The Rural Health Safety Net Under Pressure: Understanding the Potential Impact of
Over the course of the past decade, The Chartis Center for Rural Health has been a leading participant in the national conversation surrounding the rural health safety net. None of the metrics Chartis uses to track rural hospital performance indicate we have entered a period of stability or improvement. On the contrary, key indicators such as hospital operating margin, closures, and access to critical services all continue to worsen. Today, our analysis shows that 453 rural hospitals (nearly 25 percent of all rural hospitals) are vulnerable to closure.
The emergence of COVID-19 has added a new, and unexpected, pressure point that threatens to further erode the rural health safety net. For rural providers, the spread of COVID-19 across a vulnerable population has the potential to place a significant strain on existing resources (financial and operational), staffing and expertise.
In this new analysis, The Chartis Center for Rural Health explores key factors in assessing the potential impact of the COVID-19 pandemic on the rural health safety net, including access to intensive care unit beds, the reliance on outpatient service revenues and rural provider days cash on hand.
In addition to this written update, The Chartis Center for Rural Health has developed a series of heat maps for each of the categories highlighted in this report. Additionally, the complete rural hospital vulnerability study is available along with an infographic and trended heat maps. These resources are available at https://www.ivantageindex.com/research-education2/.
[1, 9] Cecil G. Sheps Center for Health Services Research, University of North Carolina,  Scientific American, Map Reveals Hidden U.S. Hotspots of Coronavirus Infection, April 2, 2020, [3, 5] The Chartis Center for Rural Health,  Federal Office of Rural Health Policy,  The Chartis Group, 2020,  National Rural Health Association, [8, 9] Healthcare Provider Cost Report Information System (HCRIS).
This research update is based on analysis of Healthcare Provider Cost Report Information System (HCRIS) data. The study population is limited to currently operating Critical Access Hospitals and Rural and Community Hospitals. Facilities affiliated with a system are excluded from analysis of days cash on hand due to unique inconsistencies in the reporting of this measure. The presence of an ICU within a facility assumes a minimum of 3 reported ICU beds consistent with the national rural average .