Rural Health Information Hub Latest News

NRHA CEO Certification Program Celebrates Five Years with New Leadership Development Offerings  

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The NRHA CEO Certification Program is celebrating five years of helping rural health Executives achieve their hospital and career goals. Since its first cohort launched in February 2020, the program has trained, tested and certified over 500 rural healthcare leaders, strengthening hospitals, clinics, and communities through certified rural health leadership.

“This program is essential for CAH or Rural CEOs, whether experienced, new, or aspiring. It absolutely builds assurance, confidence, knowledge, and a collegial trusted network,” – A recent CEO Certification Program graduate.

Introducing New Leadership Development Offerings

Witnessing the impact the programs have on individuals and their teams as they more confidently lead with increased knowledge and a new network of motivated successful peers CRHL is launching Cultural Transformation, a program designed to enhance leadership effectiveness and increase employee engagement. By fostering a thriving workplace culture, this initiative helps organizations, and their teams succeed while better serving their communities.

In addition to Cultural Transformation, CRHL is expanding its leadership development programs to include:

  • Leadership Coaching: Personalized, one-on-one coaching to help leaders refine their strategies and drive meaningful change within their organizations.
  • Executive Coaching: Specialized coaching for senior leaders to address challenges unique to rural health executives.
  • Group Coaching:A cost-effective coaching alternative where diverse members collaborate in structured sessions to enhance leadership effectiveness.
  • Rural Health Management Academy: A program designed to assist new and first-time rural health managers in strengthening leadership skills to ensure the long-term viability of rural hospitals, clinics, and communities.
  • Rural Health Leadership Academy: A combination of self-guided and group learning, helping rural health leaders develop new leadership skills and improve the sustainability of rural healthcare delivery.

 “These expanded services represent the next chapter for CRHL,” said Sydney Grant, Chief Learning Officer at CRHL. “As we celebrate five years of empowering rural health leaders, we are excited to bring forward new opportunities for leadership growth and organizational success.”

 Looking Ahead

CRHL remains dedicated to improving rural healthcare by stabilizing hospitals through leadership education and engagement. By working alongside rural health executives and industry experts, CRHL continues to develop specialized programs that elevate leadership excellence, ensuring sustainable healthcare for rural communities.

Rural healthcare leaders and organizations interested in exploring these expanded offerings should reach out Kodi Smith, kodis@nrhasc.com or (309) 233-4228.

About the Center for Rural Health Leadership

The Center for Rural Health Leadership (CRHL) equips rural healthcare leaders with the knowledge and tools needed to create stronger, more sustainable healthcare organizations. Through specialized programs and expert-driven education, CRHL is committed to developing the next generation of rural healthcare leaders and strengthening healthcare in rural America.

 

Rural Hospitals’ Financial Pressures Mount as Medicare Advantage Grows: 12 Things to Know

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From Becker’s Financial Management

Rural hospitals face mounting financial and operational challenges that threaten their long-term viability, with Medicare Advantage emerging as a growing pain point, according to a Feb. 20 report published by the American Hospital Association.

Many rural facilities continue to operate at a loss after years of turbulence, and the AHA warns that the rapid expansion of MA — along with the program’s ubiquitous challenges, including low reimbursement rates, payment delays and excessive prior authorizations — is straining rural providers and jeopardizing access to care.

“With MA plans accounting for more than half of total Medicare enrollment and growing, it’s more important than ever that the program works for patients and the providers who care for them,” AHA President and CEO Rick Pollack said. “It is critical for policymakers to address the harmful impact of Medicare Advantage’s low reimbursements and excessive administrative burdens to help ensure rural hospitals can continue to provide care to their patients and communities.”

