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. 2021 Mar;37(2):347-352.
doi: 10.1111/jrh.12553. Epub 2020 Dec 31.

Decline in Inpatient Volume at Rural Hospitals

Tyler L Malone  1   2 , George H Pink  1   2 , George M Holmes  1   2
Affiliations

Decline in Inpatient Volume at Rural Hospitals

Tyler L Malone et al. J Rural Health. 2021 Mar.

Abstract

Purpose: To investigate (1) all-payer inpatient volume changes at rural hospitals and (2) whether trends in inpatient volume differ by organizational and geographic characteristics of the hospital and characteristics of the patient population.

Methods: We used a retrospective, longitudinal study design. Our study sample consisted of rural hospitals between 2011 and 2017. Inpatient volume was measured as inpatient average daily census (ADC). Additional measured hospital characteristics included census region, Medicare payment type, ownership type, number of beds, local competition, total margin, and whether the hospital was located in a Medicaid expansion state. Measured characteristics of the local patient population included total population size, percent of population aged 65 years or older, and percent of population in poverty. To identify predictors of inpatient volume trends, we fit a linear multiple regression model using generalized estimating equations.

Findings: Rural hospitals experienced an average change in ADC of -13% between 2011 and 2017. We found that hospital characteristics (eg, census region, Medicare payment type, ownership type, total margin, whether the hospital was located in a Medicaid expansion state) and patient population characteristics (eg, percent of population in poverty) were significant predictors of inpatient volume trends.

Conclusions: Trends in inpatient volume differ by organizational and geographic characteristics of the hospital and characteristics of the patient population. Researchers and policy makers should continue to explore the causal mechanisms of inpatient volume decline and its role in the financial viability of rural hospitals.

Keywords: inpatient volume; rural health care; rural hospital.

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References

    1. Medicare Payment Advisory Commission. Chapter 3: Hospital Inpatient and Outpatient Services. Report to the Congress: Medicare payment policy, (p.65-94). March 2019.
    1. Bai G, Anderson GF. A more detailed understanding of factors associated with hospital profitability. Health Aff. 2016;35(5):889-897.
    1. Pink GH, Holmes GM, Thompson RE, Slifkin RT. Variations in financial performance among peer groups of critical access hospitals. J Rural Health. 2007;23(4):299-305.
    1. North Carolina Rural Health Research Program. 174 rural hospital closures: January 2005-Present (132 since 2010) [Internet]. n.d. [cited 2020 October 17]. Available from: https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hos...
    1. Holmes GM, Kaufman BG, Pink GH. Predicting financial distress and closure in rural hospitals. J Rural Health. 2016;33(3):239-249.

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