Changes in surgical quality and access after rural hospital closures

Abstract

There are rising concerns about the effects of rural hospital closure on access to and quality of care for impacted patients, but little remains known about surgical care. The objective of this study was to evaluate the association of hospital closure with outcomes and access to surgery for common surgical conditions. Using Medicare claims data from 2010-2020, we evaluated the impact of rural hospital closures on surgical quality and access for common operations (colectomy, cholecystectomy, appendectomy, and hernia repair). Using a dynamic difference-in-differences approach, we analyzed 36 884 and 41 185 beneficiaries who lost their nearest and second-nearest rural hospital, respectively. Our findings revealed no significant impacts on surgical quality as measured by 30-day mortality, complications, serious complications, reoperations, and readmissions. While rates of unplanned surgery did not change, median travel distance increased from 13.1 to 16.4 miles for beneficiaries who lost their nearest hospital but was unchanged for those losing their second-nearest hospital. These findings suggest that, while rural hospital closure does not adversely impact surgical quality, it does pose challenges in ensuring access to timely surgical care. Policymakers should consider tailored interventions to mitigate the persistent and growing travel disparities to obtain care in rural America.

Keywords: access to care; hospital closure; rural health; rural hospital closure; surgical quality.

Figure 1.

Illustrative example of an empirical approach to assess the impact of losing the nearest or second-nearest hospital due to rural hospital closure. Figure created using ArcGIS.

Figure 2.

Association between the nearest rural hospital closure and surgical quality and access: 2010–2020. Source: Authors’ analysis of 100% of claims from the MedPAR file: 2010–2020. Abbreviations: MedPAR, Medicare Provider Analysis and Review; pp, percentage points.

Figure 3.

Changes in travel distance to obtain surgical care prior to and after exposure to hospital closure for Medicare beneficiaries who lost their nearest vs second-nearest rural hospital due to closure. Source: Authors’ analysis of 100% of claims from the MedPAR file: 2010–2020. Abbreviation: MedPAR, Medicare Provider Analysis and Review.