The strain of caring for the COVID-19 has financially threatened hospitals across the country. Their services have swung away from profitable procedures for other diseases and conditions and from more traditional emergency room visits to beds overflowing with critically ill coronavirus cases. Many rural hospitals have little or no financial reserves and have posted financial losses that have gone on for a long time. A substantial number of these may close, and close very soon. That will leave their communities without traditional medical facilities.

According to a new study by the Center for Healthcare Quality and Payment Reform, over 500 rural hospitals faced a high risk that they would “immediately close” even before the pandemic. This was measured against two yardsticks. The first is a “cumulative negative margin” over the most recent three-year period for which data are available. The other is that liabilities exceed assets when the value of building or equipment is backed out. Based on these measures, in 22 states, over 25% of rural hospitals are at immediate risk of closing.

The reason for the trouble, according to the study, is “The smallest rural hospitals are facing closure because the payments they receive for services are less than the. cost of delivering care to patients in rural communities.” This disparity is unlikely to go away in the foreseeable future.

The Center for Healthcare Quality and Payment Reform points out that most hospitals at risk are in communities isolated enough that they will have no emergency services or inpatient care at all. The extremely ill will need to be taken elsewhere.

In three states, the rural hospitals at immediate risk of closing are over half of the total for the state. These are Connecticut at 67%, Alabama at 56% and Mississippi at 53%. Four states have no rural hospitals at risk: Delaware, New Jersey, Massachusetts and Rhode Island.

This is the number of rural hospitals at risk of immediate closure by state:

State	Total Rural Hospitals	At Immediate Risk of Closing
Alabama	48	56%
Alaska	13	31%
Arizona	18	17%
Arkansas	48	33%
California	52	12%
Colorado	41	12%
Connecticut	3	67%
Delaware	2	0%
Florida	20	30%
Georgia	61	36%
Hawaii	12	25%
Idaho	28	14%
Illinois	73	19%
Indiana	53	26%
Iowa	90	27%
Kansas	105	45%
Kentucky	69	17%
Louisiana	49	29%
Maine	25	36%
Maryland	4	25%
Massachusetts	5	0%
Michigan	63	21%
Minnesota	91	21%
Mississippi	66	53%
Missouri	57	30%
Montana	51	18%
Nebraska	72	14%
Nevada	13	15%
New Hampshire	17	6%
New Jersey	1	0%
New Mexico	24	13%
New York	51	24%
North Carolina	53	17%
North Dakota	37	24%
Ohio	70	20%
Oklahoma	73	38%
Oregon	32	13%
Pennsylvania	43	28%
Rhode Island	0	0%
South Carolina	25	40%
South Dakota	45	20%
Tennessee	51	47%
Texas	147	21%
Utah	21	5%
Vermont	13	8%
Virginia	28	43%
Washington	40	20%
West Virginia	24	25%
Wisconsin	73	14%
Wyoming	23	26%

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