To understand the variability in hospitals that qualify for special Medicare payment classifications, it is important to analyze characteristics of urban hospitals, particularly those with substantial rural patient populations. This study evaluated differences in urban hospitals with high and low percentages of rural inpatient days using several indicators. These indicators fall into five broad categories: Medicare payer mix, size, profitability, distance to the next closest hospital, and wage index.

Nearly 7% of urban hospitals (163) have a high percentage (≥40%) of inpatient days for rural patients (determined by dividing the total number of rural Medicare inpatient days by the total number of Medicare inpatient days). Ninety‐nine of these 163 hospitals have no special Medicare payment classification, 48 are Rural Referral Centers, and nine are Sole Community Hospitals/Rural Referral Centers. Some urban hospitals with no special Medicare payment classification but with a high percentage of inpatient days for rural patients might be eligible for a special payment classification but have either chosen not to apply or are not aware of their potential eligibility.