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Texas Rural Hospital Facts

  • There are approximately 180 rural hospitals in Texas out of approximately 580 total licensed hospitals (using a definition of "rural" as a county population of 75,000 and less; and larger counties but in a city of 25,000 and less).

  • These rural hospitals provide access to routine and emergency health care for 15 percent of the state’s population but cover 85 percent of the state’s geography.

  • There are 45 rural hospitals located in counties of less than 10,000 persons.

  • There are 80 Critical Access Hospitals (CAH) in Texas - special Medicare designation for certain small rural hospitals with 25 or less beds, and at least 35 miles from another hospital - some exceptions on mileage separation. CAHs receive special reimbursement consideration from Medicare.

  • There are 49 Sole Community Hospitals (SCH) in Texas - special Medicare designation for a certain rural hospitals not designated CAH and at least 35 miles from another hospital. SCHs receive special reimbursement consideration from Medicare.

  • There are 52 other rural hospitals that do not qualify as CAH or SCH.

  • Small, rural hospitals nationally have equal or better patient quality outcomes, and cost less per Medicare beneficiary than their urban counterparts.

  • Rural hospitals have a narrower financial margin that their urban hospitals.

  • Rural hospitals often cannot provide more profitable advanced services and medical procedures.

  • The operating cost in a rural hospital can be higher on a per-patient basis because of the challenging dynamics such as low patient volume, dramatic swings in patient numbers from day to day, recruitment difficulties which can drive up payroll costs, and a general lack of an economy of scale in high volume purchasing and procurement.

  • Texas rural hospitals are straining under the current reimbursement system already having to layoff personnel and eliminate positions - 28 rural hospitals report 252 positions eliminated in the last few months.

  • Rural hospitals treat older and poorer patients providing a higher percentage of Medicare and Medicaid services than urban hospitals - both which often pay less than private insurance.

  • Rural hospitals are negatively impacted more than urban hospitals from Medicaid and Medicare cuts because of the higher levels of Medicaid and Medicare patients.

  • Rural areas in Texas have the highest levels of uninsured - some as high as 50 percent - while the Texas average is 26 percent. (14 of the 15 highest uninsured level counties in the country are Texas rural counties).

  • Rural hospitals comprise two percent of the overall Texas Medicaid budget and less than five percent of all Texas hospital related Medicaid payments.

  • Rural hospitals are estimated to comprise less than 5 percent of Medicare expenditures.

  • Medicare spending is almost four percent less per rural Medicare beneficiary than care delivered in urban systems.

  • More than 80 hospitals closed in Texas during the 1980s and 1990s, most of them being rural.

  • Closures were slowed by financially stabilizing programs such as CAH, SCH, Texas Medicaid cost based payments, and other special payment provisions to rural hospitals.

  • Rural hospitals are critical to their local economy – they are often the second or third largest employer in a community, have the highest paying jobs, and are a key to economic development (No hospital – no new business).

  • Rural hospitals should be a concern for all Texans as rural areas provide the food, fuel, and fiber for the entire state, as well as being traveled through by everyone at one time or another.

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