National Association of Rural Health Clinics Research and Education Foundation
NARHC REF Lookup Tool Portal
Cost Reporting Data
NARHC has partnered with Wipfli LLP to develop and produce these customized reports for NARHC members upon their request. The RHC Benchmark Report provides rural health clinics the ability to compare Medicare cost report data to other RHCs from their state, region, and across the United States. In delivering a concise, yet meaningful report, RHC Benchmark Report includes critical data related to facility and personnel costs, visits, staffing, and other key performance metrics to identify performance gaps in an effort to improve operating efficiencies and manage the cost of providing rural health clinic services. Total encounter numbers do not include data from rural health clinics that filed low/no utilization Medicare cost reports (e.g, Pediatric RHCs)
Assistance with interpretting this information can be obtained from consultants knowledgable in Rural Health Clinic finances who have been trained in the use of the RHC Benchmark Report.
Their contact information is as follows:
- Nathan Smith – nathan.smith@wipfli.com
- Erik Prosser – eprosser@wipfli.com
The National Center for the Analysis of Healthcare Data (NCAHD)
The National Center for the Analysis of Healthcare Data (NCAHD), working together with the NARHC Research and Education Fund (REF), recently completed an update to research they conducted in 2018, on the health of the Rural Health Clinics (RHC) program. This research was designed to give policymakers and NARHC membership, a more detailed picture of trends occurring in the RHC program and where these trends were occurring across the United States.
A core component for this research was to evaluate the Center for Medicare and Medicaid’s (CMS) Quality, Certification, and Oversight Reports (QCOR) federal RHC data between 2020-2022 for relevant trends within the RHC landscape. Four key trends were apparent:
- The RHC program continues to grow;
- For the first time in likely decades, there were more, new independent RHCs than new provider-based RHCs in 2022;
- RHC “terminations” remained largely consistent in the 2020-2022 period with a slight uptick in total closures in 2022; and
- Of the RHCs that are listed as terminated in the federal data, 47% are providing care through a different model, 33% of terminated RHCs have truly closed with no healthcare being provided at that location, and roughly 19% are still operating as an RHC, just under a new CMS Certification Number (CCN).
1-Overall Growth of RHC Program
In the three-year period between 2020 and 2022 nearly a thousand new RHCs have opened (n=997) and over three hundred RHCs (n=330) have either closed, are no longer participating, or have changed their CCN number (See Figure 1 below).
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Figure 1-Total RHC Changes (2020-2022)
NARHC has seen consistent growth in the RHC program for decades and anticipates similar growth as seen during the 2020-2022 period in the future. The overall impact of this growth nationwide results in 30 of the 45 states (that participate in the RHC program), now provide increased access to care for more than 250 million people in these states, many of which reside in rural and underserved areas (see Map 1 below). Consequently, the RHC current national landscape realized an total of 8.6% increase in the program from 2020-2022 for 30 of the 45 states with RHCs (see Map 2 below).
Map 1 – National Impact of RHC Program Growth
NCAHD conducted research into each of the 330 RHCs that were listed as terminated in the federal database and refined the data further into the following categories:
- CCN Change – Describes an entity that is still operating as an RHC but underwent a change in ownership that resulted in a new certification number.
- Closed – Describes an RHC that terminated their RHC status, and no healthcare is being provided at that address.
- No Longer Participating – Describes RHCs that terminated their RHC status and are no longer participating in Medicare as RHCs but are still open providing care under some other model/facility type.
Map 2 – Current RHC Program State Aggregates
2-New Independent RHCs Overtook New Provider-Based RHCs in 2022
For the first time in likely decades, new independent RHC development outpaced new provider-based RHC development (see Figure 2 below). Given the major reforms to Medicare RHC reimbursement that occurred at the end of 2020, this trend is not surprising but nonetheless notable. Despite the name, freestanding or “independent” RHCs can in fact be owned by hospitals or health systems, so this fact does not necessarily mean that hospital/clinic consolidation has slowed in the RHC space. The current benefits of opening new provider-based RHCs are mostly related to 340B participation given that as of 2021, new provider-based RHCs are treated the same as new freestanding RHCs in terms of Medicare reimbursement policy.
Figure 2- National Impact of New RHC Openings
3-RHC Terminations Remained Largely Consistent with a Slight Increase in Terminations in 2022
From 2020 to 2022 there was not a major spike in the number of RHCs leaving the program. Concern that there would be an exodus of RHCs leaving for other models due to the Medicare payment reforms has not, at this point, manifested in the data (see Figure 3 below).
In fact, the slight increase in terminations in 2022 is actually attributable to a slight increase in the number of freestanding RHCs closing or converting to other models, not provider-based RHCs (see Figure 4 & 5 below).
Figure 3- RHC Changes by Clinic Type
Figure 4-RHC Closures Trend Analysis (2020-2022)
Figure 5-RHC No Longer Participating Trend Analysis (2020-2022)
4-Only 33% of RHC Terminations Represent True Closures
NCAHD research indicated that in approximately two-thirds of the “terminated” RHCs, there is still healthcare being provided at that address. The federal data assigns these RHCs as “terminated”, but 19% of these RHCs still operate as an RHC under a different CCN. Furthermore, while NARHC would certainly want RHCs to be the healthcare delivery model of choice for rural/underserved communities, we realize the importance that these communities have access to care. Through NCAHD’s research, it was, thankfully determined that nearly half (47%) of the terminated RHCs remained open under a different healthcare delivery model such as fee-for-service or the community health center model. Nevertheless between 2020 and 2022, the research indicated that the 110 RHC closures (55 freestanding and 55 provider-based) no longer were providing healthcare at that address. Further research would be necessary to analyze how community-wide access to outpatient care was impacted by these closed RHCs.
The NARHC Research and Education Foundation was established in 2021 to establish a repository of RHC relevant research and analysis that can be available for use by anyone interested in the success of the RHC program. REF supported research will support and guide NARHC’s ongoing policy efforts.
Please contact Nathan Baugh, NARHC Executive Director or Sarah Hohman, Director of Government Affairs at Nathan.Baugh@narhc.org or Sarah.Hohman@narhc.org with any questions.
RHC Nation Benchmarks 2022-2023
RHC Nation Benchmarks 2020-2022
