Data on Rural Hospitals

Size and Financial Status of Rural Hospitals

This table includes (1) all hospitals currently located in a rural area and (2) rural hospitals that have closed since 2005. Financial data are only shown if the hospital filed a Medicare Cost Report in 2012 or later. (The same data are shown in the map on the main page.)

  • Total Expenses shows the relative size of the hospital in terms of both inpatient and outpatient services. The amount shown is based on the most recent Cost Report available, which is 2019 for most hospitals.

  • Average Margins show the profitability of the hospital during the three most recent years for which Cost Reports are available (2017-2019 in most cases). Year–by-year data are shown in Trend in Rural Hospital Margins.

    • The Patient Service Margin represents the profit or loss from revenues and costs associated with health care services delivered to patients.
    • The Total Margin includes revenues and costs that are not directly tied to patient care as well as revenues and expenses on patient services.

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

Additional details on the methodology are available in the Methodology section.

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.

Trend in Rural Hospital Margins

This table shows whether profits and losses have been increasing or decreasing at rural hospitals that were open at the end of 2020. Margins are based on the fiscal year that ends in the year shown.

  • The Patient Service Margin represents the profit or loss from revenues and costs associated with health care services delivered to patients.
  • The Total Margin includes revenues and costs that are not directly tied to patient care as well as revenues and expenses on patient services.

Data on margins are not shown if no Cost Report for the full fiscal year is available or if revenue data were not included in the Cost Report.

Total Expenses is based on 2019 or the most recent Cost Report available.

Additional details on the methodology are available in the Methodology section.

Payer Mix and Margins

This table shows the proportion of the hospital’s total services that are paid for by different payers and the extent to which the payments from those payers cover the hospital’s cost of delivering the services.

The Share of Patient Costs represents the estimated cost of the services to the patients insured by a particular type of payer divided by the total cost of services to all patients.

  • Medicare FFS represents the hospital services delivered to patients on Original Medicare. (Services for Medicare Advantage patients are included in “Private and Other.”)

  • Medicaid, CHIP, and Indigent represents services to patients enrolled in Medicaid, CHIP (the Children’s Health Insurance Program), and state or local indigent care programs.

  • Uninsured Charity Care represents services to patients who do not have insurance and who met the hospital’s eligibility criteria for charity care. (Different hospitals use different criteria for assessing eligibility.)

  • Private and Other represents hospital services delivered to insured patients other than those with Original Medicare, Medicaid, CHIP, or other indigent care programs. This primarily represents patients with private insurance (including Medicare Advantage plans), but it will also include some governmental programs such as the Veterans Administration or Workers Compensation.

The Margins for Medicare and Medicaid represent the difference between the payments from those payers and the costs of the services delivered to the patients they insure. For example, if the margin for Medicare is -3%, it means Medicare paid 3% less than the cost of the services to the patients on Original Medicare.

For private payers, the Allowed Margin is the margin calculated using the “allowed amounts” for services under the hospital’s contract with each payer. The allowed amount includes the cost-sharing portion (i.e., deductibles, co-payments, and co-insurance) that the patients are required to pay. Since not all patients are able to pay the full cost-sharing they owe, Bad Debt shows the percentage of the cost the hospital does not receive due to these non-payments. (This also includes unpaid amounts for patients who have insurance but also qualify for charity care assistance.) The sum of the Allowed Private Margin and Bad Debt represents the hospital’s actual net margin on privately insured patients. For example, if the hospital has an Allowed Margin of +10% on privately insured patients and Bad Debt of -6%, then the actual profit on the patients is only 4%.

Additional details on the methodology are available in the Methodology section.