2019 Single Worst Year for Rural Hospital Closures, Report Finds

On top of 19 rural hospital closures, more than 450 rural hospitals are vulnerable to closure as the stability of the rural health safety-net continues to plummet, according to a recent report from the Chartis Center for Rural Health.

In collaboration with iVantage Health Analytics, the Chartis Center for Rural Health compared performance levels of nearly 2,000 open rural hospitals to those that have closed. Researchers uncovered that 453 of the 2,000 are considered “vulnerable” to closure and 216 hospitals are considered “most vulnerable” while 237 are defined as “at risk.”

“Our model provided us with the opportunity to conduct a more nuanced examination of the path toward closure and better understanding the breadth of vulnerability across the nation,” Michael Topchik, national leader for The Chartis Center for Rural Health said in the press release.

The regression model uncovered nine variables of statistical significance in predicting closures. Medicaid expansion, health system affiliation, and government control status all decreased the likelihood of hospital closure.

The variable decreased the most for Medicaid expansion status, at 62 percent on average. Those states with high levels of vulnerability are states that have failed to expand Medicaid. 

In January 2018, hospitals in Medicaid expansion states were six times less likely to see hospital closures than their counterparts in non-expansion states, according to a Health Affairs study.  

From 2008 to 2016, the hospital closure rate reduced by 0.33 per 100 hospitals in Medicaid expansion states. In contrast, hospitals in non-expansion states saw increased rates by nearly 0.45 per 100 hospitals. 

Additionally, a 100 percent increase in poverty in the threshold for childless adults made a hospital 2.5 times more vulnerable to closure than a hospital in a non-expansion state.

“Our results suggest that if future policies are adopted that both eliminate the Medicaid expansion and lower health insurance coverage rates, we will see an increase in hospital closures, especially in rural areas,” Richard Lindrooth, co-author and PhD at department of health systems, management, and policy at the Colorado Schools of Public Health.

More than 120 rural hospitals have closed over the last ten years, which continues to limit access to care for elderly populations who are less healthy than individuals in urban areas, the Chartis Center for Rural Health report found. The rural health safety-net is becoming unstable and the challenges associated with delivering care in rural communities are increasing.

Specifically, the greatest area of rural hospital vulnerability is in the Southeast and lower Great Plains. Mississippi, Missouri, Oklahoma, Tennessee, and Texas are also featured across the rural hospital vulnerability space as well. But those states who have yet to see closures should expect to see closures in the future. 

The states hit hardest by hospital closures also see the highest levels of vulnerability, which threatens to further the challenge of healthcare services at the local level.

“None of the metrics we track to measure the stability of the rural health safety net are improving, and this research allows us to quantify just how severe the implications could be if the current situation worsens," Topchik said. 

“The ability of our model to identify indicators with the greatest impact on predicting closure has the potential to better inform rural health stakeholders in their efforts to devise new policies and guidelines aimed at reducing downward pressure on rural provider revenues and improving care,” he concluded.