100 hospitals with the worst margins nationwide, ranked

Hundreds of hospitals in the U.S. are at immediate risk of closing, largely due not to financial mismanagement but inadequate reimbursements, according to the Center for Healthcare Quality and Payment Reform. 

Many of them are rural hospitals whose closures don't usually make the headlines, but that doesn't mean they're expendable. Rural communities supply most of the country's food and energy. If those communities can't access healthcare, it could mean power outages and empty pantries nationwide, even in big cities.

Those listed here have the worst total margins over the last three years, according to information from CMS. Data from 2020 was excluded from the calculations because of unusual cost and revenue changes at the pandemic's outset.

Three-year total margin figures were determined by subtracting cumulative costs from cumulative revenues over the given period, and then dividing the result by the same cumulative cost figure. This is different from the standard for-profit business approach of using revenues in the denominator.

That method assumes a business is trying to keep its costs below prices that are set by the market. Rural hospitals, however, deal with costs that depend on what services are needed, and they depend on payments set at amounts large enough to cover those costs.

The worst margins belong to Thomasville (Ala.) Regional Medical Center and Mullins, S.C.-based MUSC Health Marion Medical Center. One hospital at No. 36 in this ranking, the 25-bed Lake Geneva, Wis.-based Mercy Walworth Hospital & Medical Center, saw a three-year total margin of nearly 18 percent in the red despite its three-year patient services margin showing a whopping 433.9 percent in the green

The 100 rural hospitals with the worst three-year total margins:

Note: Only hospitals with three-year margins of negative 10 percent and worse were included in this ranking. Closed hospitals were not included. Click here to see the full data set. 

Editor's note: This article was updated Jan. 5 at 8:15 am CT. An earlier version of the article mistakenly credited the Cecil G. Sheps Center for Health Services Research for the hospital names and margins. The names and margins come from CMS via a database created and maintained by the Center for Healthcare Quality and Payment Reform. The database used Cecil G. Sheps Center information to determine whether a hospital was shuttered.

