These 10 States Are in Danger of the Most Rural Hospital Closures

Dave Mosley, US News and World Report

Hundreds of hospitals in rural America could close if their financial situations do not improve, a new analysis indicates.

People in rural communities, frequently burdened by physician shortages and older populations, often face more difficulty than their urban peers in accessing health care. Now, a new analysis from Guidehouse, a consulting firm based in Chicago, finds that about 1 in 5 rural hospitals – a total of 430 – are at high risk of closure due to their financial situations, potentially hindering many Americans' access to care and affecting 150,000 hospital-related jobs.

"Our analysis shines a new light on a rural hospital crisis that must be addressed and could significantly worsen with any downturn in the economy," David Mosley, co-author of the study and managing director at Guidehouse, said in a statement.

Rural communities already have lost dozens of hospitals. Between 2013 and 2017, 64 rural hospitals shut their doors, more than twice the number of closures in the previous five years, according to an August report from the federal Government Accountability Office. A dwindling number of patients who seek inpatient care and reductions in Medicare payments have helped drive their financial distress, researchers have found.

Researchers at Guidehouse examined total operating margin performance, days of cash on hand and debt-to-capitalization ratio to assess the "financial viability" of 2,045 rural hospitals across the country. (Delaware, New Jersey and Rhode Island were not included in the analysis as they had no qualifying rural hospitals.)

They found that 34 states had at least five rural hospitals at high risk of closure. In 31 states, at least half of the high-risk hospitals were considered essential to their communities based on Guidehouse's metrics on trauma status, serving vulnerable populations, geographic isolation and economic impact on the community.

While some states are home to greater shares of rural hospitals at risk of shutting their doors, these are the 10 states facing the most potential closures overall, according to the study.

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