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Mapping the Trends in Rural Hospital Services

Do rural Americans have sufficient access to healthcare? Plenty of data suggest the answer is “no,” including the headline number that 182 rural hospitals have closed since 2005.

But what about the hospitals that remain open? When you drill down to the service line level, are they offering the care that’s needed in their communities?

A new study from the North Carolina Rural Health Research Program finds that the answer is … complicated.

Using data from the American Hospital Association Annual Survey, researchers analyzed 29 service lines to see how availability changed from 2009 to 2017. Critical Access Hospitals (CAH) and Prospective Payment System (PPS) hospitals nationwide were included in the analysis – but only if they were classified as rural.

The good news is that most service line availability stayed the same or even increased over the 8-year time frame. Take adult cardiology, for instance: In 2009, the service line was offered by just 50% of rural PPS hospitals and 36% of CAHs. In 2017, those numbers were up to 90% and 79%, respectively.

Overall, researchers found that availability increased or stayed level for about two dozen service lines. Cardiology, colonoscopy, NICU, palliative care, and emergency psychiatric services were among the strongest gainers.

On the flip side, a half dozen service lines saw decreased availability across rural America, with some significant differences between CAH vs PPS facilities:

Researchers suggested the drop in services was likely due to three factors: low margins, declining patient volume, and workforce constraints. Mitigating those factors is crucial, they noted, because “obstetrics, home health, and surgery, are considered essential health care services in rural communities.”

The new Rural Emergency Hospital (REH) model, debuting in January 2023, is almost certain to change the current map of service availability. Because hospitals opting for REH status will have to close their inpatient units, several categories of ICU and surgical services could see significant declines.

How will REHs change their service line mix after cutting IP beds? That’s a question that goes to both mission and strategy, and the answer will look different in every community.

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