25 states at most risk of rural hospital closures

Molly Gamble (Twitter) Becker’s Hospital CFO Report

Rural hospital closures picked up in 2023 and nearly 700 rural hospitals face continued risk of closing due to serious financial challenges, with some states facing critical conditions in the short term.

The finding comes from the Center for Healthcare Quality and Payment Reform’s latest report, “Rural Hospitals at Risk of Closing.” Eight rural hospitals closed in 2023, as many as in 2022 and 2021 combined, according to the report. This followed a landmark 18 rural hospital closures in 2020, more than any year in the previous decade.

Based on the latest hospital financial information released by CMS in April 2024, CHQPR analyzes rural hospitals’ financial vulnerability in two ways: risk of closure and immediate risk of closure.

For the first category, there are hospitals at risk of closure in nearly every state. This is partly measured by financial reserve limitations that cannot offset hospital losses on patient services for more than six to seven years. In more than half of states, 25% or more of the rural hospitals are at risk of closing; in eight states, the majority of rural hospitals are at risk.

Immediate risk of closure is partly measured by tougher financial reserve limitations: those that could offset hospital losses on patient services two to three years at most. Over 300 rural hospitals are at immediate risk of closing because of the severity of their financial problems, with nearly half of rural hospitals in New York and Alabama facing such an outlook.

Given that immediate risk of closure is the more urgent of the two categories, Becker’s has ranked 25 states by the percentage of their rural hospitals at risk of closure in the next two to three years maximum. The listing for each state also contains broader information about the number of hospitals at risk of closure over the next six to seven years. The report from CHQPR assessing each state’s rural hospital health and risks can be found in full here.

New York

45% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years

57% of rural hospitals — 29 — are at risk of closure in the next 6-7 years

Alabama

44% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years

58% of rural hospitals — 30 — are at risk of closure in the next 6-7 years

Mississippi

34% of rural hospitals — 25 — are at immediate risk of closure in the next 2-3 years

52% of rural hospitals — 38 — are at risk of closure in the next 6-7 years

Connecticut

33% of rural hospitals — 1 — are at immediate risk of closure in the next 2-3 years

67% of rural hospitals — 2 — are at risk of closure in the next 6-7 years

Tennessee

31% of rural hospitals — 17 — are at immediate risk of closure in the next 2-3 years

35% of rural hospitals — 19 — are at risk of closure in the next 6-7 years

Vermont

31% of rural hospitals — 4 — are at immediate risk of closure in the next 2-3 years

62% of rural hospitals — 8 — are at risk of closure in the next 6-7 years

Oklahoma

29% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years

43% of rural hospitals — 34 — are at risk of closure in the next 6-7 years

Arkansas

29% of rural hospitals — 14 — are at immediate risk of closure in the next 2-3 years

53% of rural hospitals — 26 — are at risk of closure in the next 6-7 years

Maine

28% of rural hospitals — 7 — are at immediate risk of closure in the next 2-3 years

44% of rural hospitals — 11 — are at risk of closure in the next 6-7 years

Virginia

27% of rural hospitals — 8 — are at immediate risk of closure in the next 2-3 years

30% of rural hospitals — 9 — are at risk of closure in the next 6-7 years

Kansas

26% of rural hospitals — 26 — are at immediate risk of closure in the next 2-3 years

56% of rural hospitals — 57 — are at risk of closure in the next 6-7 years

Florida

24% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years

38% of rural hospitals — 8 — are at risk of closure in the next 6-7 years

Nevada

23% of rural hospitals — 3 — are at immediate risk of closure in the next 2-3 years

38% of rural hospitals — 5 — are at risk of closure in the next 6-7 years

New Mexico

21% of rural hospitals — 6 — are at immediate risk of closure in the next 2-3 years

25% of rural hospitals — 7 — are at risk of closure in the next 6-7 years

West Virginia

21% of rural hospitals — 6 — are at immediate risk of closure in the next 2-3 years

36% of rural hospitals — 10 — are at risk of closure in the next 6-7 years

South Carolina

20% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years

40% of rural hospitals — 10 — are at risk of closure in the next 6-7 years

Massachusetts

20% of rural hospitals — 1 — are at immediate risk of closure in the next 2-3 years

40% of rural hospitals — 2 — are at risk of closure in the next 6-7 years

Texas

18% of rural hospitals — 29 — are at immediate risk of closure in the next 2-3 years

48% of rural hospitals — 77 — are at risk of closure in the next 6-7 years

California

18% of rural hospitals — 10 — are at immediate risk of closure in the next 2-3 years

32% of rural hospitals — 18 — are at risk of closure in the next 6-7 years

Louisiana

17% of rural hospitals — 9 — are at immediate risk of closure in the next 2-3 years

44% of rural hospitals — 23 — are at risk of closure in the next 6-7 years

Pennsylvania

17% of rural hospitals — 7 — are at immediate risk of closure in the next 2-3 years

32% of rural hospitals — 13 — are at risk of closure in the next 6-7 years

Missouri

16% of rural hospitals — 9 — are at immediate risk of closure in the next 2-3 years

38% of rural hospitals — 21 — are at risk of closure in the next 6-7 years

Georgia

15% of rural hospitals — 10 — are at immediate risk of closure in the next 2-3 years

32% of rural hospitals — 22 — are at risk of closure in the next 6-7 years

Colorado

12% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years

21% of rural hospitals — 9 — are at risk of closure in the next 6-7 years

Alaska

12% of rural hospitals — 2 — are at immediate risk of closure in the next 2-3 years

18% of rural hospitals — 3 — are at risk of closure in the next 6-7 years

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