HAP Resource Center

Report: Pennsylvania Rural Hospital Landscape

A Snapshot of Issues Top of Mind for Pennsylvania’s Rural Hospital Leaders

Executive Summary

HAP Report: Pennsylvania Rural Hospital LandscapePennsylvania’s Rural Hospitals Need a Lifeline

Through fiscal year 2022, more than one-quarter of Pennsylvania’s rural hospitals were operating with a negative margin. Another 14 percent were operating with margins under 4 percent, meaning they have little to no room to maintain infrastructure and long-term sustainability.1 Without specific policy and payment supports, it will become increasingly difficult for rural hospitals to remain viable. Lack of affordable, accessible health care means rural Pennsylvania communities and the people who live in them will continue to lose vital services. Moreover, rural communities will lose a major driver that provides high-paying jobs and stimulates the economy.

In the late fall of 2023, The Hospital and Healthsystem Association of Pennsylvania (HAP) convened rural hospital executives from across the commonwealth to hear directly from them on the biggest pain points they are experiencing and their ideas for solutions.

High-Level Trends

The big picture trends of greatest concern to Pennsylvania rural hospital leaders today include:

  • Workforce shortages that threaten access to care. Rural hospitals cannot sustain current levels of agency staffing, but getting back to “normal” is a slow process, exacerbated by the lack of available qualified staff in many rural areas.
  • Broken or nonexistent access to post-acute services and supports. Limited availability of quality post-acute services, such as transportation, behavioral health, and social supports, in rural communities can result in serious consequences for patients and their families when they leave the hospital setting.
  • Low reimbursement and lack of adequate, appropriate financing. Rural hospitals are highly reliant on public payors and feeling squeezed by payors that seem indifferent to the impacts they can have on these providers.
  • Regulatory burdens that strain already stressed hospital teams. With other critical issues weighing heavily on both margins and morale, regulatory burdens have become almost insupportable.
  • Disjointed and underfunded emergency medical services (EMS) that cannot meet demand. Disparate EMS systems with varying levels of local funding and operating capacity impact rural hospitals’ ability to effectively manage both emergency services and post-acute transportation needs.



Topics: Access to Care

Revision Date: 2/12/2024

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