Small rural hospitals in the United States and the impact of COVID: A cross-sectional study.

Background: Rural hospitals in the United States face staffing and financial challenges, low patient volumes, and aging infrastructures among others. In addition, they deal with such crises as the opioid epidemic, natural disasters, and the coronavirus.

Methods: The analyses presented in this study are based on two databases: (1) the 2019 annual survey data published by the American Hospital Association (AHA) and (2) US Department of Health and Human Services (HHS) database of US hospitals containing information related to COVID-19 for the week of November 27, 2020. Using a subset of the 2019 AHA annual survey data to which the authors acquired access, this study develops a profile of rural hospitals in America. The data are proprietary property of AHA. The authors are permitted to use the data in published research but only in aggregate form. No individual hospital metrics can be used in this report. The HHS database is public data and as such is available to all. HHS recognizes the importance of providing high-quality, accessible, and timely information for entrepreneurs, researchers, and policy makers to help drive insights and better health outcomes for all. Employing this HHS database, a cross-sectional view of the impact of COVID on small, rural hospitals in the United States is undertaken. In this study, data found in the HHS database are presented only in the aggregate form.

Results and discussion: The average small, rural hospital has 20.8 beds, 10 weekly admissions, a daily census of 6.6 patients, 145 full-time personnel, 67 part-time personnel, and a total facility expense of $27 million of which payroll expense was 41%. Due to COVID, there was an increase in admissions and outpatient visits.