Rural Hospitals – Resources
Selected recent or important resources focusing on Rural Hospitals.
Medicare Payment for Rural or Geographically Isolated Hospitals, 2026
Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2026
Sponsoring organization: Congressional Research Service
view details
Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2026
Sponsoring organization: Congressional Research Service
view details
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
view details
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
view details
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
view details
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
view details
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
view details
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
view details
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
view details
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
view details
Strategies for Critical Access Hospital Financial and Operational Performance Improvement: A Systematic Review
Summarizes findings from a systematic review of peer-reviewed and grey literature published since 2000 regarding financial and operational performance improvement interventions implemented by Critical Access Hospitals (CAHs) and rural hospitals in the United States and in other developed countries. Identifies key intervention areas, including service line optimization, revenue and cost management, and technology adoption, among others. Describes how State Flex Programs and hospital administrators can use these findings to inform decision-making and resource allocation.
Author(s): Angelina Budko, Laura Bozovich McFadyen, Carrie Baldwin-SoRelle, et al.
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
view details
Summarizes findings from a systematic review of peer-reviewed and grey literature published since 2000 regarding financial and operational performance improvement interventions implemented by Critical Access Hospitals (CAHs) and rural hospitals in the United States and in other developed countries. Identifies key intervention areas, including service line optimization, revenue and cost management, and technology adoption, among others. Describes how State Flex Programs and hospital administrators can use these findings to inform decision-making and resource allocation.
Author(s): Angelina Budko, Laura Bozovich McFadyen, Carrie Baldwin-SoRelle, et al.
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
view details
An Examination of All-Payer Inpatient Rural Hospital Bypass
Examines the extent to which rural patients bypassed their nearest rural hospital for inpatient care in eight states. Analyzes data on inpatient hospital admissions for rural residents of these states using the 2018 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Identifies factors associated with hospital-level bypass rates by patient and hospital characteristics.
Author(s): Craig D. Holden, Shena Popat, Alana Knudson, Marilyn G. Klug
Date: 03/2026
Sponsoring organization: ETSU/NORC Rural Health Research Center
view details
Examines the extent to which rural patients bypassed their nearest rural hospital for inpatient care in eight states. Analyzes data on inpatient hospital admissions for rural residents of these states using the 2018 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Identifies factors associated with hospital-level bypass rates by patient and hospital characteristics.
Author(s): Craig D. Holden, Shena Popat, Alana Knudson, Marilyn G. Klug
Date: 03/2026
Sponsoring organization: ETSU/NORC Rural Health Research Center
view details
Medicare Learning Network: Hospital Price Transparency
Contains information on federal hospital price transparency regulations and compliance, what patients need to know, and a list of helpful websites.
Date: 03/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
view details
Contains information on federal hospital price transparency regulations and compliance, what patients need to know, and a list of helpful websites.
Date: 03/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
view details
A Comparison of Independent and System-Affiliated Rural Hospitals
Compares independent and system-affiliated rural hospitals by organizational characteristics, financial performance, and county characteristics. Presents Medicare Cost Report data from 2023-2024 on the number and percentage of independent and system-affiliated rural hospitals by state, ownership characteristics, Medicare payment classification, use of swing beds, financial distress, and more.
Author(s): Aditya R. Pillutla, Sruthi Malavika Srinivasan, Kristie Thompson, George Pink, Tyler Malone
Date: 02/2026
Sponsoring organization: North Carolina Rural Health Research Program
view details
Compares independent and system-affiliated rural hospitals by organizational characteristics, financial performance, and county characteristics. Presents Medicare Cost Report data from 2023-2024 on the number and percentage of independent and system-affiliated rural hospitals by state, ownership characteristics, Medicare payment classification, use of swing beds, financial distress, and more.
Author(s): Aditya R. Pillutla, Sruthi Malavika Srinivasan, Kristie Thompson, George Pink, Tyler Malone
Date: 02/2026
Sponsoring organization: North Carolina Rural Health Research Program
view details
2026 Stability of the Rural Health Safety Net: State and National Data Tables
Provides links to national and state data tables showing the financial impact of federal policies such as sequestration and bad debt reimbursement on rural hospital revenues, jobs, and gross domestic product. Presented at the February 2026 National Rural Health Association Policy Institute.
Date: 02/2026
Sponsoring organization: Chartis Center for Rural Health
view details
Provides links to national and state data tables showing the financial impact of federal policies such as sequestration and bad debt reimbursement on rural hospital revenues, jobs, and gross domestic product. Presented at the February 2026 National Rural Health Association Policy Institute.
Date: 02/2026
Sponsoring organization: Chartis Center for Rural Health
view details
Additional resources are available related to this guide. See the full list of resources by topic for: