This study examines Critical Access Hospitals (CAHs) and
Prospective Payment System (PPS) hospitals, with no more
than 50 beds, in rural areas that are eligible to
convert to a Rural Emergency Hospital (REH). For this
study, hospitals with low emergency department (ED)
volume are considered to be most likely to convert to an
REH. We identified 356 REH-eligible hospitals with six or
fewer ED visits/day, and 325 with between 6.01-12 ED
visits/day. In comparison to hospitals with greater ED
volume (12.01-30 ED visits/day), the hospitals with
- Are more likely to be located in the Midwest, be a
CAH, be government-owned, and not be affiliated with a
- Have lower acute inpatient volume (median acute
average daily census of 0.9 patients for 0-6 ED
visits/day and 2.0 patients for 6.01-12 ED visits/day).
- Have lower outpatient volume (median annual
outpatient visits of 8,381 for 0-6 ED visits/day and
17,249 for 6.01-12 ED visits/day).
- Are more likely to own and operate their own
ambulance service, are more likely to have a Rural Health
Clinic or a skilled nursing facility, but are less likely
to be affiliated with an air ambulance company.
- Have similar access to computed tomography
scanner services but are less likely to provide magnetic
resonance imaging services.
- Have fewer overall physicians with hospital
privileges but a similar number of Advanced Practice
The REH may be a viable alternative to an inpatient
facility, particularly in communities where a rural
hospital is at risk of closure. However, there is little
published literature on the characteristics and
operations of these facilities from which to generate
best practices in implementation. Conversion to an REH will
require careful attention to many operational issues, such
as those identified in this study.