The Rising Level of Concern about the Rural Hospitals Gains Traction

There appears to be a general lack of awareness concerning the value rural hospitals bring to a community.

Over the upcoming weeks I will be spending time reporting on rural hospitals. My reporting will include critical access hospitals of which two of them I am associated with.

For me it has been quite a learning curve when compared to short term acute care hospitals. Many times, there is a lack of knowledge of the value that rural hospitals bring to people in those areas.

A few known statistics: The rural population has changed in the past 10 years; the 60 million U.S. residents living in rural areas in 2020 made up 17.9 percent of the U.S. population. A typical rural county contained less than 10 percent of the population of a typical urban county in 2020—23,000 people compared with 245,000.

Residents who live in smaller and more isolated rural settings often face greater difficulties accessing provisions and services or commuting to work, including access to quality healthcare in their local communities. The COVID-19 pandemic had significant widespread negative consequences to these vulnerable areas.

Rural hospitals have been and will always be a critical part of the nation’s health care delivery system.  In addition, in many cases, the small rural hospital is not just the sole provider of hospital services in its community, it is the sole or primary source of all healthcare services in that community and may even be one of the largest employers of that area.

According to the American Hospital Association, (AHA), there are 6,093 hospitals in the United States, of which 1,796 are considered rural hospitals. Rural hospitals are an integral part of the healthcare system with significant contributions to overall community well-being. Rural hospitals provide services across the continuum of care from primary care to long-term care, yet a couple of the challenges that they face are attracting quality physicians to set up a practice in their area, the lack of many services and specialties patients may require, and the lack of financial sustainability of patients without insurance, especially during this time of inflation, hence non-compensated care.

Recent years, however, have presented challenges for rural hospitals. Factors such as low reimbursement rates, increased regulation, reduced patient volumes, and uncompensated care have caused many rural hospitals to struggle financially. Some more staggering statistics:

There have been 183 rural hospital closures since January 2005, Of that number, 99 were complete closures and 84 were converted closures. Some of the challenges that we will get into in future presentations are the low patient volumes, geographic isolation, and attracting and retaining a sufficient workforce.

In addition, rural hospitals and health systems often lack access to capital that helps fund development of new models of care, and they are often more susceptible to the effects of economic changes or downturns in their communities.  

In summary, rural providers across the nation, indeed, do care for and lift up their communities every single day. They are truly indispensable to the patients they serve, and we must continue to work together with our rural partners to advance health in America. 

Stay tuned for future reporting.


John Zelem, MD, FACS

John Zelem, MD, is principal owner and chief executive officer of Streamline Solutions Consulting, Inc. providing technology-enabled, expert physician advisor services. A board-certified general surgeon with more than 26 years of clinical experience, Dr. Zelem managed quality assessment and improvement as a former executive medical director in the past. He developed expertise in compliance, contracts and regulations, utilization review, case management, client relations, physician advisor programs, and physician education. Dr. Zelem is a member of the RACmonitor editorial board.

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