Twelve things to know:

  1. Rural hospitals receive about 90.6% of traditional Medicare rates on a cost basis from MA plans, according to the report. Quality of care is also affected, with 81% of rural clinicians reporting declines due to insurer requirements.
  2. Rural MA patients also face longer hospital stays, spending 9.6% more time in the hospital before transitioning to post-acute care compared to similar traditional Medicare patients, according to the AHA.
  3. Administrative burdens have also grown, with nearly four in five rural clinicians reporting an increase in administrative tasks over the past five years, and 86% saying these demands have negatively affected patient outcomes.
  4. A survey cited in the AHA report found that nearly 80% of rural clinicians have experienced a rise in administrative tasks over the past five years, with 86% reporting negative effects on patient outcomes. Delays in MA plan approvals lead to longer hospital stays for patients awaiting post-acute care — 9.6% longer than traditional Medicare beneficiaries — further driving up costs for already struggling rural hospitals.
  5. MA has grown rapidly in recent years, with about 32.8 million people (54% of the eligible Medicare population) now enrolled in an MA plan. In rural areas, the growth rate has been even steeper, with MA enrollment quadrupling since 2010, according to the AHA. At its current trajectory, MA is expected to cover most rural Medicare beneficiaries in the near future.
  6. Many seniors opt for MA plans due to supplemental benefits, such as vision and dental coverage, as well as cost-sharing protections. However, for rural hospitals, this shift has led to significant financial and operational challenges.
  7. Historically, traditional Medicare has reimbursed hospitals at rates below the cost of care, according to the AHA report, which found that MA plans pay even less, reimbursing rural hospitals at just 90.6% of traditional Medicare rates on average. For Medicare-dependent and low-volume hospitals, this rate drops to 85%, while critical access hospitals receive only 95% of their costs under MA plans.
  8. This payment disparity cost rural hospitals an estimated $1 billion in 2023 alone. Given that Medicare accounts for a larger share of rural hospital revenue than urban hospitals — 43% versus 37% — these lower rates have an outsized impact on rural providers.
  9. The AHA argues that the financial instability caused by MA policies is accelerating the closure and downsizing of rural hospitals. Over the past decade, more than 100 rural hospitals have closed or converted to other provider types. Additionally, 432 rural hospitals are at risk of closing, according to a Feb. 11 report from Chartis, a healthcare advisory services firm.
  10. A conflicting study published in November 2023 by the American Journal of Managed Care found that increasing MA enrollment did not increase rural hospitals’ financial distress or risk of closing. Researchers studied rural hospitals in 14 states and found that MA enrollment in rural hospital counties grew from 14.3% of Medicare beneficiaries in 2008 to 28.4% in 2019. Additionally, the percentage of Medicare inpatient stays paid for by MA plans increased from 6.5% in 2008 to 20.6% in 2019.
  11. When MA penetration increased by 1% in a county, hospitals’ financial stability increased slightly, and they experienced a 5% reduction in risk of closing, according to the AJMC study. One in 5 of the hospitals studied treated no MA patients during the study period. The findings challenge concerns that MA plans harm rural hospitals through lower payments or added administrative burdens.
  12. With MA enrollment expected to continue to grow, the AHA has urged policymakers to ensure that rural hospitals can sustain operations while providing high-quality care. The report suggests several key reforms, including:
    • Streamlining prior authorization processes to protect timely access to medical care and drugs covered under the medical benefit.
    • Cost-based reimbursement for critical access hospitals from MA plans.
    • Ensuring prompt payment from insurers for medically necessary, covered healthcare services provided to patients.
    • Requiring MA plan clinicians who review coverage denials to share their name and credentials and ensure they meet CMS rules and have relevant training and expertise.
    • Improving data collection, reporting and transparency with a focus on metrics that are meaningful indicators of patient access, including appeals, grievances and denials.
    • Expanding network adequacy requirements for post-acute care sites.

Click here for more details on the AHA report.

PHC4 Produces Special Report on the Financial Health of Hospitals in Rural Pennsylvania

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For the first time, PHC4 has released a public report shedding light on the finances of rural hospitals in Pennsylvania.

PHC4’s Special Report on the Financial Health of Pennsylvania Rural Hospitals, Fiscal Year 2023, displays data for general acute care hospitals (GAC hospitals) located in rural counties, as defined by the Center for Rural Pennsylvania. Those hospitals fitting this definition within PHC4’s Financial Analysis 2023 Volume One report are included in this new resource.

