Rural hospitals
Rural critical access hospitals discharge 31% fewer patients than in 2011, from a fifth more building per bed
On an average night in 2024, the typical critical access hospital had 6 patients for its 25 beds. Its clinic space grew 71%.
· Medicare cost reports, fiscal years 2011 to 2024
Critical access is a Medicare designation for small rural hospitals, most of them far from the next hospital, with no more than 25 acute beds. Medicare pays them based on their costs rather than a fixed price per stay. There are about 1,300 of them with usable cost reports.
Follow the 851 that reported usable square feet every year from 2011 to 2024, and set them beside the 2,155 general hospitals that did the same. Both added building. But in the general hospitals, beds filled up; in the critical access hospitals, they emptied.
Building per bed against the share of beds filled, 2011 to 2024
One point a year; the arrow ends at 2024. Hospitals that reported every year.
Source: Medicare cost reports (HCRIS), Worksheets B-1 and S-3. Floor space over beds; patient days over bed days available.
In 2011 the critical access hospitals filled 37% of their beds and had 3,290 square feet of building for each. By 2024, 33% and 3,988. The general hospitals moved the other way on occupancy, from 64% to 69%, while their space per bed also grew.
Fewer patients, more clinics
The patients these hospitals send home after a stay fell 31%, counting the 551 whose counts are steady from year to year. Beds barely changed. Floor space grew 18%, and the fastest-growing part of it was clinic space, up 71%. Outpatient departments went from 11% of the building to 17%; inpatient units shrank from 19% to 16%.
Critical access hospitals: change since 2011
The same 851 hospitals every year; patients discharged at the 551 with steady counts.
Source: Medicare cost reports (HCRIS), Worksheets B-1 and S-3.
Six patients on a typical night
In fiscal year 2024 the median critical access hospital had 6 patients in its beds on an average night, and 25 beds. A quarter had fewer than 3.2. 528 of the 1,256 averaged fewer than five patients, and 38 fewer than one. The count may include patients in swing beds, acute beds used for nursing care after a stay.
Patients on an average night, each critical access hospital, fiscal year 2024
One dot per hospital. Blue: fewer than five patients a night.
Loading 1,256 hospitals…
Source: Medicare cost reports (HCRIS), Worksheet S-3: patient days over the days the report covers.
Fewest patients in Nebraska
Among states with ten or more critical access hospitals, the median runs from 2.8 patients a night in Nebraska to 11.9 in New York.
Median patients on an average night, critical access hospitals, fiscal year 2024
States with three or more critical access hospitals reporting.
- Patients a night
- Under 3
- 3 to 5
- 5 to 7
- 7 to 10
- 10 or more
Source: Medicare cost reports (HCRIS), Worksheet S-3.
How these figures were made
- Critical access hospitals with a usable Medicare cost report in every fiscal year from 2011 to 2024 (851), against general hospitals with the same (2,155); the dots are every critical access hospital with a usable report for fiscal year 2024 (1,256).
- Usable means the square feet passed the database's checks and the beds agree with the bed-days. Discharges are not checked by those tests, so their line uses the 551 critical access hospitals whose counts never jump by more than 60% from one year to the next.
- Beds and patient days are the hospital total line of Worksheet S-3. One hospital that reported more patient days than bed days is left out of the dots.
- Hospitals that stopped filing are not in a balanced panel at all; some of them are on this list. The same comparison for general hospitals: more building, not more beds.
| Year | Square feet | Beds | Square feet per bed | Occupancy | Discharges |
|---|---|---|---|---|---|
| 2011 | 62,327,165 | 18,947 | 3,290 | 37% | 404,359 |
| 2012 | 63,394,411 | 18,868 | 3,360 | 36% | 385,492 |
| 2013 | 64,328,074 | 18,811 | 3,420 | 36% | 368,209 |
| 2014 | 65,273,294 | 18,743 | 3,483 | 36% | 362,912 |
| 2015 | 66,259,031 | 18,677 | 3,548 | 35% | 357,487 |
| 2016 | 67,502,538 | 18,627 | 3,624 | 35% | 345,764 |
| 2017 | 68,711,189 | 18,622 | 3,690 | 34% | 337,570 |
| 2018 | 69,426,028 | 18,553 | 3,742 | 34% | 328,578 |
| 2019 | 70,591,005 | 18,558 | 3,804 | 33% | 311,344 |
| 2020 | 71,338,677 | 18,531 | 3,850 | 33% | 289,578 |
| 2021 | 72,149,514 | 18,526 | 3,895 | 35% | 304,912 |
| 2022 | 72,474,170 | 18,514 | 3,915 | 33% | 290,063 |
| 2023 | 73,034,534 | 18,397 | 3,970 | 32% | 281,628 |
| 2024 | 73,449,002 | 18,416 | 3,988 | 33% | 278,189 |
| State | Hospitals | Median patients a night | Median square feet per bed |
|---|---|---|---|
| Alaska | 13 | 3.6 | 6,042 |
| Alabama | 4 | 6.5 | 2,051 |
| Arkansas | 25 | 5.5 | 2,774 |
| Arizona | 15 | 6.2 | 3,862 |
| California | 34 | 7 | 3,351 |
| Colorado | 31 | 4.5 | 4,157 |
| Florida | 10 | 7 | 2,212 |
| Georgia | 29 | 10 | 2,594 |
| Hawaii | 7 | 14.4 | 2,197 |
| Iowa | 75 | 4.2 | 3,983 |
| Idaho | 26 | 3.7 | 3,741 |
| Illinois | 54 | 6.4 | 4,417 |
| Indiana | 28 | 6.6 | 4,250 |
| Kansas | 76 | 5.2 | 2,533 |
| Kentucky | 28 | 8.2 | 2,253 |
| Louisiana | 25 | 5.3 | 2,702 |
| Massachusetts | 4 | 10.2 | 5,409 |
| Maine | 14 | 11.1 | 4,285 |
| Michigan | 30 | 5.2 | 4,424 |
| Minnesota | 65 | 4.6 | 4,923 |
| Missouri | 35 | 7.4 | 3,623 |
| Mississippi | 25 | 8.6 | 2,608 |
| Montana | 47 | 10.8 | 2,698 |
| North Carolina | 19 | 10.8 | 4,528 |
| North Dakota | 29 | 6.2 | 2,804 |
| Nebraska | 61 | 2.8 | 3,101 |
| New Hampshire | 13 | 10.1 | 5,149 |
| New Mexico | 11 | 4.8 | 3,471 |
| Nevada | 12 | 4.2 | 3,559 |
| New York | 19 | 11.9 | 4,171 |
| Ohio | 26 | 7.8 | 3,766 |
| Oklahoma | 34 | 8 | 1,723 |
| Oregon | 24 | 8.8 | 4,126 |
| Pennsylvania | 15 | 8.4 | 4,176 |
| South Carolina | 3 | 8.4 | 2,192 |
| South Dakota | 39 | 3.1 | 2,509 |
| Tennessee | 13 | 5.1 | 1,846 |
| Texas | 82 | 4.3 | 2,940 |
| Utah | 13 | 4.6 | 2,527 |
| Virginia | 8 | 9.7 | 4,377 |
| Vermont | 8 | 13.7 | 4,871 |
| Washington | 37 | 9.3 | 3,936 |
| Wisconsin | 55 | 8 | 4,938 |
| West Virginia | 19 | 10.1 | 3,935 |
| Wyoming | 16 | 4.6 | 3,745 |