Department  of Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
HOSPITAL  CLOSURE:  1991 
DECEMBER  1992  OFFICE  OF INSPECr.OR  GENERAL 
The mission of the Office of Inspector  General  (OIG),  as mandated  by Public Law 95-452, as 
amended, is to protect  the integrity of the Department  of Health  and Human Services (HHS) 
programs as well as the health  and welfare of beneficiaries sewed by those programs.  This 
statutory mission is earned  out through  a nationwide network of audits, investigations, and 
inspections conducted  by three  OIG operating  components:  the Office of Audit Semites,  the 
Office of Investigations, and the Office of Evaluation  and Inspections.  The OIG also informs 
the Secretary of HHS of progr~  and management  problems, and recommends  courses to 
correct them. 
OFFICE OF AUDIT  SERVICES 
The OIGS Office of Audit Setices  (OAS) provides all:auditing services for HHS, either  by 
conducting audits with its own audit resources or by overseeing audit work done by others. 
Audits examine the performance  of HHS programs and/or its grantees  and contractors  in 
carrying out their respective responsibilities and are intended  to provide independent 
assessments of HHS programs and operations  in order to reduce waste, abuse, and 
mismanagement  and to promote  economy and efficiency throughout  the Department. 
OFFICE OF INVESTIGATIONS 
The OIGS Office of Investigations (01)  conducts criminal, civil, and administrative 
investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries  and of 
unjust enrichment  by providers.  The investigative efforts of 01 lead to criminal convictions, 
administrative sanctions, or civil money penalties.  The 01 also oversees State Medicaid fraud 
control units which investigate and prosecute  fraud and patient  abuse in the Medicaid program. 
OFFICE OF EVALUATION  AND  INSPECTIONS 
The OIGS  Office of Evaluation  and Inspections  (OEI)  conducts short-term  management  and

program evaluations  (called inspections) that focus on issues of concern  to the Department,

the Congress, and the public.  The findings and recommendations  contained  in these inspection

reports generate  rapid, accurate,  and up-to-date  information on the efficiency, vulnerability,

and effectiveness of departmental  programs.

OEIS Atlanta  Regional  Office prepared  this report  under the direction of Jesse J. Flowers,

Regional Inspector  General  and Christopher  Koehler, Deputy Regional Inspector  General.

Principal OEI staff included:

ATLANTA REGION  HEADQuARm

Ron Kalil  Cathaleen  Ahern

Maureen  Wke  Linda Moscoe

Paula Bowker

Ruth  Reiser

For additional copies of this report,  please call the Atlanta Regional  Office at (404)-331-4108.
 Department  of Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENEML 
HOSPITAL  CLOSURE:  1991 
DECEMBER  1992  OEI-04-92-00440  EXECUTIVE  SUMMARY