The analysis shows that during Fiscal Year 2023 (FY23), there were 64 (41%) GAC hospitals located in a rural county. Of these GAC hospitals, 31 (48%) operated at a loss based on operating margins during FY23 and 28 (44%) operated at a loss based on total margins during FY23. The average net patient revenue for these hospitals operating at a loss was $107 million in FY23.

Barry D. Buckingham, PHC4’s Executive Director, suggests that the financial challenges of rural hospitals may have significant implications for health care access in rural areas. Buckingham states, “As rural hospitals close or reduce services due to financial pressures, residents of these areas may face longer travel times to access care, reduced availability of emergency services, and a potential general decline in the quality of health or health care services.” Rural hospitals often operate in geographically isolated areas, serving smaller populations with higher percentages of elderly and low-income individuals. Other contributing factors to the data displayed may include:

  • Decreased Reimbursements: Lower payments from government programs like Medicare and Medicaid, as well as private insurers, have put a strain on rural hospitals’ finances.
  • Aging Populations: Many rural areas have an aging population, which often requires more complex and expensive care.
  • Hospital Volume: Rural hospitals often serve smaller populations, which can make it difficult to generate enough revenue to cover costs.
  • Higher Operating Costs: Rural hospitals may face higher operating costs due to factors such as transportation, staff shortages, and the need to maintain specialized services.
  • Economic Challenges: Rural communities often face economic challenges, which can impact the ability of residents to pay for health care.

For more information, visit phc4.org. To review the full report and interactive data visualizations click here.

PHC4 is an independent council formed under Pennsylvania statute (Act 89 of 1986, as amended by Act 15 of 2020) in order to address rapidly growing health care costs. PHC4 continues to produce comparative information about the most efficient and effective health care to individual consumers and group purchasers of health services. In addition, PHC4 produces information used to identify opportunities to contain costs and improve the quality of care delivered.  

Reducing Sugar-Sweetened and Acidic Beverage Consumption: Pilot Project

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The PA Coalition for Oral Health and the Pennsylvania Department of Health Oral Health Program are working together on a multimedia communications campaign for 11–17-year-olds on reducing sugar-sweetened and acidic beverage consumption in certain PA counties.

The project is multifaceted, consisting of a social media campaign, as well as print materials to be displayed in-office/in the waiting room, and an interactive demonstration. They are looking for clinics in Allegheny, Berks, Centre, Clarion, Crawford, Jefferson, Lancaster, or Lehigh counties that would be able to display the print materials and conduct the interactive demonstration at one community event this spring. If spacing is an issue, the sugar-sweetened beverage materials and acid materials can be displayed separately.

The PA Coalition for Oral Health are asking that materials be displayed from March 3, 2025- May 30, 2025, and that during at least one community event during that time, you complete the acid interactive demonstration. All materials will be mailed to you free of charge and are yours to keep at the end of the campaign. The materials that would be displayed in your office/waiting room are:

Please email Lia BenYishay by Wednesday, Feb.26, 2025 if you’re interested or if you have any follow-up questions.

100 Top Critical Access Hospitals Listed, By State

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The Chartis Center for Rural Health released its annual list of the top 100 critical access hospitals in the U.S. on February 12.

To determine the 2025 list, the firm used the Chartis Rural Hospital Performance INDEX, which assesses performance in inpatient market share, outpatient market share, quality, outcomes, patient perspective, cost, charge and finance.

Here are the top 100 critical access hospitals in the U.S., listed by state:

Arkansas

  • Mercy Hospital Paris

Colorado

  • East Morgan County Hospital (Brush)
  • Kit Carson County Memorial Hospital (Burlington)
  • Mt. San Rafael Hospital (Trinidad)
  • Rio Grande Hospital (Del Norte)
  • Wray Community District Hospital

Florida

  • Calhoun Liberty Hospital (Blountstown)

