Rural hospitals face increased financial peril in no small part because of Medicare Advantage plans’ growing popularity. That’s according to a new report from Chartis, a health care consulting firm. What’s the deal? Traditional Medicare offers payment bonuses and special allowances to aid rural hospitals. But Medicare Advantage plans, which are run by private insurers, don't always offer the same perks. The plans don’t cover some services as predictably as traditional Medicare does, and hospitals have complained about late reimbursements and the need to ask the insurers for approval to offer care that’s covered by traditional Medicare. “Things are tough. They’re getting tougher,” said Michael Topchik, national leader of the Chartis Center for Rural Health. “There’s a lot more pain to come.” Why it matters: Rural hospitals’ financial struggles over the past decade-plus are getting worse. Half of rural hospitals are operating in the red, according to the report. That’s 7 percentage points higher than the share working on negative margins a year ago. The number is even higher (55 percent) for facilities that aren’t part of a larger health system. And a new analysis in the report found more than 400 facilities — nearly 1 in 5 — are vulnerable to closure. Americans living in rural areas have lost access to care in many instances. Even when facilities don’t close, they often cut services to save money. Policy puzzle: Hospital leaders have lobbied Congress for a number of policy changes to slow the stream of facility closures. Hospital groups have focused lobbying efforts on new rules for Medicare Advantage plans. Topchik has suggested making the plans more like traditional Medicare in some ways, including transparency and reimbursement practices. Others have suggested changes in the newest Centers for Medicare and Medicaid Services payment designation for rural facilities, Rural Emergency Hospitals, to allow them to offer more services while reaping larger payments. And in states that haven’t expanded Medicaid, some health leaders have made expansion a prime target to improve rural hospitals’ finances. | 