PURPOSE 
To  describe  the  extent,  characteristics  and  impact  of hospital  closure  in 1991. 
BACKGROUND 
The  closure  of hospitals  in recent  years  has  generated  public  and  congressional  concern. 
According  to a number  of recent  studies,  more  hospitals  are  expected  to close  in coming 
years.  Questions  have  been  raised  about  thephenomenon  ofhospital  closure,  as well as 
the  implications  for  public  policy. 
We  released  a report  in May  1989 describing  the  nationwide  phenomenon  of hospital 
closure  in  1987.  We  continued  analysis  of hospital  closure  to  determine  trends  and 
effects  of the  phenomenon.  We  issued  subsequent  reports  on  1988, 1989 and  1990 
hospital  closures. 
The  findings  from  the  OIG  1987, 1988, 1989 and  1990 studies  were  similar.  The 
hospitals  that  closed  were  small  and  had  low occupancy  rates.  When  the  hospitals 
closed,  few patients  were  affected.  Most  could  get  medical  care  nearby. 
FINDINGS 
Our  inspection  of hospital  closures  in 1991 produced  findings  similar  to those  previously 
reported  for  1987, 1988, 1989 and  1990. 
Fifty-seven  general,  acute  care  hospitals  closed,  one  more  than  in the  previous 
b	
year.  They  were  located  in 27 States.  Eight  new hospitals  opened,  and  1 hospital 
that  closed  prior  to  1991 reopened  in 1991. 
Thirty-six  of the  closed  hospitals  were  rural  and  21 were  urban.  A higher 
k	
percentage  of rural  hospitals  (1.4 percent)  closed  in  1991 than  did urban  hospitals 
(0.8 percent). 
Closed  hospitals  in both  rural  and  urban  areas  were  much  smaller  than  the 
F	
national  averages.  Rural  hospitals  that  closed  had  an  average  size of 32 beds 
compared  to an  average  of 86 beds  for  all rural  hospitals  nationally.  Urban 
hospitals  that  closed  had  an  average  size of 103 beds  compared  to  an  average  of 
247 beds  for  all urban  hospitals  nationally. 
Occupancy  rates  for  closed  rural  and  urban  hospitals  were  lower  than  the  national 
k	
averages.  Rural  hospitals  that  closed  hadanaverage  occupancy  rate  of23  percent 
compared  to an  average  of 37.5 percent  for  all rural  hospitals  nationally.  Urban 
i  hospitals  that  closed  had  an  average  occupancy  rate  of 36 percent  compared  to an 
average  of 56.4 percent  for  all urban  hospitals  nationally. 
No  significant  differences  existed  in the  average  Medicare  utilization  between 
b	
hospitals  that  closed  and  all hospitals  nationally. 
In urban  areas,  the  average  Medicaid  utilization  among  hospitals  that  closed  was 
b	
higher  than  the  urban  national  average  (17.4 percent  vs. 11.7 percent).  No 
significant  differences  existed  in the  average  Medicaid  utilization  among  rural 
hospitals  that  closed  and  all rural  hospitals  nationally. 
Although  residents  in a few communities  had  to travel  greater  distances  for 
F	
hospital  care,  most  had  emergency  and  inpatient  medical  care  available  within  20 
miles  of a closed  hospital. 
	 At  the  time  of our  inspection,  32 of the  57 closed  hospital  facilities  (56 percent) 
were  being  used  for  health-related  services.  Also,  plans  were  being  made  for 
using  10 of the  remaining  25 vacant  hospitals  for  health-related  services. 
ii  TABLE  OF  CONTENTS

EXECUTIV-ESUMMARY  . . . . . . . . . . . ...*..  1 
INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1

FINDINGS

Extent	 and  Characteristics  of Closed  Hospitals  . . . . . . . . . . . . . . . . . . . . . . . .  3

How  Many  Closed  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3

Where  Were  They  . . . . . . . . . . . ..  s.  .ss  .- .s  s-  .3

How  Many  Opened  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4

What  Were  the  Closed  Hospitals  Like  . . . . . . . . . . . . . . . . . . . . . . . ...4

Impact  ofHospital  Closure  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...7

How  Many  Patients  Were  Affected  . . . . . . . . . . . . . . . . . . . . . . . . . . ..7

Are  Inpatient  Care  and  Emergency

Services  Available  . . . . . . . . . . . .........................  . ..8

What  Is the  Building  Used  For  Now  . . . . . . . . . . . . . . . . . . . . . . . . . ..9

Follow-up  Study  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...............l* 
Summary  . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................  10

.ll 
mNO~  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
APPENDIXES 
Appendix  A  Methodology  . . . . . . . . . . . . . . . . . . . ..................A-l 
Appendix  B:  Number  of Hospital  Closuresby  State  . . . . . . . . . . . . . . . . . . .  B-1

Append&C:  Number  of Hospital  Closuresby 
Hospital  Name  and  bcation.  . . . . . . . . . . . . . . . . . . . . . ..C-l  INTRODUCTION

