Rural Hospital Closures Tied to Improved Cancer Surgery Outcomes

Patients who underwent lung or colon cancer surgery at rural hospitals that later closed experienced improved postoperative outcomes after being transferred to nearby high-performing oncology centers, according to a new study published in JAMA Network Open.¹

Rural health care facilities, either primary care or surgical, are facing financial strain and closure, thus exacerbating the gap in health care access for those living in rural areas.^1,2 The hospitals that closed were often smaller, for-profit, nonteaching, and nononcologic specialty hospitals located in metropolitan areas. However, the patient population they served was often older, Black, Hispanic, or of other races, with more comorbid conditions and urgent admissions compared with Medicare fee-for-service (FFS) beneficiaries who were treated at a hospital that did not close. The study findings underscore the importance of rural hospitals for marginalized populations and highlight that their closure can benefit patients by transferring them to higher-performing hospitals, thus improving their postoperative outcomes.¹

Study Design and Patient Population

Patient data were pulled from Medicare inpatient and Part B claims and used to identify those who had an inpatient stay for cancer resection for nonmetastatic colon or lung cancer between 2008 and 2019. Hospitals assessed for closure during the same time periods included short-stay acute-care hospitals or critical access hospitals (CAHs).

There were 558,708 Medicare beneficiaries included in the study, 64.5% of whom underwent colon cancer surgery. Of this group, the median age was 77 years, and 54.3% were female patients. Of the 35.5% of beneficiaries who underwent lung cancer surgery, the median age was 73 years, and 51.7% were female patients. During the study period, there were 3965 hospitals performing colon cancer surgical procedures, of which 267 (6.7%) closed, and there were 2182 hospitals performing lung cancer surgical procedures, of which 108 (4.9%) closed. Of the 578 hospitals that closed, only 1.7% performed colon procedures and 1.0% performed lung procedures.

Characteristics of Closing Hospitals

The closing hospitals were more likely to have fewer than 100 beds and half the median annual volume compared with hospitals that did not close. They were also found to be more likely to report for-profit ownership (colon: 107 [40.1%] vs 639 [17.3%]; lung: 38 [35.2%] vs 382 [18.4%]) and less likely to be teaching hospitals. Hospitals that closed were also less likely to have an approved American College of Surgeons cancer program (colon: 38 [14.2%] vs 1352 [36.6%]; lung: 32 [29.6%] vs 1232 [59.4%]) and to be CAHs, but more likely to be located in metropolitan areas (colon: 194 [72.7%] vs 2164 [58.5%]; lung: 100 [92.6%] vs 1718 [82.8%]).¹

Rural Hospitals Serve Vulnerable Populations

There are, however, active programs to help support rural health clinics (RHCs) and primary care given their service to the surrounding community. For example, the National Health Service Corps offers loan forgiveness to clinicians who work in health professional shortage areas. RHCs are also eligible for enhanced reimbursement rates from CMS.¹

Furthermore, beneficiaries with both cancers were more likely to undergo surgery in their hospital service area (colon: 3974 [66.0%] at closing hospitals vs 212,753 [60.0%] at nonclosing hospitals; lung: 1099 [56.7%] vs 86,682 [44.2%], respectively) and travel less for surgery. Despite this, those who underwent surgery for colon and lung cancer at closing hospitals were associated with worse postoperative outcomes, a higher 90-day mortality (adjusted OR [aOR], 1.11 [95% CI, 1.01-1.22] and 1.26 [95% CI, 0.96-1.64], respectively), and 90-day complications (aOR, 1.10 [95% CI, 1.01-1.21] and 1.44 [95% CI, 1.17-1.76], respectively).¹

This study was limited by the use of Medicare administrative data, which lacks detailed clinical information such as cancer stage, and by its focus on fee-for-service beneficiaries, reducing generalizability to younger or non-FFS populations. Potential misclassification of hospital closures and unmeasured confounders may have biased results, and the observational design precludes causal inference.

“Policymakers should rigorously evaluate closures using multiple metrics and prioritize investments in hospitals whose closure would pose the greatest harm to patients and their communities,” the study authors concluded.


References
1. Kim MY, Staiger DO, Brooks GA, Wang Q, Wong SL, Tosteson AN. Outcomes among Medicare beneficiaries after cancer surgery in hospitals that subsequently closed. JAMA Netw Open. 2026;9(1):e2553704. doi:10.1001/jamanetworkopen.2025.53704
2. McCormick B. Clinician shortages, access gaps challenge rural primary care. AJMC^®. November 17, 2025. Accessed January 12, 2026. https://www.ajmc.com/view/clinician-shortages-access-gaps-challenge-rural-primary-care