curry Health Network (several posts from November 2014 through February 2015).