RankHospitalLocationNo. of bedsTotal 2021 expense3 year margin on patient services
3 year total margin
1 Thomasville Regional Medical Center Thomasville Ala. 29 $16.6M -53.1% -46.2%
2 MUSC Health Marion Medical Center Mullins S.C. 124 $46.6M -24.7% -43.2%
3 Defiance Regional Medical Center Defiance Ohio 35 $87M 36.4% -39.2%
4 Lallie Kemp Medical Center Independence La. 24 $46.9M -41.2% -38.0%
5 Hill Regional Hospital Hillsboro Texas 25 $28.8M -2.1% -34.8%
6 Stroud Regional Medical Center Stroud Okla. 25 $57.5M -31.7% -33.4%
7 Big Sky Medical Center Big Sky Mont. 4 $16.7M -28.3% -31.7%
8 The Physicians' Hospital In Anadarko Anadarko Okla. 25 $68M -29.7% -31.2%
9 Saint Thomas Stones River Hospital Woodbury Tenn. 55 $11.4M -36.4% -30.8%
10 Fairfax Community Hospital Fairfax Okla. 25 $32.7M -38.5% -29.6%
11 Southern Virginia Regional Medical Center Emporia Va. 80 $28.6M -10.1% -29.4%
12 Westfield Memorial Hospital Westfield N.Y. 4 $11.7M -38.1% -29.1%
13 Fishermen's Community Hospital Marathon Fla. 8 $25.7M -29.2% -29.0%
14 Bellville St Joseph Health Center Bellville Texas 32 $16.7M -40.4% -28.2%
15 Ascension Sacred Heart Gulf Port Saint Joe Fla. 19 $23.5M -31.1% -27.1%
16 Fostoria Community Hospital Fostoria Ohio 15 $45.9M 22.7% -26.9%
17 Saint Thomas DeKalb Hospital Smithville Tenn. 71 $14.1M -26.5% -26.6%
18 Lanai Community Hospital Lanai City Hawaii 4 $6.2M -39.9% -24.9%
19 Seton Smithville Regional Hospital Smithville Texas 36 $16.1M -25.7% -23.7%
20 Pineville Community Health Center Pineville Ky. 120 $13.8M -46.5% -23.0%
21 Stillwater Medical - Perry Perry Okla. 26 $9.7M -32.2% -22.8%
22 Izard County Medical Center Calico Rock Ark. 25 $7.1M -28.7% -21.8%
23 Big South Fork Medical Center Oneida Tenn. 25 $11.8M -19.8% -21.5%
24 Unicoi County Hospital Erwin Tenn. 10 $11.1M -21.4% -20.9%
25 Bob Wilson Memorial Hospital Ulysses Kan. 45 $13.6M -34.3% -20.5%
26 Bon Secours Southampton Memorial Hospital Franklin Va. 221 $57.9M -3.9% -20.4%
28 Eureka Springs Hospital Commission Eureka Springs Ark. 15 $8.2M -23.4% -20.1%
29 Haskell Regional Hospital Stigler Okla. 25 $10.1M -23.1% -19.8%
30 Vanderbilt Bedford Hospital Shelbyville Tenn. 104 $37.5M -2.9% -19.4%
31 Highland Community Hospital Picayune Miss. 60 $53.3M -12.8% -18.2%
32 Carilion Tazewell Community Hospital Tazewell Va. 238 $19.6M -4.3% -18.2%
33 Colusa Medical Center Colusa Calif. 48 $29.8M -9.4% -18.1%
34 Rush County Memorial Hospital La Crosse Kan. 24 $7.6M -27.4% -18.1%
35 Kiowa County Memorial Hospital Greensburg Kan. 25 $9.9M -30.6% -18.0%
36 Mercy Walworth Hospital & Medical Center Lake Geneva Wis. 25 $558.7M 433.9% -17.9%
37 Muscogee (Creek) Nation Medical Center Okmulgee Okla. 20 $28.4M -35.4% -17.8%
38 Hillsboro Community Hospital Hillsboro Kan. 15 $9.3M -32.3% -17.7%
39 MUSC Health Lancaster Medical Center Lancaster S.C. 217 $111M -8.4% -17.1%
40 Glenn Medical Center Willows Calif. 47 $33.6M -18.6% -16.8%
41 Sparrow Carson Hospital Carson City Mich. 87 $50.3M -9.6% -16.8%
42 Washington County Hosp Inc Plymouth N.C. 25 $20.8 -17.2% -16.6%
43 Creek Nation Community Hospital Okemah Okla. 25 $19.4M -64.0% -16.6%
44 Sanford Aberdeen Medical Center Aberdeen S.D. 48 $76.4M -24.5% -15.7%
45 Mid Coast Medical Center - Central Llano Texas 25 $7M -6.4% -15.7%
46 Sharon Hospital Sharon Conn. 78 $65.1M -13.4% -15.6%
47 Hillcrest Hospital Cushing Cushing Okla. 99 $16.4M 2.2% -15.2%
48 Crosbyton Clinic Hospital Crosbyton Texas 2 $4.6M -42.5% -15.1%
49 Kau Hospital Pahala Hawaii 21 $30.2M -34.8% -14.9%
50 Tanner Medical Center-East Alabama Wedowee Ala. 15 $13.7M -40.6% -14.8%
