Rural Health Clinic Ownership, Structure, and Operational Factors: A Mixed Methods Study

There are over 5,600 Rural Health Clinics (RHCs) across the United States, providing essential primary and preventive services to rural populations that often lack access to health care resources. RHCs are subject to different regulations and payment structures compared to many other clinical delivery sites, such as payment through All-Inclusive Rate (AIR) payment systems and not being required to participate in the Merit-based Incentive Payment System (MIPS). Further, the landscape of RHCs, their ownership types, service provision, and finances are ever-evolving and subject to changing policy environments, ultimately impacting access to care for rural populations. For example, payment caps were added in 2021, but existing small, provider-based RHCs were exempt from that cap, grandfathered into maintaining a higher cap based on their previous rate. In addition, since December 2024, RHCs can provide and be reimbursed for more specialty care. The unique rules governing RHCs and policy levers combined with the rural context can have varying implications for operations and access.

This mixed methods study will combine multiple quantitative datasets to describe RHC ownership type and changes, affiliations, staffing, and volume across the U.S., including variations in these characteristics by geography and ownership characteristics. These analyses will be supplemented by qualitative interviews to capture how RHCs with different ownership types and structures experience and implement clinical and operational integration.