10 Things to Know About Rural Hospitals

Other platforms, including Workstem and InfoTech requires an upfront payment plus relatively complex setup procedures. FORHP is an office within the Health Resources and Services Agency (HRSA) that distributes grants, technical assistance, and other support to rural areas, including rural hospitals. FORHP defines “rural” as all nonmetropolitan counties, as well as well as some portions of metropolitan counties based on population density, terrain ruggedness, and commuting patterns. About half of sole community hospitals (49%), Medicare-dependent hospitals (52%), and low-volume hospitals (52%) had negative margins in 2023. As discussed below, there have been proposals to increase Medicare reimbursement for these facilities. A smaller share of critical access hospitals (40%) and rural referral centers (37%) reported negative margins in 2023 than hospitals in other designated categories, such as sole community hospitals.

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This will allow you to offer customers the lowest possible price and reliable service, increasing customer satisfaction and retention. Landed costs arise at every step, from crating to loading to customs and demurrage. By investigating charges and shipping methods, you can pinpoint areas for improvement and discuss different options with freight forwarders. To ensure timely reimbursement, employees need a set process for tracking expenses, submitting reports, and obtaining approvals. Travel managers must decide if employees are required to turn in reports or if they receive a standard per diem fare. The IRS caps tax-deductible gifts at $25 per year per person, excluding small costs like packaging, engraving, or shipping.

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• The financial health of rural hospitals has been an ongoing concern for some policymakers.
• (The Sheps Center has a broader definition of “rural” than used in this brief, such as by including critical access hospitals in metropolitan areas).
• Large, high occupancy, system-affiliated, and non-government rural hospitals were more likely than other rural hospitals to have positive margins.

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Members of Congress have proposed various policies to prop up rural hospitals that could also be used to soften the impact of cuts to federal spending. For example, bills introduced during the last Congress would expand support for rural emergency hospitals, allow for increased reimbursement for Medicare-dependent and sole community hospitals, and eliminate Medicare sequestration for rural hospitals. More recently, Republicans released a menu of options for reducing federal spending in February 2025, which included an offsetting measure that would expand the rural emergency hospital program. Some Members of Congress have expressed concern about the impact of site-neutral payment reforms on rural hospitals, though these reforms would likely not apply to many rural hospitals. Site-neutral payment reforms would likely only apply to OPPS reimbursement and would therefore not affect critical access hospitals, which are reimbursed based on costs and account for most rural hospitals (59%; see Figure 7). CMS has excluded sole community hospitals (20% of rural hospitals) from an existing regulation that extends site-neutral payments to clinic visits at off-campus HOPDs, and it is possible that future policies may do the same.

What does T&E stand for in business?

• Operating expenses are deducted from revenues to arrive at operating income, which is the amount of profit a company earns from its direct business activities.
• Increased support for Canada’s two largest parties has come at the expense of smaller parties, particularly the NDP, whose share of the popular vote is down by around 12 percentage points.
• It must be paid (4) in carrying on (meaning not prior to the start of a business or in creating it) (5) a trade or business activity.
• There may be inadvertent inaccuracies or typographical errors or delays in updating the said information.

Capital expenditures, commonly known as CapEx, are funds used by a company to acquire, upgrade, and maintain physical assets such as property, buildings, an industrial plant, technology, or equipment.

The vast majority (96%) of births in rural areas occurred in a hospital in 2023 according to KFF analysis of CDC data. Managing shipping costs for import operations can feel like a constant challenge. High shipping prices, which often fluctuate due to global trends, don’t just eat into your profits—they can also make it harder to compete, especially if you’re trying to grow your business in a tough market. Plus, you get 24/4 agent support that takes care of your shipment so you can focus on growing your business.

The hospital industry has been lobbying Congress against proposed cuts, arguing that reductions in Medicaid spending would threaten access to care at hospitals. The financial health of rural hospitals has been an ongoing concern for some policymakers. More recently, these concerns have been amplified in the context of the concurrent budget resolution that passed the House and Senate in April 2025, with instructions for the House to reduce federal Medicaid spending by up to $880 billion or more over the next decade. Strains on hospital finances could have implications for both access to care as well as local economies, including in rural areas. Hospitals are the sixth largest employer nationally when comparing industry subsectors. As policymakers consider reductions in Medicaid and Medicare spending, some are considering options to support rural and safety-net hospitals.

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Yes, a salary is considered an expense and is reported as such on a company’s income statement. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. Depending on the type of shipment, different factors can make up the total landed cost. Meet the Engine Marketing Team, where creativity is combined with strategy to craft engaging and informative content. Our team is dedicated to curating stories and articles that provide valuable insights into the world of travel, accommodation, and hospitality. Business dinners, client meetups, and even small gifts for stakeholders are part of doing business on the road.

