Drivers of Hospital Service Line Openings and Closings

Rural hospitals face pressures related to finances, staffing, and small populations, all of which contribute to operational challenges for hospitals and individual service lines. Existing evidence quantifies the frequency of individual service line changes across different hospital types, sizes, and rurality, including both openings and closures, as well as the potential impacts on operating margins. However, the specific drivers of service changes are not well understood. Understanding drivers and potential impacts of service line changes may enable relevant policy actions, program design, or hospital strategies. This qualitative study will be guided by the following research questions using semi-structured interviews with hospital leaders involved in service line decisions:

• What organizational, community, and contextual factors influence decisions to close hospital service lines among rural Inpatient Prospective Payment System (IPPS) & Critical Access Hospital (CAHs)?
• What are the perceived impacts of service line closures among rural IPPS hospitals and CAHs, including impacts on the organization, community, and other local hospitals?
• What organizational, community, and contextual factors influence decisions to open hospital service lines among rural IPPS hospitals and CAHs?
• What are the perceived impacts of service line openings among rural IPPS hospitals and CAHs, including impacts on the organization, community, and other local hospitals?