Rural Emergency Hospitals (REHs)

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2026

Average Salary Expense in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2026
This study describes hospital wage patterns for Critical Access Hospitals and Prospective Payment System hospitals from 2018–2022, examining the Low Wage Index Policy in effect between 2020-22.
Average Salary Expense in Rural and Urban Hospitals in 2022 Compared With 2018, by Hospital Characteristics
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2026
This study compares labor costs at rural and urban hospitals before COVID and examines whether pay grew differently across hospitals. It identifies hospital characteristics linked to staffing costs and what they reveal about financial resilience during unexpected disruption.
Geographic Variation in Average Salary Expense Among Rural Hospitals Nationwide, 2018–2022
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2026
This brief examines how wages changed at rural hospitals from 2018–2019 to 2021–2022, focusing on geographic differences among CAHs and rural PPS hospitals. By tracking salary expense per FTE, it highlights the workforce and financial pressures rural hospitals faced as COVID disrupted care delivery and labor markets.
Medicare Wage Index Trends in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2026
This study tracks how Medicare wage index values changed for rural and urban PPS hospitals from 2018–2022. It shows how these values shifted over time and explains how policy and labor market forces may be driving geographic differences in hospital payment.
Did Rural Emergency Hospital Converters Avoid Closure
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2026
This research letter provides the first empirical look at whether the Rural Emergency Hospital (REH) designation is helping financially distressed rural hospitals avoid closure.
An Early Look at Profitability Before and After Conversion to Rural Emergency Hospital
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2026
Converting to a Rural Emergency Hospital (REH) may provide struggling, low-volume rural hospitals with a more stable financial model by eliminating unprofitable inpatient services in exchange for some significant financial benefits. This brief provides an early assessment of financial performance before and after conversion to REH status.

2023

Rural Emergency Hospital Map and Data
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 10/2023
This interactive map tracks hospitals that have converted to Rural Emergency Hospitals since January 2023.
Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
Journal Article
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 09/2023
The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.

2022

Small Rural Hospitals with Low-Volume Emergency Departments That May Convert to a Rural Emergency Hospital (REH)
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2022
This study profiles rural hospitals eligible to convert to Rural Emergency Hospitals. The objective is to characterize rural hospitals with very low emergency department volume to inform the clinical and operational decisions that will be required to implement this new provider model.

2021

How Many Hospitals Might Convert to a Rural Emergency Hospital?
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2021
In this study, three measures were used to predict the number of rural hospitals with 50 beds or less that are likely to consider conversion to a Rural Emergency Hospital: 1) three years negative total margin; 2) average daily census (acute + swing) less than three; and 3) net patient revenue less than $20 million.