Rural emergency hospitals: Emerging patterns of adaptation and community perception.

Purpose: Rural hospitals face persistent financial challenges that often threaten their survival. To address this, the 2023 "Rural Emergency Hospital" (REH) designation offers Critical Access Hospitals and hospitals with fewer than 50 beds enhanced Medicare reimbursement and annual facility payments...

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Published in:Journal of Rural Health Vol. 42; no. 1; pp. 1 - 11
Main Authors: Van Sandt, Anders, Line, Kaitlyn, Gruber, Anja, Meier, Cris, Carpenter, Craig, Loveridge, Scott
Format: research tables/charts Journal Article
Published: Wiley-Blackwell Winter2026
Online Access:View this record in EBSCOhost
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      dt: Winter2026
      vid: 42
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      pub: Wiley-Blackwell
      place: Malden, Massachusetts
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        192435525
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        192435525
        10.1111/jrh.70112
        192435525
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        atl: Rural emergency hospitals: Emerging patterns of adaptation and community perception.
      aug:
        au:
          Van Sandt, Anders
          Line, Kaitlyn
          Gruber, Anja
          Meier, Cris
          Carpenter, Craig
          Loveridge, Scott
        affil: Department of Agricultural and Resource Economics, Colorado State University, Fort Collins Colorado,, USA
      sug:
        subj:
          Hospitals, Rural
          Emergency Service
          Adaptation, Psychological
          Organizational Change
          Community Health Services
          Attitude of Health Personnel Evaluation
          Human
          Funding Source
          Content Analysis
          Health Services Accessibility
          Health Facility Closure
          Multimethod Studies
          Descriptive Statistics
          Data Analysis Software
      ab: Purpose: Rural hospitals face persistent financial challenges that often threaten their survival. To address this, the 2023 "Rural Emergency Hospital" (REH) designation offers Critical Access Hospitals and hospitals with fewer than 50 beds enhanced Medicare reimbursement and annual facility payments if they discontinue inpatient services while maintaining outpatient care and a 24‐hour emergency department. This study evaluates the characteristics of hospitals that choose REH conversion and examines the perceived community impact of the change. Methods: We analyze Centers for Medicare & Medicaid Services cost report data to compare converting hospitals to eligible nonconverting hospitals. We also conduct a content analysis of 33 news articles and phone interviews with local rural residents to assess how REH conversions are presented in the media and perceived in communities. Findings: Hospitals that converted to REH status had low inpatient volumes, occupancy rates, and revenues, suggesting they were positioned to benefit financially from eliminating inpatient services. Content analysis revealed that news articles were primarily neutral in tone (54.5%), with most (90%) describing the financial benefits of conversion. Interviews with rural residents highlighted negative perceptions of local health care and revealed that many preferred not to use their local REH even when available. Conclusions: REH designation may provide financial lifelines to rural hospitals with declining inpatient demand, but community skepticism and limited willingness to use REHs may constrain their role in sustaining health care access. The long‐term effectiveness of this policy may depend on addressing both financial viability and community trust in rural health care delivery.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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