Did Hospitals That Converted to Rural Emergency Hospital (REH) Avoid Closure?

The goal of the Rural Emergency Hospital (REH) designation is to preserve access to essential services for rural residents, and to decrease the likelihood of hospital closures; some worry that the REH offers an option for otherwise financially strong hospitals to shed services. This study will investigate whether hospitals that converted to an REH in 2023 and 2024 would have likely closed in the absence of the REH designation.

The project will consist of three parts: 1) Comparison of organizational characteristics of REH conversions to closed hospitals, including net patient revenue, average daily census (acute, SNF, observation), number of full-time employees, Medicare payment classification, system affiliation, ownership, State/Region, and other variables; 2) Comparison of the financial performance of REH conversions to closed hospitals for three years prior to closure or conversion, including profitability, liquidity, capital structure, outpatient, labor, growth, and other indicators; and 3) Development of a multivariable model to predict whether hospitals that converted to an REH would have closed if the REH designation had not been available.

Publications

• Did Rural Emergency Hospital Converters Avoid Closure
  Journal Article
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 03/2026
  This research letter provides the first empirical look at whether the Rural Emergency Hospital (REH) designation is helping financially distressed rural hospitals avoid closure.