Rural Health
Resources by Topic: Healthcare facilities
National Association of Rural Health Clinics 2026 Policy Survey Report
Summarizes results of a 2026 national survey of Rural Health Clinics (RHCs). Presents data on the average payer mix, telehealth use and management trends, Medicare Advantage (MA) contracts and reimbursement rates compared to traditional Medicare rates, value-based care participation, challenges, and more.
Date: 04/2026
Sponsoring organization: National Association of Rural Health Clinics
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Summarizes results of a 2026 national survey of Rural Health Clinics (RHCs). Presents data on the average payer mix, telehealth use and management trends, Medicare Advantage (MA) contracts and reimbursement rates compared to traditional Medicare rates, value-based care participation, challenges, and more.
Date: 04/2026
Sponsoring organization: National Association of Rural Health Clinics
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Payer Mix Shifts and Profitability at Critical Access Hospitals, 2011 to 2023
Analyzes 1,384 Critical Access Hospitals between 2011 and 2023 to determine the impact of changes in commercial, Medicare, Medicaid, and uncompensated care on their finances. Discusses reimbursement policy based on study findings.
Author(s): Yusheng Jia, Yue Li, Xueya Cai, Samuel J. Enumah
Citation: Health Affairs Scholar, 4(4)
Date: 04/2026
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Analyzes 1,384 Critical Access Hospitals between 2011 and 2023 to determine the impact of changes in commercial, Medicare, Medicaid, and uncompensated care on their finances. Discusses reimbursement policy based on study findings.
Author(s): Yusheng Jia, Yue Li, Xueya Cai, Samuel J. Enumah
Citation: Health Affairs Scholar, 4(4)
Date: 04/2026
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Geographic Variation in Average Salary Expense Among Rural Hospitals Nationwide, 2018–2022
Examines the change in hospital wages between 2018–2019 and 2021–2022, with a focus on the geographic variation in these changes among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. Describes the variation in average salary expense per full-time equivalent (FTE) employee for rural hospitals from 2018 to 2022. Appendices include the median salary expense per FTE of rural hospitals each year by U.S. Census region, state Medicaid expansion status, Core-Based Statistical Area (CBSA), Frontier and Remote Area (FAR) code, and by state.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Examines the change in hospital wages between 2018–2019 and 2021–2022, with a focus on the geographic variation in these changes among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. Describes the variation in average salary expense per full-time equivalent (FTE) employee for rural hospitals from 2018 to 2022. Appendices include the median salary expense per FTE of rural hospitals each year by U.S. Census region, state Medicaid expansion status, Core-Based Statistical Area (CBSA), Frontier and Remote Area (FAR) code, and by state.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Medicare Wage Index Trends in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Provides an overview of the wage index and its role in hospital reimbursement and financial stability. Describes the pattern of wage index values for rural and urban prospective payment system (PPS) hospitals from 2018 to 2022. Explores the impact of the low-wage index policy (LWIP), which was implemented in fiscal year 2020, and the potential implications of its discontinuation in fiscal year 2025.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Provides an overview of the wage index and its role in hospital reimbursement and financial stability. Describes the pattern of wage index values for rural and urban prospective payment system (PPS) hospitals from 2018 to 2022. Explores the impact of the low-wage index policy (LWIP), which was implemented in fiscal year 2020, and the potential implications of its discontinuation in fiscal year 2025.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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A Closer Look at Rural Nursing Homes
Compares characteristics of nursing homes in rural and urban areas including patient population data, distribution, and ownership. Also discusses payer mix, healthcare quality, and staffing levels. Highlights changes between 2015 and 2025 for some data.
Author(s): Priya Chidambaram, Alice Burns, Robin Rudowitz
Date: 04/2026
Sponsoring organization: KFF
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Compares characteristics of nursing homes in rural and urban areas including patient population data, distribution, and ownership. Also discusses payer mix, healthcare quality, and staffing levels. Highlights changes between 2015 and 2025 for some data.