Iowa

  • Cass Health (Atlantic)
  • CHI Health Missouri Valley
  • Clarke County Hospital (Osceola)
  • Floyd Valley Healthcare (Le Mars)
  • Greater Regional Medical Center (Creston)
  • Grundy County Memorial Hospital (Grundy Center)
  • Hancock County Memorial Hospital (Britt)
  • Loring Hospital (Sac City)
  • UnityPoint Health Jones Regional Medical Center (Anamosa)
  • Van Diest Medical Center (Webster City)
  • Washington County Hospital (Washington)

Idaho

  • Shoshone Medical Center (Kellogg)
  • St. Luke’s Wood River Medical Center (Ketchum)

Kansas

  • Artesian Valley Health System (Meade)
  • Clay County Medical Center (Clay Center)
  • Community Memorial Healthcare (Marysville)
  • Fredonia Regional Hospital
  • Hodgeman County Health Center (Jetmore)
  • Morris County Hospital (Council Grove)
  • Nemaha Valley Community Hospital (Seneca)
  • Patterson Health Center (Anthony)
  • Rooks County Health Center (Plainville)
  • Sabetha Community Hospital

Louisiana

  • Ochsner St. Anne Hospital (Raceland)

Massachusetts

  • Fairview Hospital (Great Barrington)

Maine

  • Stephens Memorial Hospital (Norway)

Minnesota

  • Avera Granite Falls Health Center
  • CentraCare – Redwood Hospital (Redwood Falls)
  • Kittson Healthcare (Hallock)
  • Lake View Hospital (Two Harbors)
  • Mayo Clinic Health System – St. James
  • Mayo Clinic Health System – Waseca
  • Meeker County Memorial Hospital (Litchfield)
  • New Ulm Medical Center (New Ulm)
  • Olivia Hospital & Clinic
  • Pipestone County Medical Center & Family Clinic Avera (Pipestone)
  • Riverwood Healthcare Center (Aitkin)

Missouri

  • Carroll County Memorial Hospital (Carrollton)
  • Community Hospital Fairfax
  • Cox Barton County Hospital (Lamar)
  • Pike County Memorial Hospital (Louisiana)

Montana

  • Barrett Hospital & HealthCare (Dillon)
  • Bitterroot Health – Daly Hospital (Hamilton)
  • Central Montana Medical Center (Lewistown)
  • Community Hospital of Anaconda

North Dakota

  • CHI Mercy Health of Valley City
  • CHI St. Alexius Health Carrington Medical Center
  • Jamestown Regional Medical Center
  • Langdon Prairie Health
  • Sanford Mayville Medical Center
  • South Central Health (Wishek)
  • Towner County Medical Center (Cando)

Nebraska

  • Antelope Memorial Hospital (Neligh)
  • Avera St. Anthony’s Hospital (O’Neill)
  • Beatrice Community Hospital & Health Center
  • Boone County Health Center (Albion)
  • Brodstone Healthcare (Superior)
  • CHI Health St. Mary’s (Nebraska City)
  • Community Medical Center (Falls City)
  • Crete Area Medical Center
  • Howard County Medical Center (Saint Paul)
  • Jefferson Community Health & Life (Fairbury)
  • Johnson County Hospital (Tecumseh)
  • Melham Medical Center (Broken Bow)
  • Memorial Health Care Systems (Seward)
  • Phelps Memorial Health Center (Holdrege)
  • Thayer County Health Services (Hebron)

Oklahoma

  • Mercy Hospital Watonga

Oregon

  • Grande Ronde Hospital
  • St. Charles Prineville

South Dakota

  • Avera Hand County Memorial Hospital (Miller)
  • Hans P. Peterson Memorial Hospital (Philip)
  • Madison Regional Health

Texas

  • Lavaca Medical Center (Hallettsville)
  • Moore County Hospital District (Dumas)
  • Olney Hamilton Hospital
  • Reeves Regional Health (Pecos)

Utah

  • Central Valley Medical Center (Nephi)
  • Garfield Memorial Hospital (Panguitch)

Virginia

  • Page Memorial Hospital (Luray)

