Inpatient use and key health care services offered at rural hospitals have declined over the past decade. Has the quest for efficiency in hospitals led to a dangerously low surge capacity and ability to effectively handle public health emergencies?

In the context of recent policy developments, such as declining inpatient services and the Rural Emergency Hospital introduction, new research can address whether rural hospitals have maintained sufficient inpatient infrastructure to handle increased health care demand during a public health emergency. As the COVID-19 pandemic has demonstrated, maintenance of surge capacity is critical to protect the future health of rural populations.

Using hospital cost reports from the CMS Healthcare Cost Report Information System (HCRIS), we will study facility characteristics and utilization (among other variables). We will also use HRSA Area Health Resources Files, CDC Social Vulnerability Index files, USDA frontier and remote area (FAR) codes, and FEMA National Risk Index for Natural Hazards files to gather additional stratification variables (e.g., community demographics, social vulnerability index, remoteness, natural hazard risk).