Hundreds of hospitals in the U.S. are at immediate risk of closing, largely due not to financial mismanagement but inadequate reimbursements, according to the Center for Healthcare Quality and Payment Reform.
Many of them are rural hospitals whose closures don't usually make the headlines, but that doesn't mean they're expendable. Rural communities supply most of the country's food and energy. If those communities can't access healthcare, it could mean power outages and empty pantries nationwide, even in big cities.
Those listed here have the worst total margins over the last three years, according to information from CMS. Data from 2020 was excluded from the calculations because of unusual cost and revenue changes at the pandemic's outset.
Three-year total margin figures were determined by subtracting cumulative costs from cumulative revenues over the given period, and then dividing the result by the same cumulative cost figure. This is different from the standard for-profit business approach of using revenues in the denominator.
That method assumes a business is trying to keep its costs below prices that are set by the market. Rural hospitals, however, deal with costs that depend on what services are needed, and they depend on payments set at amounts large enough to cover those costs.
The worst margins belong to Thomasville (Ala.) Regional Medical Center and Mullins, S.C.-based MUSC Health Marion Medical Center. One hospital at No. 36 in this ranking, the 25-bed Lake Geneva, Wis.-based Mercy Walworth Hospital & Medical Center, saw a three-year total margin of nearly 18 percent in the red despite its three-year patient services margin showing a whopping 433.9 percent in the green.
The 100 rural hospitals with the worst three-year total margins:
Note: Only hospitals with three-year margins of negative 10 percent and worse were included in this ranking. Closed hospitals were not included. Click here to see the full data set.
Editor's note: This article was updated Jan. 5 at 8:15 am CT. An earlier version of the article mistakenly credited the Cecil G. Sheps Center for Health Services Research for the hospital names and margins. The names and margins come from CMS via a database created and maintained by the Center for Healthcare Quality and Payment Reform. The database used Cecil G. Sheps Center information to determine whether a hospital was shuttered.
| Rank | Hospital | Location | No. of beds | Total 2021 expense | 3 year margin on patient services |
3 year total margin
| |
|---|---|---|---|---|---|---|---|
| 1 | Thomasville Regional Medical Center | Thomasville | Ala. | 29 | $16.6M | -53.1% | -46.2% |
| 2 | MUSC Health Marion Medical Center | Mullins | S.C. | 124 | $46.6M | -24.7% | -43.2% |
| 3 | Defiance Regional Medical Center | Defiance | Ohio | 35 | $87M | 36.4% | -39.2% |
| 4 | Lallie Kemp Medical Center | Independence | La. | 24 | $46.9M | -41.2% | -38.0% |
| 5 | Hill Regional Hospital | Hillsboro | Texas | 25 | $28.8M | -2.1% | -34.8% |
| 6 | Stroud Regional Medical Center | Stroud | Okla. | 25 | $57.5M | -31.7% | -33.4% |
| 7 | Big Sky Medical Center | Big Sky | Mont. | 4 | $16.7M | -28.3% | -31.7% |
| 8 | The Physicians' Hospital In Anadarko | Anadarko | Okla. | 25 | $68M | -29.7% | -31.2% |
| 9 | Saint Thomas Stones River Hospital | Woodbury | Tenn. | 55 | $11.4M | -36.4% | -30.8% |
| 10 | Fairfax Community Hospital | Fairfax | Okla. | 25 | $32.7M | -38.5% | -29.6% |
| 11 | Southern Virginia Regional Medical Center | Emporia | Va. | 80 | $28.6M | -10.1% | -29.4% |
| 12 | Westfield Memorial Hospital | Westfield | N.Y. | 4 | $11.7M | -38.1% | -29.1% |
| 13 | Fishermen's Community Hospital | Marathon | Fla. | 8 | $25.7M | -29.2% | -29.0% |