Wisconsin

  • Black River Memorial Hospital (Black River Falls)
  • Mayo Clinic Health System – Red Cedar (Menomonie)
  • Memorial Hospital of Lafayette County (Darlington)
  • River Falls Area Hospital
  • ThedaCare Medical Center – Shawano
  • Upland Hills Health (Dodgeville)
  • Western Wisconsin Health (Baldwin)
  • Westfields Hospital & Clinic (New Richmond)

West Virginia

  • Grant Memorial Hospital (Petersburg)
  • Hampshire Memorial Hospital (Romney)

Wyoming

  • North Big Horn Hospital (Lovell)
  • Star Valley Health (Afton)
  • Washakie Medical Center (Worland)

Research Brief Highlights Language Spoken in Pennsylvania

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The U.S. Census Bureau released the 2019-2023 American Community Survey (ACS) 5-Year Estimates last December, providing updated insights into demographic trends across Pennsylvania. Our latest brief highlights trends in languages spoken at home and English proficiency levels across the Commonwealth, counties, and school districts.

Key Findings from the Report:

  • Over 12 percent of Pennsylvanians aged five and older speak a language other than English at home, with Spanish being the most common (5.4%).
  • More than one-third of non-English speakers (39.1%) are considered limited English proficient (LEP), meaning they speak English “less than very well.”

For more information on LEP in Pennsylvania, read this month’s brief

CMS Releases Announcement on Federal Navigator Program Funding

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The Centers for Medicare & Medicaid Services (CMS) today announced a reduction in funding for the Affordable Care Act (ACA) Navigator program to $10 million. The savings from this reduction will allow the Federally-facilitated Exchanges (FFEs) to focus on more effective strategies that improve Exchange outcomes and to reduce the user fee in future years, which would translate into a reduction in premium. This change will directly benefit people enrolled without subsidies who pay the full premium for their health insurance. In addition, lower premiums will reduce the burden on hardworking American taxpayers who fund the premium subsidies through the FFEs.

Despite receiving $98 million in the 2024 plan year, Navigators only enrolled 92,000 consumers—just 0.6 percent of plan selections through the FFEs during the open enrollment period—at a cost of $1,061 per enrollment. Additionally, the average cost per enrollment exceeded $3,000 for 12 of the 56 Navigator grantee organizations. Looking back at the grant period covering the 2019 plan year—the year before the COVID-19 pandemic under a similar regulatory approach—Navigators likewise enrolled 0.6 percent of total enrollments through the FFEs at a substantially lower cost of $10 million. This previous grant funding level reflects a far more efficient $211 per enrollment.

The Navigator program is funded by user fees, and the decrease in funding to $10 million per year will save a total of $360 million over the next four years of the five-year period of performance, which began August 27, 2024, and runs through August 26, 2029. Because the user fee is directly passed through to the premium that health insurers charge, the savings from the Navigator program supports lower premiums for consumers in the individual health insurance market. People who do not qualify for federal premium subsidies will directly benefit from lower premiums. Lower premiums will also translate to less federal spending on premium subsidies. This change is for Navigators in the states with FFEs in the next grant period for plan year 2026. States operating state-based exchanges and state-based exchanges operating on the federal platform are responsible for determining the funding available for Navigator programs in their states.

Additional performance data for Navigators further supports this reduction. Data show that for the 2019 plan year, Navigators provided post-enrollment assistance to approximately 205,000 consumers. Despite markedly more funding and substantially higher enrollment levels, the level of post-enrollment assistance dropped to approximately 86,000 consumers for the 2024 plan year.

Overall, Navigator performance data shows that the current level of funding does not represent a reasonable return on investment. These numbers indicate that Navigators are not enrolling nearly enough people to justify the substantial amount of federal dollars previously spent on the program. This reduction will ensure funding is focused on meeting the statutory goals of the program more efficiently and effectively.

In coordination with this announcement, CMS is posting updated Navigator funding, enrollment, and service-level data for the grant periods covering the 2017 plan year to the 2024 plan year.

To view the data, visit 2024 Navigator Funding and Enrollment Data. 

432 Rural Hospitals at Risk of Closure; Breakdown By State

Posted on by lad3

From Becker’s Financial Management

There are 432 rural hospitals vulnerable to closure, according to a Feb. 11 report from Chartis, a healthcare advisory services firm.

