Changes in the Provision of Health Care Services by Rural Critical Access Hospitals and Prospective Payment System Hospitals in 2009 Compared to 2017


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 DatabaseTM.

Key Findings:

  • 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 specialties—birthing/postpartum services, 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.
North Carolina Rural Health Research and Policy Analysis Center
Randall John, Kathleen Knocke, Sharita Thomas, Kristie Thompson, Mark Holmes, George Pink