| 14 | Bellville St Joseph Health Center | Bellville | Texas | 32 | $16.7M | -40.4% | -28.2% |
| 15 | Ascension Sacred Heart Gulf | Port Saint Joe | Fla. | 19 | $23.5M | -31.1% | -27.1% |
| 16 | Fostoria Community Hospital | Fostoria | Ohio | 15 | $45.9M | 22.7% | -26.9% |
| 17 | Saint Thomas DeKalb Hospital | Smithville | Tenn. | 71 | $14.1M | -26.5% | -26.6% |
| 18 | Lanai Community Hospital | Lanai City | Hawaii | 4 | $6.2M | -39.9% | -24.9% |
| 19 | Seton Smithville Regional Hospital | Smithville | Texas | 36 | $16.1M | -25.7% | -23.7% |
| 20 | Pineville Community Health Center | Pineville | Ky. | 120 | $13.8M | -46.5% | -23.0% |
| 21 | Stillwater Medical - Perry | Perry | Okla. | 26 | $9.7M | -32.2% | -22.8% |
| 22 | Izard County Medical Center | Calico Rock | Ark. | 25 | $7.1M | -28.7% | -21.8% |
| 23 | Big South Fork Medical Center | Oneida | Tenn. | 25 | $11.8M | -19.8% | -21.5% |
| 24 | Unicoi County Hospital | Erwin | Tenn. | 10 | $11.1M | -21.4% | -20.9% |
| 25 | Bob Wilson Memorial Hospital | Ulysses | Kan. | 45 | $13.6M | -34.3% | -20.5% |
| 26 | Bon Secours Southampton Memorial Hospital | Franklin | Va. | 221 | $57.9M | -3.9% | -20.4% |
| 28 | Eureka Springs Hospital Commission | Eureka Springs | Ark. | 15 | $8.2M | -23.4% | -20.1% |
| 29 | Haskell Regional Hospital | Stigler | Okla. | 25 | $10.1M | -23.1% | -19.8% |
| 30 | Vanderbilt Bedford Hospital | Shelbyville | Tenn. | 104 | $37.5M | -2.9% | -19.4% |
| 31 | Highland Community Hospital | Picayune | Miss. | 60 | $53.3M | -12.8% | -18.2% |
| 32 | Carilion Tazewell Community Hospital | Tazewell | Va. | 238 | $19.6M | -4.3% | -18.2% |
| 33 | Colusa Medical Center | Colusa | Calif. | 48 | $29.8M | -9.4% | -18.1% |
| 34 | Rush County Memorial Hospital | La Crosse | Kan. | 24 | $7.6M | -27.4% | -18.1% |
| 35 | Kiowa County Memorial Hospital | Greensburg | Kan. | 25 | $9.9M | -30.6% | -18.0% |
| 36 | Mercy Walworth Hospital & Medical Center | Lake Geneva | Wis. | 25 | $558.7M | 433.9% | -17.9% |
| 37 | Muscogee (Creek) Nation Medical Center | Okmulgee | Okla. | 20 | $28.4M | -35.4% | -17.8% |
| 38 | Hillsboro Community Hospital | Hillsboro | Kan. | 15 | $9.3M | -32.3% | -17.7% |
| 39 | MUSC Health Lancaster Medical Center | Lancaster | S.C. | 217 | $111M | -8.4% | -17.1% |
| 40 | Glenn Medical Center | Willows | Calif. | 47 | $33.6M | -18.6% | -16.8% |
| 41 | Sparrow Carson Hospital | Carson City | Mich. | 87 | $50.3M | -9.6% | -16.8% |
| 42 | Washington County Hosp Inc | Plymouth | N.C. | 25 | $20.8 | -17.2% | -16.6% |
| 43 | Creek Nation Community Hospital | Okemah | Okla. | 25 | $19.4M | -64.0% | -16.6% |
| 44 | Sanford Aberdeen Medical Center | Aberdeen | S.D. | 48 | $76.4M | -24.5% | -15.7% |
| 45 | Mid Coast Medical Center - Central | Llano | Texas | 25 | $7M | -6.4% | -15.7% |
| 46 | Sharon Hospital | Sharon | Conn. | 78 | $65.1M | -13.4% | -15.6% |
| 47 | Hillcrest Hospital Cushing | Cushing | Okla. | 99 | $16.4M | 2.2% | -15.2% |
| 48 | Crosbyton Clinic Hospital | Crosbyton | Texas | 2 | $4.6M | -42.5% | -15.1% |
| 49 | Kau Hospital | Pahala | Hawaii | 21 | $30.2M | -34.8% | -14.9% |
| 50 | Tanner Medical Center-East Alabama | Wedowee | Ala. | 15 | $13.7M | -40.6% | -14.8% |
| 51 | Floyd Cherokee Medical Center | Centre | Ala. | 60 | $15.3M | -16.7% | -14.8% |
| 52 | McKenzie County Healthcare Systems Inc | Watford City | N.D. | 24 | $45.8M | -22.7% | -14.8% |
| 53 | Gundersen St Elizabeth's Hospital and Clinics | Wabasha | Minn. | 25 | $44.3M | -19.6% | -14.5% |
| 54 | Alliancehealth Madill | Madill | Texas | 25 | $16.5M | -13.2% | -14.5% |
| 55 | UPMC Lock Haven | Lock Haven | Pa. | 25 | $42.1M | -14.1% | -14.4% |
| 56 | MUSC Health Chester Medical Center | Chester | S.C. | 82 | $53.2M | -12.5% | -14.3% |
| 57 | North Baldwin Infirmary | Bay Minette | Ala. | 78 | $45.9M | -8.3% | -14.2% |
