The coronavirus disease 2019 (COVID-19) pandemic is a financial stress test for US hospitals.1,2 Revenues have declined from the suspension of elective procedures and nonessential services, and many hospitals have experienced a surge of critically ill patients. These circumstances have created an unprecedented challenge for rural hospitals, many of which entered the crisis in poor financial condition due to the loss of patients to regional referral centers and rural depopulation.3 Of the 4663 acute care hospitals in the US, approximately 47% are located in rural areas across 49 states.4 The added financial strain of COVID-19 has the potential to accelerate the closure of rural hospitals, draining health care resources and jobs from rural communities that have lost 130 hospitals since 2010.5,6
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Eric T. Roberts, PhD, Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, A653 Crabtree Hall, Pittsburgh, PA 15261 (email@example.com).
Published Online: June 10, 2020. doi:10.1001/jama.2020.9744
Conflict of Interest Disclosures: Drs Fried and Liebers reported previously serving as consultants to the Pennsylvania Office of Rural Health. Dr Fried reported receiving personal fees from Pennsylvania Department of Health outside the submitted work. Dr Liebers reported receiving personal fees from the Pennsylvania Office of Rural Health outside the submitted work. Dr Roberts was supported by a grant from the Agency for Healthcare Research and Quality (K01HS026727).
Disclaimer: This content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality, the Pennsylvania Office of Rural Health, or the Pennsylvania Department of Health.
Additional Contributions: We thank Julie Donohue, PhD (Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health), and Derek Angus, MD, MPH (Department of Critical Care Medicine, University of Pittsburgh School of Medicine), for helpful comments on an earlier draft of this article. The authors also gratefully acknowledge the contribution of Mark Herzog, MD, MPP (1992-2020), in inspiring our writing.
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