Rural hospitals in crisis mode

Since 2005, 104 rural hospitals have closed, with another 89 facilities no longer providing inpatient services, according to data compiled by the University of North Carolina's Cecil G. Sheps Center for Health Services Research. 

Thirty-seven of those 104 closures have occurred since 2020, highlighting the amplified financial challenges that rural hospitals and health systems face amid persisting workforce shortages, rising costs and leveling reimbursement. 

Below are the 37 rural hospitals that closed since 2020, beginning with the most recent.

Editor's note: Facilities with an asterisk (*) signify converted closures (facilities that no longer provide inpatient services, but continue to provide some healthcare services, such as primary care, skilled nursing care or long-term care).

- St. Mark's Medical Center (La Grange, Texas)
- Herington (Kan.) Hospital
- Spectrum Health Kelsey Hospital (Lakeview, Mich.)
- Indiana University Health Blackford Hospital (Hartford City, Ind.)*
- Martin General Hospital (Williamston, N.C.)
- Patients Choice Medical Center of Smith County (Raleigh, Miss.)
- St. Margaret's Health-Spring Valley (Ill.)
- UPMC Lock Haven (Pa.)*
- St. Margaret's Health-Peru (Ill.)
- Clinton (Okla.) Regional Hospital* (reopened under new management Oct. 30)
- Ascension St. Vincent Dunn (Bedford, Ind.)
- Blessing Health Keokuk (Iowa)
- Audrain Community Hospital (Mexico, Mo.)
- Callaway Community Hospital (Fulton, Mo.)
- Acoma-Canoncito-Laguna Service Unit (Acoma, N.M.)*
- Galesburg (Ill.) Cottage Hospital*
- Bristow (Okla.) Medical Center*
- MercyOne Oakland Medical Center (Oakland, Neb.)*
- Community HealthCare System-St. Marys (Kan.)*
- Perry Community Hospital (Linden, Tenn.)
- Northridge Medical Center (Commerce, Ga.)*
- Southwest Georgia Regional Medical Center (Cuthbert, Ga.)
- Shands Lake Shore Regional Medical Center (Lake City, Fla.)
- Cumberland River Hospital (Celina, Tenn.)
- Bluefield (W.Va.) Regional Medical Center*
- Saint Luke's Cushing Hospital (Leavenworth, Kan.)*
- Shands Live Oak (Fla.) Regional Medical Center*
- Shands Starke (Fla.) Regional Medical Center*
- Williamson (W.V.a) Memorial Hospital*
- Decatur County General Hospital (Parsons, Tenn.)
- Sumner Community Hospital (Wellington, Kan.)
- Edward W. McCready Memorial Hospital (Crisfield, Md.)*
- Mayo Clinic Health System-Springfield (Minn.)*
- Central Hospital of Bowie (Texas)*
- UPMC Susquehanna Sunbury (Pa.)*
- Pinnacle Regional Hospital (Boonville, Mo.)
- Mountain View Regional Hospital (Norton, Va.)*

To address concerns that rural and critical access hospital closures are reducing access to care for people in rural areas, CMS established the rural emergency hospital designation, a new Medicare provider type, effective Jan. 1.

Just 16 facilities have converted to rural emergency hospitals so far, but more may follow suit in 2024 as rural hospitals continue to be challenged by staffing shortages and rising costs, which are stifling recovery efforts and leaving some on the brink of bankruptcy or closure

Many hospital leaders see mobile health, expanded partnerships and new payment methods as keys to solving rural healthcare's challenges and curbing rural hospital closures. 

"Although more rapidly changing the payment system away from fee-for-service will help, the best hope and most progress is to change the behavior of the large systems and universities to view rural areas not as referral pipelines but as citizens and providers that need real population healthcare partners," Jeff Thompson, MD, CEO Emeritus at La Crosse, Wis.-based Gundersen Health System, told Becker's. "Not closing, but re-focusing the work of rural providers and rural hospitals that have already been shifting to outpatient work [will help]."

Morehead, Ky.-based St. Claire Healthcare President and CEO Donald Lloyd, II. believes the U.S. healthcare system cannot perpetuate a stable rural health infrastructure until it addresses three significant issues critical to achieve rural health sustainability.

"First, we must develop and attract a rural-centric pipeline of talent to meet our clinical and workforce needs, "Mr. Lloyd said. "Second, we must realize that it is not economically possible to sustain a full service acute care hospital in every rural community. Such a realization takes great political courage but also clinical creativity to meet the community's needs. Third, CMS and state Medicaid agencies must establish payment methodologies that sustain institutions in low volume and safety-net environments."

Other rural hospital leaders are reinforcing the need to collaborate, expand services and grow to ensure financial sustainability. 

"Collaboration and diversification are the key strategies for future success. We should look for ways we can collaborate with other organizations and providers to expand and diversify our services," Thomas Siemers, CEO of Wilbarger General Hospital in Vernon, Texas, told Becker's. "Rural hospitals will have to try new strategies, start new services, adapt to the changing needs of patients. The key is to keep our patients local so they don't have to travel for care. Rural hospitals will have to share revenue and/or pay for the services provided by other organizations/providers. But it's worth it. We've got to grow."

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