Data on Urban and Rural Hospitals

Location, Size, Type, and Most Recent Margins

This table includes information on urban and rural hospitals that were operating in 2022. Financial data shown are from the Medicare Cost Report filed in the most recent fiscal year available as of April 2023. The table can be sorted by clicking the arrows next to each column heading. The data can be restricted to a specific state or hospital or to hospitals within a specific range of expenses or margins using the filtering boxes.

• Rural vs Urban. A hospital is classified here as “rural” if it is located in a rural community that meets the criteria established by the Health Resources and Services Administration (HRSA). (Different definitions of “rural” are used by other federal agencies and some states.) Under the HRSA definition, a community is rural if it is either:

  • a nonmetropolitan county; or
  • a census tract in a metropolitan county that has a Rural Urban Community Area (RUCA) code of 4 or greater; or
  • a census tract in a metropolitan county that is (a) at least 400 square miles in size, (b) has a population density of 35 or fewer persons per square mile, and (c) has a RUCA code of 2 or 3; or
  • an outlying county in a metropolitan area that does not have an urbanized area. This last criterion was added in 2022, causing several dozen hospitals to be reclassified as rural instead of urban.

• System Name is the name of the multi-hospital system, if any, that the hospital is owned by, managed by, or affiliated with. The nature of a hospital’s relationship with the system may differ significantly by hospital and by system.

• Payment Method indicates the method Medicare used to pay the hospital in the most recent fiscal year.

  • CAH = Critical Access Hospital (most rural hospitals are classified as Critical Access Hospitals)
  • IPPS = standard Inpatient Prospective Payment System payment (most urban hospitals are are classified as IPPS hospitals).
  • Low Volume = Low Volume Adjustment in IPPS payment
  • SCH = Sole Community Hospital
  • MDH = Medicare Dependent Hospital
  • RRC = IPPS Rural Referral Center
  • Cancer = PPS-Exempt Cancer Hospital
  • Indian = Indian Health Service facility

• FY Ending is the ending month of the most recent hospital fiscal year for which a 12-month Medicare Cost Report is available.

• Total Expenses shows the total annual expenses incurred by the hospital, based on the most recent Medicare Cost Report available. This is a better way of assessing the relative size of the hospital than the number of inpatient beds, since annual expenses includes both the hospital’s inpatient and outpatient services.

• The Patient Services Margin represents the profit or loss from revenues and costs associated with health care services delivered to patients, based on the most recent Medicare Cost Report available.

• The Total Margin includes all revenues and costs in the most recent year, including those that are not directly tied to patient care as well as revenues and expenses on patient services.

Many hospitals have a positive total margin despite incurring losses on patient services because they receive revenues from investments, other businesses, local tax revenues, state grants, or federal grants that offset the losses. If these other sources of revenue were to decrease or be terminated, the hospital might no longer have revenues sufficient to cover its costs.

Financial margins reported in fiscal years that ended after March 2020 and before June 2021 will generally differ significantly from earlier years because they include the initial months of the pandemic when some of the biggest impacts on hospital costs and revenues occurred. Total margins increased for many hospitals in both 2020 and 2021 because of the receipt of special federal assistance during the pandemic.

Information on margins in earlier years for rural hospitals are shown in the tables on Size and Financial Status of Rural Hospitals and Trend in Rural Hospital Margins.

Additional details on the methodology used to calculate the margins are available in the Methodology section.