Chartis analyzed 15 vulnerability indicators and found that 10 were statistically significant in predicting hospital closures, including: Medicaid expansion status, average length of stay, occupancy, percentage change in net patient revenue and years of negative operating margin.

Of the 48 states with rural hospitals, 38 have at least one at risk of closure, according to the report. The states with the highest number of vulnerable hospitals are:

  1. Texas: 47
  2. Kansas: 46
  3. Mississippi: 28
  4. Oklahoma: 23
  5. Georgia: 22

Arkansas (50%) has the highest percentage of rural hospitals at risk of closure, followed by Mississippi (47%) and Kansas (47%).

The percentage of rural hospitals at risk of closure by state is as follows:

More than 41% of hospitals

  • Arkansas
  • Florida
  • Kansas
  • Mississippi
  • Tennessee

31% to 40%

  • Georgia
  • Missouri
  • Oklahoma
  • South Carolina
  • Texas

26%-30%

  • Alabama
  • North Carolina
  • South Dakota

21%-25%

  • Illinois
  • Louisiana
  • Maryland
  • Nebraska
  • New Mexico
  • Wyoming

16%-20%

  • Kentucky
  • Ohio

10%-15%

  • California
  • Indiana
  • Michigan
  • Minnesota
  • Montana
  • New York
  • Pennsylvania
  • Virginia
  • West Virginia

1%-9%

  • Arizona
  • Colorado
  • Hawaii
  • Idaho
  • Iowa
  • North Dakota
  • Utah
  • Wisconsin

0%

  • Alaska
  • Connecticut
  • Delaware
  • Maine
  • Massachusetts
  • Nevada
  • New Hampshire
  • New Jersey
  • Oregon
  • Rhode Island
  • Vermont
  • Washington

White House Forms ‘Make America Healthy Again’ Commission

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From Becker’s Leadership and Management

President Donald Trump has signed an executive order creating the Make America Healthy Again Commission after Robert Kennedy Jr. was confirmed Feb. 13 as HHS secretary in a 52-48 Senate vote.

Mr. Kennedy will chair the commission, which is tasked with investigating “the root causes of America’s escalating health crisis,” with an initial focus on pediatric chronic disease, according to a Feb. 13 White House fact sheet on the executive order.

The commission will release its childhood chronic disease assessment in the next 100 days and will follow up with a strategy to improve children’s health within the next 180 days. The key priorities of the investigation include funding studies on what causes disease, promoting healthier food, expanding preventative treatment options and increasing health research transparency.

“The commission aims to restore trust in medical and scientific institutions and hold public hearings, meetings, roundtables and similar events to receive expert input from leaders in public health,” the release said.

The commission also has four policy directives to help reverse chronic disease:

  • Ensure open access and transparency to federally funded health research data while preventing conflicts of interest.
  • Focus federally funded health research on high-quality studies to help understand the cause of American illness.
  • Work with U.S. farmers to ensure food in America is affordable, abundant and healthy.
  • Provide flexible health coverage and expand treatment options to support lifestyle-based disease prevention.

The release pointed to information consistent with CDC data that found 6 in 10 adults in the U.S. live with at least one chronic illness, and 4 in 10 have two or more. It also touched on a spike in autism rates, childhood cancers and overmedication, with more than 3.4 million children in the U.S. on medication for attention-deficit disorder and attention-deficit/hyperactivity disorder, with diagnoses on the rise, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder data.

It also pointed to information consistent with a 2023 Gallup poll that found only one-third of Americans have trust in the U.S. health system.

During his two confirmation hearings on Jan. 29-30, Mr. Kennedy frequently discussed his Make America Healthy Again agenda, which aims to cut chronic disease, tackle obesity and diabetes, and improve food policy, prevention-based care and environmental health.

In his new role, Mr. Kennedy’s portfolio will comprise HHS agency and program oversight, as well as a nearly $2 trillion budget. Among the agencies under his purview are CDC, CMS, FDA and the National Institutes of Health.