Data on Urban and Rural Hospitals
Location, Size, Type, and Most Recent Margins
This table includes information on urban and rural short-term acute care hospitals that were operating in 2024. Financial data shown are from the Medicare Cost Report filed in the most recent fiscal year available as of January 2025. 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.
Definitions of the variables are provided below the table.
Information About the Data
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
- an outlying county in a metropolitan area that does not have an urbanized area; or
- a Census tract in a metropolitan county that has a Rural Urban Commuting 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
- a Census tract in a metropolitan county that is at least 20 square miles in area and has a Road Ruggedness Scale (RRS) of 5 (highly rugged) and a RUCA code of 2 or 3.
(NOTE: The HRSA criteria for “rural” were revised in 2022 and 2024, and some hospitals changed classification as a result. Other federal agencies, including the Centers for Medicare and Medicaid Services, only consider a hospital to be “rural” if it is located in a non-metropolitan county, and exclude hospitals located in rural portions of metropolitan areas.)
A few hospitals have been reclassified as “rural” in the data tables and analyses here even though they are located in a census tract that is classified as urban because they are in a zip code that is primarily rural.
In addition, if a hospital is located in an area classified as “urban” but is paid by Medicare as a Critical Access Hospital (CAH) or a Rural Emergency Hospital (REH), it is included in the tables that provide information regarding “rural hospitals”.
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)
- REH = Rural Emergency Hospital
- 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. 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 Trend in Rural Hospital Margins table.
Margins are not shown for some hospitals because they do not receive payments based on the number and types of services they deliver or report revenue in the same way as other hospitals do.
Details on the methodology used to calculate the margins are available in the Methodology section.