About 60 million people — nearly one in five Americans — live in rural areas and depend on their local hospitals for care. This year, 18 of those hospitals have closed, making 2019 a record year for rural hospital closures.
Across the U.S., 119 rural hospitals have closed since 2010, according to the Cecil G. Sheps Center for Health Services Research. Of the 31 states that have seen at least one rural hospital close since 2010, Texas leads with 20 rural hospital closures. It's followed by Tennessee, which has seen 13 hospitals close.
A variety of issues have put rural hospitals in a fragile position. Low patient volume and heavy reliance on government payers are among the challenges rural healthcare organizations have faced for years. Newer challenges, such as the shift from inpatient to outpatient care, increased regulatory burden and the high cost of pharmaceutical drugs, also threaten rural hospitals' ability to maintain access to healthcare services, according to a report by the American Hospital Association.
The Sheps Center began tracking rural hospital closures in 2005. Since then, 161 hospitals in rural communities have shut down. The number of closures has steadily increased over the past three years. Many of the 18 rural hospitals that shut down so far this year faced reimbursement issues and cited dwindling patient volumes as a reason they were forced to close.
The downfall of EmpowerHMS, a hospital operator formerly based in Kansas City, Mo., pushed the total number of rural hospital closures to a record high this year. The company closed a handful of rural hospitals across the U.S. this year, and several of its hospitals are working their way through the bankruptcy process.
The challenges rural hospitals are facing will likely persist next year, and more hospitals will close. Across the U.S., more than 600 rural hospitals are vulnerable to closure, according to an estimate from iVantage Health Analytics, a firm that compiles a hospital strength index based on data about financial stability, patients and quality indicators.
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