Author(s): Priya Chidambaram, Alice Burns, Robin Rudowitz
Date: 04/2026
Sponsoring organization: KFF
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Expanding Zero Suicide: Qualitative Assessment of Community Mental Health Center Partnerships Supporting Rural Suicide Prevention
Examines the impact of the Zero Suicide framework and its ability to promote community mental health supports. Utilizes semi-structured interview feedback from Zero Suicide organizations served by a Community Mental Health Center (CMHC) and discusses suicide prevention partnerships, information sharing, and staffing in rural areas.
Author(s): Ryan Marawala, Thomas Delaney
Citation: Community Mental Health Journal
Date: 04/2026
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Examines the impact of the Zero Suicide framework and its ability to promote community mental health supports. Utilizes semi-structured interview feedback from Zero Suicide organizations served by a Community Mental Health Center (CMHC) and discusses suicide prevention partnerships, information sharing, and staffing in rural areas.
Author(s): Ryan Marawala, Thomas Delaney
Citation: Community Mental Health Journal
Date: 04/2026
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Average Salary Expense in Rural and Urban Hospitals in 2022 Compared with 2018, by Hospital Characteristics
Explores how the COVID-19 pandemic may have affected wage disparities across rural and urban hospitals. Describes the median wages by total employee full-time equivalents (FTE) for rural and urban hospitals from 2017-2018 to 2021-2022. Compares the growth in labor cost for rural and urban hospitals by selected hospital characteristics, including system affiliation, hospital ownership, and number of acute care beds.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Explores how the COVID-19 pandemic may have affected wage disparities across rural and urban hospitals. Describes the median wages by total employee full-time equivalents (FTE) for rural and urban hospitals from 2017-2018 to 2021-2022. Compares the growth in labor cost for rural and urban hospitals by selected hospital characteristics, including system affiliation, hospital ownership, and number of acute care beds.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Average Salary Expense in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Examines and compares wage patterns of Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals as related to the Low Wage Index Policy (LWIP) in effect from 2020-2022. Utilizes hospital data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) between 2018 and 2022 and analyzes median salaries. Discusses the impact of Medicare payments and LWIP on hospitals.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Examines and compares wage patterns of Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals as related to the Low Wage Index Policy (LWIP) in effect from 2020-2022. Utilizes hospital data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) between 2018 and 2022 and analyzes median salaries. Discusses the impact of Medicare payments and LWIP on hospitals.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Early Evaluation of the Rural Emergency Hospital Program
Results of a study conducted January 2023 to December 2025, to assess differences between hospitals that converted to Rural Emergency Hospital (REH) status and eligible rural hospitals that did not. Includes statistics on the financial performance of the hospitals before and after conversion, and hospital features and services provided, with breakdowns by REH or non-REH status.
Author(s): Mitchell Mead, Nina M. Clark, Janice C. Probst, et al.
Citation: JAMA Network Open, 9(4), e269217
Date: 04/2026
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Results of a study conducted January 2023 to December 2025, to assess differences between hospitals that converted to Rural Emergency Hospital (REH) status and eligible rural hospitals that did not. Includes statistics on the financial performance of the hospitals before and after conversion, and hospital features and services provided, with breakdowns by REH or non-REH status.
Author(s): Mitchell Mead, Nina M. Clark, Janice C. Probst, et al.
Citation: JAMA Network Open, 9(4), e269217
Date: 04/2026
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2025 National CAH Quality Inventory & Assessment National Report
Presents a high-level summary of key data points from the September-November 2025 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; median swing bed admissions and swing bed length of stay; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; CAH quality payment model participation; and CAH quality improvement topic priorities.
Author(s): Madeleine Pick, Robert Barclay
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Presents a high-level summary of key data points from the September-November 2025 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; median swing bed admissions and swing bed length of stay; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; CAH quality payment model participation; and CAH quality improvement topic priorities.
Author(s): Madeleine Pick, Robert Barclay
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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