Sole providers of hospital care in rural areas.

This study examines the possibility of developing alternative targeting criteria for identifying small rural hospitals that serve as the sole providers of hospital care in their market areas. Compared to facilities currently targeted under Medicare payment policies, high market share hospitals are larger, less isolated facilities that deliver more complex care to their patients than other rural hospitals. They do not appear to serve vulnerable patient populations. Most importantly, these facilities appear to be financially viable and are likely to continue to provide services to their patients. The results of the study suggest that appropriate targeting criteria for identifying essential access facilities for reimbursement policy should focus on both structural characteristics and utilization patterns.