51 Floyd Cherokee Medical Center Centre Ala. 60 $15.3M -16.7% -14.8%
52 McKenzie County Healthcare Systems Inc Watford City N.D. 24 $45.8M -22.7% -14.8%
53 Gundersen St Elizabeth's Hospital and Clinics Wabasha Minn. 25 $44.3M -19.6% -14.5%
54 Alliancehealth Madill Madill Texas 25 $16.5M -13.2% -14.5%
55 UPMC Lock Haven Lock Haven Pa. 25 $42.1M -14.1% -14.4%
56 MUSC Health Chester Medical Center Chester S.C. 82 $53.2M -12.5% -14.3%
57 North Baldwin Infirmary Bay Minette Ala. 78 $45.9M -8.3% -14.2%
58 Saint Thomas Highlands Hospital Sparta Tenn. 60 $22.2M -18.6% -14.1%
59 Margaretville Memorial Hospital Margaretville N.Y. 15 $25.1M -23.6% -13.7%
60 Helena Regional Medical Center Helena Ark. 155 $23.4M -12.9% -13.6%
61 Carle Richland Memorial Hospital Olney Ill. 123 $65.6M 1.2% -13.2%
62 Baptist Memorial Hospital - Carroll County Huntingdon Tenn. 70 $26.3M -13.1% -13.2%
63 Lakeland Community Hospital Haleyville Ala. 49 $23.1M -9.9% -13.1%
64 Fillmore Community Hospital Fillmore Utah 19 $10.5M 3.6% -13.0%
65 UPMC Jameson New Castle Pa. 123 $122.4M -6.4% -12.9%
66 Ketchikan Medical Center Ketchikan Alaska 25 $94.7M -3.1% -12.6%
67 McLaren Central Michigan Mount Pleasant Mich. 151 $147.2M -14.4% -12.5%
68 Marion Regional Medical Center Hamilton Ala. 57 $22.5M -18.7% -12.1%
69 UPMC Horizon Greenville Pa. 157 $151.2M -2.3% -12.1%
70 Lee County Community Hospital Pennington Gap Va. 6 $20.6M -1.7% -12.0%
71 Franciscan Health Rensselaer Rensselaer Ind. 25 $35.9M -6.9% -11.7%
72 Alliance Healthcare System Holly Springs Miss. 40 $12.2M -11.5% -11.7%
73 Community Memorial Hospital Hicksville Ohio 25 $34.3M -10.4% -11.7%
74 Haskell Memorial Hospital Haskell Texas 25 $13.8M -34.2% -11.7%
75 Carnegie Tri-County Municipal Hospital Carnegie Okla. 21 $19.2M -15.1% -11.6%
76 Providence Seaside Hospital Seaside Ore. 25 $83.5M 1.4% -11.6%
77 Monument Health Custer Hospital Custer S.D. 11 $29.4M -14.4% -11.5%
78 UCHealth Pikes Peak Regional Hospital Woodland Park Colo. 15 $26.6M -8.0% -11.4%
79 Aspirus Merrill Hospital Merrill Wis. 25 $20.7M -0.2% -11.4%
80 Sgmc Lanier Campus Lakeland GA 25 $18.8M -17.1% -11.0%
81 Geary Community Hospital Junction City Kan. 92 $42.7M -22.2% -11.0%
82 UPMC Chautauqua at WCalif. Jamestown N.Y. 88 $131.7M -17.9% -11.0%
83 Hancock County Hospital Sneedville Tenn. 10 $7.2M -6.7% -11.0%
84 Johnson County Community Hospital Mountain City Tenn. 2 $9.2M -11.5% -10.9%
85 Patients Choice Medical Center of Smith County Raleigh Miss. 29 $2.9M 4.8% -10.8%
86 Providence St Joseph Hospital Chewelah Wash. 17 $20.4M -0.2% -10.7%
87 Crenshaw Community Hospital Luverne Ala. 65 $15M -22.6% -10.6%
89 Falls Community Hospital and Clinic Marlin Texas 44 $12.7M -24.2% -10.6%
90 Martin General Hospital Williamston N.C. 49 $27.7M -7.1% -10.5%
91 Randolph Hospital Asheboro N.C. 145 $114M -7.2% -10.5%
92 Rappahannock General Hospital Kilmarnock Va. 35 $40.5M -14.5% -10.5%
93 Othello Community Hospital Othello Wash. 16 $20.5M -19.0% -10.5%
94 Mangum Regional Medical Center Mangum Okla. 18 $16.7M -15.8% -10.3%
95 Prisma Health Oconee Memorial Hospital Seneca S.C. 169 $188.1M -7.0% -10.3%
96 Platte County Memorial Hospital Wheatland Wyo. 25 $25.5M -8.4% -10.3%
97 Marion General Hospital Columbia Miss. 79 $16.5M -17.2% -10.2%
98 Scenic Mountain Medical Center Big Spring Texas 132 $45.9M -9.4% -10.2%
99 Bronson South Haven Hospital South Haven Mich. 82 $37.9M -18.9% -10.1%
100 Kohala Hospital Kapaau Hawaii 25 $14.2M -38.0% -10.0%

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