This Is How Many Rural Hospitals Could Close in Every State

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The strain of caring for the sick during the COVID-19 crisis has financially threatened hospitals across the country. Their services have swung away from profitable procedures for other diseases and conditions and from more traditional emergency room visits to beds overflowing with critically ill coronavirus cases. Many rural hospitals have little or no financial reserves and have posted financial losses that have gone on for a long time. A substantial number of these may close, and close very soon. That will leave their communities without traditional medical facilities.

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According to a new study by the Center for Healthcare Quality and Payment Reform, over 500 rural hospitals faced a high risk that they would “immediately close” even before the pandemic. This was measured against two yardsticks. The first is a “cumulative negative margin” over the most recent three-year period for which data are available. The other is that liabilities exceed assets when the value of building or equipment is backed out. Based on these measures, in 22 states, over 25% of rural hospitals are at immediate risk of closing.

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According to the study, “the smallest rural hospitals are facing closure because the payments they receive for services are less than the cost of delivering care to patients in rural communities.” This disparity is unlikely to go away in the foreseeable future.

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The Center for Healthcare Quality and Payment Reform points out that most hospitals at risk are in communities isolated enough that they will have no emergency services or inpatient care at all. The extremely ill will need to be taken elsewhere.

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In three states, the rural hospitals at immediate risk of closing are over half of the total for the state. These are Connecticut at 67%, Alabama at 56% and Mississippi at 53%. Four states have no rural hospitals at risk: Delaware, New Jersey, Massachusetts and Rhode Island.

This is the number of rural hospitals at risk of immediate closure by state:

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State Total Rural Hospitals At Immediate Risk of Closing
Alabama 48 56%
Alaska 13 31%
Arizona 18 17%
Arkansas 48 33%
California 52 12%
Colorado 41 12%
Connecticut 3 67%
Delaware 2 0%
Florida 20 30%
Georgia 61 36%
Hawaii 12 25%
Idaho 28 14%
Illinois 73 19%
Indiana 53 26%
Iowa 90 27%
Kansas 105 45%
Kentucky 69 17%
Louisiana 49 29%
Maine 25 36%
Maryland 4 25%
Massachusetts 5 0%
Michigan 63 21%
Minnesota 91 21%
Mississippi 66 53%
Missouri 57 30%
Montana 51 18%
Nebraska 72 14%
Nevada 13 15%
New Hampshire 17 6%
New Jersey 1 0%
New Mexico 24 13%
New York 51 24%
North Carolina 53 17%
North Dakota 37 24%
Ohio 70 20%
Oklahoma 73 38%
Oregon 32 13%
Pennsylvania 43 28%
Rhode Island 0 0%
South Carolina 25 40%
South Dakota 45 20%
Tennessee 51 47%
Texas 147 21%
Utah 21 5%
Vermont 13 8%
Virginia 28 43%
Washington 40 20%
West Virginia 24 25%
Wisconsin 73 14%
Wyoming 23 26%

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