Rural hospitals represent more than half of all hospitals in the United States, providing essential access to inpatient, outpatient, and emergency medical services in rural communities. FORHP provides technical assistance and support to address the unique needs of rural hospitals through the following programs. Learn more about the Hospital State Division at FORHP (PDF - 73 KB).
Hospital Closures
Between January 2010 and January 2019, 95 rural hospitals closed, 32 of which were Critical Access Hospitals. Events such as these have caused rural hospitals to receive increased attention from policy makers, advocates, and the media.
FORHP evaluates the impact of rural hospital closures. Working with external partners, FORHP identifies actual and planned closures from direct reports and the media, which provides real-time monitoring of closures 
not possible from administrative data files.
FOHRP grantees, the State Offices of Rural Health, and State Flex Programs have worked with communities to assess the impact of hospital closures. In recent years, the FORHP-funded Rural Health Research Gateway published the following research:
- After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care. (June 2017)
- Characteristics of Communities Served by Hospitals at High Risk of Financial Distress (December 2017)
- Geographic Variation in 2016 Profitability of Urban and Rural Hospitals (March 2018)
- Geographic Variation in Uncompensated Care between Rural and Urban Hospitals (June 2018)
- Rural Hospital Mergers from 2005 through 2016 (August 2018)
- A Comparison of Closed Rural Hospitals and Perceived Impact (April 2015)
- The Rising Rate of Rural Hospital Closures (July 2015)
- Uncompensated Care Burden May Mean Financial Vulnerability For Rural Hospitals In States That Did Not Expand Medicaid (October 2015)
- Geographic Variation in Risk of Financial Distress among Rural Hospitals (January 2016)
- Prediction of Financial Distress among Rural Hospitals (January 2016)
- Trends in Risk of Financial Distress among Rural Hospitals (October 2016)
The National Organization of State Offices of Rural Health developed the State Office of Rural Health Roadmap for Working with Vulnerable Hospitals (October 2016) to identify tools and resources to help SORHs and communities deal with closures.
Resources for Hospitals
Technical Assistance and Services Center receives a cooperative agreement from FORHP to develop resources and provide trainings to assist with CAH quality financial and operational improvement; population health; and emergency medical service activities. The center website houses toolkits, webinars and other resources on these topics.
The Flex Monitoring Team is supported by a cooperative agreement to analyze data from CAHs and evaluate the impact of Medicare Rural Hospital Flexibility investments. Data and reports specific to CAH quality, finance, and community health topics are available on the website. CAH managers can request a password to access CAHMPAS, the Critical Access Hospital Measurement and Performance Assessment System, to compare their hospital’s performance on numerous quality and financial indicators with other CAHs in the state and around the country.