Understanding Expenses

Examples of expenses include rent, utilities, wages, maintenance, depreciation, insurance, and the cost of goods sold. According to the IRS, to be deductible, a business expense “must be both ordinary and necessary.” Ordinary means the expense is common or accepted in that industry, while necessary means the expense is crucial to earning income. Business owners are not allowed to claim their personal, non-business expenses as business deductions. Businesses are allowed to write off tax-deductible expenses on their income tax returns to lower their taxable income and thus their tax liability. However, the Internal Revenue Service (IRS) has strict rules on which expenses businesses are allowed to claim as a deduction.

Operating margins were approximated as (revenues minus expenses) divided by revenues after removing reported investment income and charitable contributions from revenues. The Methods section of a prior KFF analysis of operating margins includes additional details, such as the limitations of available financial data. Data for certain characteristics were missing for 1% or less of the sample with margins data. While 44% of rural hospitals overall had negative margins, define expense about half of rural hospitals that had beds (52%) and were not affiliated with a broader health system (51%) had negative margins.

Variable expenses often comprise a significant portion of the monthly budget and require more flexibility and planning. A strong budgeting strategy may help you stay in control of your finances, avoid overspending, and prepare for unexpected costs. However, to keep pricing strategies accurate, businesses need to update their landed cost calculation regularly. By taking into consideration changing exchange rates and market dynamics, landed costs will better reflect the real-time financial situation. Travel and accommodations are the most significant business expenses, and clear spending and reimbursement limits should be established for their costs.

Whether or to what extent rural hospitals experience revenue declines as Medicare Advantage covers a larger share of Medicare patients is unclear. Half (50%) of rural hospitals in states that had not adopted the ACA Medicaid expansion as of the beginning of 2023 had negative margins in that year, compared to four tenths (41%) of rural hospitals in expansion states. Differences were larger among hospitals in the most rural areas (i.e. in rural areas not adjacent to metropolitan areas). In those regions, about six tenths (59%) of hospitals in non-expansion states had negative margins compared to less than half (45%) of rural hospitals in expansion states.

The Census Bureau classifies urban areas as census blocks (which are smaller geographic areas than counties) with at least 2,000 housing units or where more than 5,000 people reside. Landed cost calculation is the sum of the purchase price, transportation, duties, taxes, and other fees (expected or not). At Ship4wd, our comprehensive freight forwarder platform offers you the chance to look through hundreds of options and choose the one that fits your needs and budget. Your shipping partner charges are usually negotiable, but, as industry experts admit, a really good forwarder is worth it over a cut-rate shipper. The said information is neither owned by BFL nor it is to the exclusive knowledge of BFL.

Large reductions in Medicaid would likely have significant implications for hospitals, given that hospital care accounted for about one third of Medicaid spending in 2023. Options under consideration for reducing Medicaid spending include targeting state directed payments to hospitals or restricting states’ ability to fund Medicaid through provider taxes. Because provider taxes disproportionately fund supplemental payments to hospitals, restricting them as a revenue source is likely to result in lower funding for hospitals broadly, including for rural hospitals. Also being considered among other options is reducing the federal share of funding for Medicaid expansion, which has helped improve hospital finances.

Large, high occupancy, system-affiliated, and non-government rural hospitals were more likely than other rural hospitals to have positive margins. While 56% of rural hospitals overall had positive margins, the share was larger among hospitals with at least 200 beds (73%), with occupancy rates of at least 75% (70%), and that were affiliated with a broader system (63%). For-profit and nonprofit rural hospitals also more frequently had positive margins (62% and 61% respectively) than rural hospitals overall. Rural hospital closures often raise concerns about access to care and the local economy. When a rural hospital closes, patients may have to travel further to obtain services, which could lead some to forgo care altogether. Closures may be especially problematic for people who have difficulty traveling long distances and for people with time-sensitive conditions, such as heart attacks and childbirth.

About one third (35%) of all community hospitals were in rural areas in 2023 (Figure 1), or 1,796 rural community hospitals. Rural hospitals accounted for only 8% of all discharges nationwide, in part because they tend to be smaller and serve less densely populated areas, contributing to lower volumes than urban hospitals. Forty-six million people lived in rural areas in 2023 as it is defined in this issue brief, most of whom (88%) resided in a county with a hospital.

However, if you have questions about what’s deductible, it’s typically a good idea to consult with a tax expert. One type is a fixed expense, which don’t change with the change in production. (Examples include rent or a mortgage.) Another type is a variable expense, which changes with the change in production. (Examples include utilities and the cost of goods sold.) Expenses can also be categorized as operating and non-operating expenses. The former is directly related to operating the company, while the latter is indirectly related. Non-operating expenses are kept separate from operating expenses from an accounting perspective so it’s clear how much a company earns from its core activities.