Spotlight on Rural Health
More than 65 million Americans—or about 20 percent of the population—live in rural areas. Rural residents often face difficulty accessing health care because of clinician shortages and hospital closures. Since 2005, nearly 200 rural hospitals have closed or dropped inpatient care, leaving communities with less access to emergency care, maternity services, chemotherapy, and other services.
Our Work
AIR leverages expertise in data analysis, technical assistance, human-centered design and stakeholder engagement to understand and help solve the health care challenges facing rural communities.
Our work includes evaluating the Rural Community Hospital Demonstration (RCHD) for the Centers for Medicare & Medicaid Services (CMS). The RCHD is testing whether cost-based Medicare payment can help rural hospitals with less than 51 inpatient beds remain financially viable and avoid closure. The mixed-methods evaluation examines the RCHD’s effects on Medicare payments and hospital financial conditions using CMS hospital cost reports, other secondary data sources, and interviews with hospital leaders. The evaluation includes a difference-in-differences design to generate impact estimates for the intervention.
AIR’s work also includes efforts to improve the performance of approximately160 small and rural hospitals by assessing quality measures, supporting preparedness for public health emergencies, and identifying and disseminating best practices for quality improvement and patient safety through the CMS Hospital Quality Improvement Contractor initiative.
Similarly, through a partnership with the state of Oklahoma, AIR designed, implemented, and evaluated training for rural primary care clinicians to prescribe medications for opioid use disorder, an evidence‑based intervention combining behavioral therapy and medication, reflecting AIR’s readiness to support comprehensive, state‑level rural health transformation efforts.