PURPOSE 
To  describe  the  extent,  characteristics  and  impact  of hospital  closure  in  1991. 
BACISGRO~ 
acute  care  hospitals  has  generated  public 
In the  past  several  years,  the  closure  ofgeneral, 
According  to a number  of recent  studies,  more  hospitals  are 
and  congressional  concern. 
Questions  have  been  raised  about  the  phenomenon  of 
expected  to  close  in coming  years. 
as well  as implications  for public  policY. 
hospital  closure  in the  United  States, 
We  released  a report  in May  1989 describing  the  extent,  characteristics  and  impact  of 
That  inspection  showed  that  69 hospitals 
hospital  closure  in the  United  States  in 1987. 
closed  in  1987.  Many  health  policy  officials  in both  the  Executive  and  Legislative 
Branches  of the  Federal  Government  who  had  been  informed  of the  1987 results 
encouraged  us to continue  analysis  of the  phenomenon  to detect  differences  in the  rate 
of hospital  closure  and  in the  characteristics  and  impact  of hospitals  that  close. 
Similar  inspections  of the  phenomenon  of hospital  closure  in  1988, 1989 and  1990 showed 
that  88, 76 and  56 hospitals  closed  respectively. 
HOSPITAL  CLOSURE 
#  OF  CLOSURES 
1001 
00 
69 
56 
/  . 
so 
40 
2C 
[  1999  1990 
f1907 
YEAR 
1
 The  findings  from  the  1987, 1988, 1989 and  1990 inspections  were  similar.  The  hospitals 
that  closed  were  small  and  had  low occupancy  rates.  When  the  hospitals  closed,  few 
patients  were  affected.  Most  could  get  medical  care  nearby. 
SCOPE 
We  examined  hospitals  that  closed  in calendar  year  1991. 
For  purposes  of this  study,  the  following  definitions  were  used. 
Hospitak  A facility  that  provides  general,  short-term,  acute  medical  and  surgical 
inpatient  services. 
Closed  Hospiti  One  that  stopped  providing  general,  short-term,  acute  inpatient 
services  in  1991.  If a hospital  merged  with  or was  sold  to another  hospital  and  the 
physical  plant  closed  for inpatient  acute  care,  it was considered  a closure.  If a hospital 
both  closed  and  reopened  in  1991, it was not  considered  a closure. 
METHODOLOGY 
To  determine  the  extent  and  impact  of hospital  closure,  we obtained  information  from 
State  licensing  and  certification  agencies,  State  health  planning  agencies,  State  hospital 
associations,  HCFA  data  bases,  officials  associated  with  closed  and  nearby  hospitals,  and 
local  public  officials. 
We  obtained  information  on the  characteristics  of all hospitals  and  those  that  closed  in 
1991 from  the  Hospital  Cost  Report  Information  System  (HCRIS)  maintained  by HCFA. 
Appendix  A describes  our  methodology  in further  detail. 
2
 FINDINGS

The  Inspector  Generals  study  of hospitals  closed  in 1991 showed  that: 
Fifty-seven  general,  acute  care  hospitals  closedin  1991, Onemorethan  in the 
b	
previous  year. 
Most  hospitals  that  closed  were  small  and  had  low occupanq  rates. 
F 
When  a hospital  closed,  few patients  were  affected. 
b 
Although  residents  of a few communities  had  to travel  greater  distances  for 
k	
hospital  care,  most  had  emergency  and  inpatient  medical  care  available  within  20 
miles  of the  closed  hospital. 
EXTENT  AND  CHARACIERISTICS  OF  CLOSED  HOSPITALS 
How Many  Closed 
In  1991, there  were  more  than  6,800 hospitals  in the  United  States.  Of those,  5,334 were 
general,  short-term,  acute  care  hospitals  entered  on HCFAS  data  base  as participating  in 
the  Medicare  program.  Fifty-seven  (57) hospitals  closed  in  1991 -- about  1 percent  of all 
hospitals  nationally.  One  more  hospital  closed  in  1991 than  in the  previous  year. 
HOSPITALS  IN THE  U.S.:  5,334 
CLOSED  IN  1991:  57 (1.1%) 
When  they  closed,  the  general,  acute  care  inpatient  bed  supply  was reduced  by 3,314 
beds,  or 0.4 percent. 
JWzereWere They 
The  closed  hospitals  were  located  in 27 States.  Texas  had  the  greatest  number  of 
closures  (8), followed  by Minnesota  (6), California  (5), Mississippi  (5)  and  Missouri  (4). 
These  5 States  represented  almost  half  (49 percent)  of the  closures  in  1991.  Seventeen 
States  had  one  closure  each.  Appendix  B lists the  number  of hospital  closures  by State. 
Appendix  C lists the  closures  by hospital  name  and  location. 
3
 Nationally,  a higher  percentage  of rural  hospitals  (1.4 percent)  closed  in  1991 than  did 
urban  hospitals  (0.8 percent). 
RURAL  URBAN 
HOSPITALS  IN THE  U.S.:  2$509  &725 
CLOSED  IN  1991:  36 (1.4%)  21 (0.8%) 
How Many  Opened 
While  57 hospitals  closed  in 1991, 8 new general,  acute  care  hospitals  opened,  adding  708 
beds  to the  national  supply  of beds. 
 