| 58 | Saint Thomas Highlands Hospital | Sparta | Tenn. | 60 | $22.2M | -18.6% | -14.1% |
| 59 | Margaretville Memorial Hospital | Margaretville | N.Y. | 15 | $25.1M | -23.6% | -13.7% |
| 60 | Helena Regional Medical Center | Helena | Ark. | 155 | $23.4M | -12.9% | -13.6% |
| 61 | Carle Richland Memorial Hospital | Olney | Ill. | 123 | $65.6M | 1.2% | -13.2% |
| 62 | Baptist Memorial Hospital - Carroll County | Huntingdon | Tenn. | 70 | $26.3M | -13.1% | -13.2% |
| 63 | Lakeland Community Hospital | Haleyville | Ala. | 49 | $23.1M | -9.9% | -13.1% |
| 64 | Fillmore Community Hospital | Fillmore | Utah | 19 | $10.5M | 3.6% | -13.0% |
| 65 | UPMC Jameson | New Castle | Pa. | 123 | $122.4M | -6.4% | -12.9% |
| 66 | Ketchikan Medical Center | Ketchikan | Alaska | 25 | $94.7M | -3.1% | -12.6% |
| 67 | McLaren Central Michigan | Mount Pleasant | Mich. | 151 | $147.2M | -14.4% | -12.5% |
| 68 | Marion Regional Medical Center | Hamilton | Ala. | 57 | $22.5M | -18.7% | -12.1% |
| 69 | UPMC Horizon | Greenville | Pa. | 157 | $151.2M | -2.3% | -12.1% |
| 70 | Lee County Community Hospital | Pennington Gap | Va. | 6 | $20.6M | -1.7% | -12.0% |
| 71 | Franciscan Health Rensselaer | Rensselaer | Ind. | 25 | $35.9M | -6.9% | -11.7% |
| 72 | Alliance Healthcare System | Holly Springs | Miss. | 40 | $12.2M | -11.5% | -11.7% |
| 73 | Community Memorial Hospital | Hicksville | Ohio | 25 | $34.3M | -10.4% | -11.7% |
| 74 | Haskell Memorial Hospital | Haskell | Texas | 25 | $13.8M | -34.2% | -11.7% |
| 75 | Carnegie Tri-County Municipal Hospital | Carnegie | Okla. | 21 | $19.2M | -15.1% | -11.6% |
| 76 | Providence Seaside Hospital | Seaside | Ore. | 25 | $83.5M | 1.4% | -11.6% |
| 77 | Monument Health Custer Hospital | Custer | S.D. | 11 | $29.4M | -14.4% | -11.5% |
| 78 | UCHealth Pikes Peak Regional Hospital | Woodland Park | Colo. | 15 | $26.6M | -8.0% | -11.4% |
| 79 | Aspirus Merrill Hospital | Merrill | Wis. | 25 | $20.7M | -0.2% | -11.4% |
| 80 | Sgmc Lanier Campus | Lakeland | GA | 25 | $18.8M | -17.1% | -11.0% |
| 81 | Geary Community Hospital | Junction City | Kan. | 92 | $42.7M | -22.2% | -11.0% |
| 82 | UPMC Chautauqua at WCalif. | Jamestown | N.Y. | 88 | $131.7M | -17.9% | -11.0% |
| 83 | Hancock County Hospital | Sneedville | Tenn. | 10 | $7.2M | -6.7% | -11.0% |
| 84 | Johnson County Community Hospital | Mountain City | Tenn. | 2 | $9.2M | -11.5% | -10.9% |
| 85 | Patients Choice Medical Center of Smith County | Raleigh | Miss. | 29 | $2.9M | 4.8% | -10.8% |
| 86 | Providence St Joseph Hospital | Chewelah | Wash. | 17 | $20.4M | -0.2% | -10.7% |
| 87 | Crenshaw Community Hospital | Luverne | Ala. | 65 | $15M | -22.6% | -10.6% |
| 89 | Falls Community Hospital and Clinic | Marlin | Texas | 44 | $12.7M | -24.2% | -10.6% |
| 90 | Martin General Hospital | Williamston | N.C. | 49 | $27.7M | -7.1% | -10.5% |
| 91 | Randolph Hospital | Asheboro | N.C. | 145 | $114M | -7.2% | -10.5% |
| 92 | Rappahannock General Hospital | Kilmarnock | Va. | 35 | $40.5M | -14.5% | -10.5% |
| 93 | Othello Community Hospital | Othello | Wash. | 16 | $20.5M | -19.0% | -10.5% |
| 94 | Mangum Regional Medical Center | Mangum | Okla. | 18 | $16.7M | -15.8% | -10.3% |
| 95 | Prisma Health Oconee Memorial Hospital | Seneca | S.C. | 169 | $188.1M | -7.0% | -10.3% |
| 96 | Platte County Memorial Hospital | Wheatland | Wyo. | 25 | $25.5M | -8.4% | -10.3% |
| 97 | Marion General Hospital | Columbia | Miss. | 79 | $16.5M | -17.2% | -10.2% |
| 98 | Scenic Mountain Medical Center | Big Spring | Texas | 132 | $45.9M | -9.4% | -10.2% |
| 99 | Bronson South Haven Hospital | South Haven | Mich. | 82 | $37.9M | -18.9% | -10.1% |
| 100 | Kohala Hospital | Kapaau | Hawaii | 25 | $14.2M | -38.0% | -10.0% |