The Flex Monitoring Team (FMT) has released a new product, the Workforce Toolkit to Support Critical Access Hospitals and Rural Providers. This toolkit provides background on health care workforce challenges in the U.S., describes common workforce challenges faced by Critical Access Hospitals (CAHs), and provides examples and links to external resources that CAHs may use to address their own workforce needs and enhance recruitment and retention.

The toolkit includes five modules, which each discuss key workforce challenges and resources by topic. These include an introductory module that summarizes broad challenges in the rural health care workforce as well as modules on organizational culture and leadership, leveraging partnerships, emergency medical services workforce, and administrative and support staff workforce.

Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program

Huang Huang, PhD; Xi Zhu, PhD; Fred Ullrich, BA; A. Clinton MacKinney, MD, MS; Keith Mueller, PhD

This brief presents financial performance trends of hospitals who participated in Medicare’s Shared Savings Program (SSP) from 2011 to 2018. Trends in six financial outcomes are compared between SSP and non-SSP hospitals over time and between rural and urban hospitals.

Key Findings:

• Hospitals participating in the SSP had, on average, higher outpatient revenue, higher inpatient revenue, higher net patient revenue, higher operating margins, lower inpatient revenue share, and higher Medicare revenue share at the baseline year 2011 and throughout the study period.
• Compared to their respective non-SSP counterparts, rural SSP hospitals experienced a higher percentage increase in outpatient revenue than urban SSP hospitals.
• Rural hospitals participating in SSP experienced higher increases in inpatient revenue and net patient revenue than rural hospitals not participating in SSP. In contrast, urban hospitals participating in SSP experienced lower increases in these measures than urban hospitals not participating in SSP.

Access the report here.

Additional Report:

• Impact of Medicare Shared Savings Program Participation on Hospital Financial Performance: An Event-Study Analysis – (2022) Health Services Research, 58(1); 116-127.

Contact Information:

Keith J. Mueller, PhD; keith-mueller@uiowa.edu
Director, RUPRI Center for Rural Health Policy Analysis
University of Iowa College of Public Health
Office: 1.319.384.3832

From Becker’s Hospital Review

In the past five years, over 100 rural hospitals have stopped delivering babies, contributing to the 57% of rural U.S. hospitals that lack labor and delivery services.

This finding comes from the Center for Healthcare Quality and Payment Reform. Its July report details the number of rural hospitals by state that lack maternity care services, those that do offer such services, the financial losses incurred from maternity care and the travel time to the nearest hospital providing OB services.

“Over 80% of pregnancy-related deaths are preventable with appropriate prenatal, labor & delivery, and post-partum care,” the CHQPR report notes. “Although improvements in maternity care are needed in all parts of the country to reduce mortality rates, one of the greatest challenges is in rural areas, because most rural hospitals are no longer providing maternity care at all.”

Of the 978 rural hospitals that offer labor & delivery services, almost 40% lost money on patient services overall in 2022 through 2023, meaning their ability to continue delivering maternity care is at risk.

Below are the 19 states with the highest percentage of rural hospitals lacking OB or maternity care. In each of these states, the percentage of rural hospitals without OB care exceeds the U.S. average of 57%. There are ties below, resulting in 19 states with 12 rankings for the greatest proportion of hospitals without OB care.

Readers can find CHQPR’s report on maternity care deserts among rural hospitals in full here.

1. Florida 
Total rural hospitals: 22
Number without OB services: 20
Percentage without OB services: 91%

2. North Dakota 
Total rural hospitals: 39
Number without OB services: 31
Percentage without OB services: 79%

3. Louisiana
Total rural hospitals: 56
Number without OB services: 42
Percentage without OB services: 75%

4. Illinois
Total rural hospitals: 74
Number without OB services: 55
Percentage without OB services: 74%

West Virginia
Total rural hospitals: 31
Number without OB services: 23
Percentage without OB services: 74%

5. Nevada
Total rural hospitals: 14
Number without OB services: 10
Percentage without OB services: 71%

6. Virginia
Total rural hospitals: 30
Number without OB services: 21
Percentage without OB services: 70%

7. Alabama
Total rural hospitals: 52
Number without OB services: 36
Percentage without OB services: 69%

Oklahoma
Total rural hospitals: 81
Number without OB services: 56
Percentage without OB services: 69%

8. Mississippi
Total rural hospitals: 72
Number without OB services: 49
Percentage without OB services: 68%

9. Arkansas
Total rural hospitals: 50
Number without OB services: 32
Percentage without OB services: 64%

Georgia
Total rural hospitals: 72
Number without OB services: 46
Percentage without OB services: 64%

Montana
Total rural hospitals: 55
Number without OB services: 35
Percentage without OB services: 64%

10. South Dakota 
Total rural hospitals: 49
Number without OB services: 31
Percentage without OB services: 63%

Pennsylvania
Total rural hospitals: 43
Number without OB services: 27
Percentage without OB services: 63%

11. Iowa
Total rural hospitals: 94
Number without OB services: 58
Percentage without OB services: 62%

12. Texas
Total rural hospitals: 164
Number without OB services: 97
Percentage without OB services: 59%

Kansas
Total rural hospitals: 100
Number without OB services: 59
Percentage without OB services: 59%

California 
Total rural hospitals: 58
Number without OB services: 34
Percentage without OB services: 59%