As rural hospitals continue to struggle financially
across the U.S., hospital administrators must make
decisions regarding the type and mix of services to offer
at their hospitals. A previous study by Knocke et al.
found reductions in the percentage of rural hospitals
offering several important service lines, such as skilled
nursing, obstetrics, labor and delivery, and home health.
However, changes in the provision of rural health care
services by payment classification have yet to be
explored. The purpose of this brief is to explore changes
in the availability and provision of different health
care services among rural Critical Access Hospitals
(CAHs) and Prospective Payment System (PPS) hospitals in
2009 compared to 2017. We analyzed data regarding the
availability of different health care services from the
American Hospital Association (AHA) Annual Survey
- Of the 29 services considered, most increased by
2017. Twenty-three services increased among rural CAHs,
and 21 increased among rural PPS hospitals.
- One service remained the same among rural CAHs
(assisted living), and three services remained the same
among rural PPS hospitals (assisted living, emergency
department, and adult general medicine/surgery). These
also changed very little among rural CAHs.
- The percentage of hospitals offering four service
medical/surgical intensive care, obstetrics, and skilled
nursing— declined in both rural CAHs and rural PPS
hospitals when comparing 2009 to 2017.
- In addition to the aforementioned services, rural
CAHs were less likely to offer adult general
medicine/surgery and home health services in 2017 than
they were in 2009.
- Rural PPS hospitals were less likely to offer
pediatric general medicine/surgery in 2017 than in 2009.