Intro: The purpose of this research was to investigate the financial experience of Low Volume Hospitals (LVHs) in comparison to other rural hospitals.

Methods: Descriptive and bivariate statistics (non-parametric equality of medians, Wilcoxon rank-sum, t-test and chi-square) were used to identify rural LVHs, compare rural LVH characteristics to those of rural non-LVHs, and to simulate the potential profitability consequences of changes to the LVH program.

Results: Based on this analysis, only one percent of current LVHs would continue to qualify for the LVH adjustment under the 2005 standards.

Conclusion: Without additional action from policymakers, the ACA LVH program will expire on October 1, 2017, and the program will revert to the original 2005 standards. Allowing the LVH program to revert to the 2005 standards is likely to have a negative financial impact on LVHs and could impair access to care for Medicare beneficiaries residing in more isolated rural areas.