Once again, the anti-hospital, billionaire-backed Arnold Ventures is pushing its anti-hospital agenda with a “report” that is so disingenuous and has so many limitations that it cannot be taken seriously. In this case, a one-pager from the group twists numbers to make the Orwellian claim that “site-neutral payment reforms will protect rural patients.” They go on to diminish the extent to which rural hospitals serve their communities and flippantly write-off the proposed site-neutral cuts facing rural hospitals as “minimal.” However, the facts tell a far different story

In reality, the rural hospitals that would be impacted by the Lower Costs, More Transparency Act — many of which operate with negative or break-even margins — would face $272 million in cuts over ten years.

These impacted rural hospitals alone:

  • Provide 33 million total outpatient visits a year;
  • Deliver nearly a third of all babies delivered in rural areas;
  • Care for over four million emergency visits a year;
  • Already experience a negative 16.4% Medicare outpatient margin and a negative 12.1% overall Medicare margin.

More cuts will drive these margins even further into the red and jeopardize access to care for patients and communities. 

In addition to downplaying the impact of these cuts, Arnold Ventures also purposefully belittles the importance of the rural hospitals that would be subject to these cuts. In the one-pager, Arnold Ventures claims that the “facilities subject to reforms only account for 2% of all rural outpatient spending,” which implies that the outpatient spending at those hospitals account for a very small share of total spending.

This is misleading at best. It appears that what they have done is examine just a sliver of spending at the hospital outpatient departments of the affected hospitals, ignoring the true magnitude of all the services that the impacted hospitals provide to their communities. 

The reality is that the impacted rural hospitals account for 18% of all rural outpatient prospective payment system (OPPS) hospitals, but almost 40% of OPPS spending across all rural hospitals; and provide care for 33% of Medicare beneficiaries seen in rural hospitals.[1]

The AHA recently demonstrated that hospitals and health systems play critical roles in preserving access to care for patients and communities in rural America. They have increasingly stepped up to fill voids in care by reinvesting through access points like hospital outpatient departments, also known as “HOPDs.” These sites of care provide essential services for many rural and low-income communities across the country. Oftentimes, hospitals have been a lifeline for struggling rural physician practices — helping to keep their doors open so they can continue caring for their patients.

Misrepresenting the scope and importance of rural hospitals — as Arnold Ventures does — is a great disservice to the patients and communities that rely on them for access to care that too often cannot be found elsewhere and is not provided by others in the health care sector.


Aaron Wesolowski is AHA’s vice president of research strategy and policy communications.

[1] These figures and other statistics reported above are calculated from a variety of sources including the 2022 American Hospital Association Annual Survey; sources cited in the Dec. 2023 AHA fact sheet showing impacts of the site-neutral provisions in the Lower Costs, More Transparency Act (H.R. 5378); and 2022 Medicare cost reports. 

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