Research / Rural Development

SLC Regional Resource | June 2021

Rural Hospitals During the COVID-19 Pandemic

Nick Bowman

Rural hospitals are a vital part of the U.S. healthcare sector and provide strong economic impacts. These healthcare facilities, which have an average of 25 inpatient beds, differ from urban hospitals in several ways. Many rural hospitals serve as the first point of care, sending patients to larger hospitals with more staff and medical equipment for specialized treatment. Due to their larger size and budgets, urban hospitals can offer a more comprehensive array of services. However, many rural hospitals perform just as well as urban hospitals and, in some cases, even outperform them.

Due to several factors, rural hospitals have struggled financially for years; 180 of them have closed since January 2005, with most closures in the South.* The reasons behind these closures include decreasing rural populations, changing federal healthcare regulations, and geographic isolation. A February 2019 report from Navigant, a Chicago-based consulting firm, found that 21 percent of U.S. rural hospitals were at high risk of closing unless their finances improve.

Since the emergence of COVID-19, Southern states have taken numerous measures in response to the pandemic. This SLC Regional Resource provides a summary of important state-level legislation related to rural hospitals and rural healthcare enacted between January 2020 and April 2021.

* For more on these issues, please see the November 2019 SLC Regional Resource, Rural Hospitals: Here Today, Gone Tomorrow.

Webinar | September 2020

Alternative Payment Models in Healthcare

Roger Moore

To slow the growth of healthcare costs and improve outcomes for patients, many stakeholders are experimenting with alternative payment models (APMs), a relatively new approach to paying for medical care that financially rewards providers for delivering high-quality, cost-effective care. In contrast to traditional fee-for-service payment methods, which reimburse providers for each service or procedure performed, APMs are designed to incentivize a value-based approach that emphasizes quality over quantity.

This program features a presentation about the Pennsylvania Rural Health Model, an initiative designed to address the financial challenges faced by rural hospitals. Under the Rural Health Model, providers are reimbursed via global budget payments – an APM that offers a pre-determined amount, for a fixed period of time, for a specific patient population – to deliver care that aligns with community health needs. Pennsylvania is the first state in the country to design and implement an APM that is exclusively focused on rural hospitals.


Gary Zegiestowsky, Executive Director, Rural Health Redesign Center Authority, Pennsylvania
Janice Walters, Chief Operating Officer Consultant, Rural Health Redesign Authority, Pennsylvania

Agriculture & Rural Development Committee Virtual Program
Webinar | July 2020

Implications of Recent Trade Agreements for the American Farm
Addressing Mental Health in Rural Communities

Nick Bowman

Agriculture & Rural Development Committee Virtual Program

Implications of Recent Trade Agreements for the American Farm

Many in the agriculture sector have heralded the United States-Mexico-Canada Agreement and the Phase-One Agreement with China as unparalleled opportunities to provide their products to growing consumer bases and to promote free and fair trade. This program provides a briefing on these two important trade deals and explores how they could impact the U.S. agricultural sector, especially in light of the COVID-19 pandemic.


Max Moncaster, Director of Public Policy, National Association of State Departments of Agriculture, Virginia

Addressing Mental Health in Rural Communities

According to the U.S. Centers for Disease Control and Prevention, suicides among farmers are 1.5 times higher than the national average. Experts warn that rising farm debt, limited access to mental health resources, harvests impacted by extreme weather, and the lingering impacts of a long-running trade war with China—and now the COVID-19 pandemic—all are contributing to significant stress among those in the agriculture community. This program examines initiatives to increase awareness of rural stress issues and warning signs; identify ways to communicate and cope with stress; and access local resources and support.


Keith Mueller, Head of the Department of Health Management and Policy, University of Iowa

Senator Casey Murdock

Casey Murdock


Vice Chair
Senator Tyler Harper

Tyler Harper


Past Chair

Daniel B. Verdin III

South Carolina

Nick Bowman

Nick Bowman
Policy Analyst

The SLC Agriculture & Rural Development Committee's agenda focuses on issues critical to the future of farming and farm communities, such as the distribution of water and other natural resources – critical for the agricultural sector – and new opportunities for the export of agricultural commodities to international markets. Several reports prepared by the committee have measured the economic impact of the agricultural sector, often considered the "engine of the economy" in most Southern states. The committee's work also centers on the continued development of rural communities, highlighting access to healthcare and transportation; integration with the global economy; the many differences and surprising similarities between rural and urban America; and how to bridge the infrastructure challenges that divide these communities.

More SLC Research into Rural Development

Other | December 2019

Issues to Watch - 2020

Policy Analysis | November 2019

Federal Analysis: Rural Health Agenda

SLC Regional Resource | November 2019

Rural Hospitals: Here Today, Gone Tomorrow

Policy Analysis | April 2019

Federal Legislation on Rural Hospitals

Other | January 2019

Issues to Watch - 2019

SLC Special Series Report | May 2017

Blown Away: Wind Energy in Southern States (Part 1)

Policy Analysis | February 2014

The "Black Belt"

SLC Regional Resource | January 2009

Capital Access in the Black Belt

SLC Regional Resource | January 2006

State Rural Initiatives: Where the Money Comes From

SLC Regional Resource | July 2005

Rural Centers in the South

SLC Regional Resource | December 2003

A Rural Policy for the 21st Century