Rural Hospital Closures 2005-Current

Do you know of a hospital that closed within the past 10 years that is not on our list? Do you know of a hospital that is on the brink of closure? Please complete an inquiry below or email your information and tips to us here: ncrural@unc.edu

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What is a rural hospital?

A rural hospital is any short-term, general acute, non-federal hospital that is a. not located in a metropolitan county OR b. is located in a RUCA type 4 or higher OR c. is a Critical Access Hospital.

What is a closed hospital?

We follow the convention of the Office of Inspector General that a closed hospital is “A facility that stopped providing general, short-term, acute inpatient care [….] We did not consider a hospital closed if it: Merged with, or was sold to, another hospital but the physical plant continued to provide inpatient acute care, Converted to critical access status, or Both closed and reopened during the same calendar year and at the same physical location.”

A facility that no longer provides health services is considered a “complete hospital closure.” Note that a facility that closed its inpatient unit but continued to provide other health services, like emergency, rehabilitation, and/or outpatient services, at the same physical location would be considered a “converted hospital closure”. Likewise, a facility that dramatically scaled back its inpatient services (e.g. from 70 beds to 2) would be considered “open” because it continues to provide inpatient services (albeit in a vastly reduced manner).

In some instances, a hospital closes but reopens in another location. In these circumstances, we use our best judgment as to whether access to inpatient services in the rural community was considerably affected by the move to the new location. A move across town or outside city limits would generally not be considered a “closure”; reopening in a community 10-15 miles away, however, likely would.

How do you gather information about closures?

We collect information from various sources, including web searches, news alerts, analyses of Centers for Medicare and Medicaid Services data, information exchange with the National Rural Health Association, the federal Office of Rural Health Policy, and from submission by the public.

How do you track closures?
Once we have identified rural hospitals at risk, we monitor them to gather information on why and when the will closure occur. We also monitor these facilities even after the closure occurred. Closed hospitals can re-open.
A “closed but re-opened” hospital will appear on lists and maps produced for the public. These closures are usually identified by the assumption that there is no intent or action plan to re-open as a hospital at the time of closure. This closure would have previously been included in our count of closed rural hospitals at one point in the past.

Are rural hospital closures a new phenomenon?

No. Policymakers began paying attention in the late 1980s. The Office of Inspector General of the U.S. Department of Health and Human Services conducted a report in 1989 examining closures in 1987; because there was so much interest, the report was repeated on an annual basis for a few years. As the rate slowed in the late 1990s and early 2000s, interest waned until recently.

Why have closures increased lately? Is it the effect of ___(policy)___?

Closures have been ticking up since the recession of 2008-2009. There are likely multiple contributing factors, including failure to recover from the recession, population demographic trends, market trends (e.g. increased rates of merger and affiliation), decreased demand for inpatient services, and new models of care (e.g. Accountable Care Organizations). Long-standing trends – such as generally poorer financial performance in the South – may contribute to closure rates. Some observers have noted the potential effect of the Affordable Care Act (“Obamacare”) and/or the correlation with a state’s decision of whether to expand Medicaid.

For more information see: Additional Research on Rural Hospital Closures