In addition  to  the  new  openings  during  1991, 1 hospital  that  closed  prior  to  1991 
reopened  in  1991, adding  another  30 beds. 
What  Were the Closed Hixpidr  Like 
~  Hospitals  that  closed  in 1991 were  small.  Almost  two-thirds  (65 percent)  of the 
hospitals  that  closed  had  fewer  than  50 beds. 
SIZE  OF  CLOSED  HOSPITALS 
Number  of Beds  Rural  Urban  Total  Percent 
O-29  17  1  18  31.6 
30-49  15  4  19  33.3 
50-99  4  7  11  19.3 
100-199  0  7  7  12.3 
200-299  0  2  2  3.5 
300>  0  0  0  0.0 
TOTALS  36  21  57  100.0 
4  Both  themral  andurban  hospitals  that  closedh  1991 were  considerably  smaller  than  the 
average  size of rural  and  urban  general,  acute  care  hospitals  nationally. 
H.~SPI TALS  THAT  CLOSED	
WERE  SMALL	
s  of  Beds	
3oo	
246.5	
250	
2oo	
150-	
86.1	
-loo	
50-	
0-	
RURAL  HOSPITALS  URBAN  HOSPITALS	
-National  Avg  -Closed  Hospital  Avg	
were  lower  than  the 
occmancy  Occupancy  rates  for  closed  rural  and  urban  hospitals 
. 
national  averages.l 
LOW	
OCCUPANCY  RATES  WERE 
70%	
564%	
60% 
50%	
37.5%	
40%-	 / A	
30%-	
20%-	
?o%	
cl% 	
RURAL  HOSPITALS  URBAN  HOSPITALS	
_Nat!onal  Avg  -Closed  HO  Splta  I  A.g	
5
 Medicare  Utilizatiorx  Nonsignificant  differences  existed  inthe  average  Medicare 
utilization  between  hospitals  that  closed  and  all hospitals  nationally.2 
MEDICARE  UTILIZATION	
tio%	
51.  E%	
5 cl%	
40%	
3D%	
20%-	
*o%	
cl%  	
RURAL  HOSPITALS  URBAN  HOSPITALS	
_Nutlonal  Avg  ~Closed  Hosp,  tal  Avg	
Medicaid  Utilization  In urban  areas,  the  average  Medicaid  utilization  among  hospitals 
that  closed  was higher  than  the  urban  national  average  (17.4 percent  vs. 11.7 percent). 
No significant  differences  existed  in the  average  Medicaid  utilization  among  rural 
hospitals  that  closed  and  all rural  hospitals  nationally? 
MEDICAID  UTILIZATION	
20%	
~a%	
16%	
14%	
11.8% 
72%	 /  --1 
10%	
am	
6%	
4%	
2%	
o%	
RURAL  HOSPITALS  UREAN  HOSPITALS	
_  Nat,  onal  Avg  =Closed  Hospital  Avg	
6
 IMPACI  OF  HOSPITAL  CIXISURE 
In communities  where  hospitals  closed  in 1991, we  assessed  the 
b  number  of patients  affected  by closure  of hospitals, 
b  availability  of inpatient  care  and  emergency  medical  services,  and 
b  current  use  of the  closed  hospital  facility. 
How Many Patients  Wme Afleciixi 
For  rural  hospitals  that  closed  in 1991, the  average  daily census  in the  year  prior  to 
closure  was seven  patients.  The  urban  hospitals  had  an average  daily census  of 37 
patients. 
WHEN  HOSPITALS  CLOSED,

HOW  MANY  PATIENTS  WERE  AFFECTED?

Rural  Hospitals  Urban  Hospitals 
Average  Number  of Beds  32.0  102.9 
Average  Occupancy  Rate  23.0%  36.O?ZO 
X  X 
Average  Number  of Patients  7.4  37.0 
We  analyzed  Medicare  utilization  data  to determine  the  number  of elderly  patients

affected  by hospital  closure  in  1991.  In rural  hospitals  that  closed,  four  Medicare

patients  were  in the  hospital  on an  average  day in the  year  prior  to  closure.  In the  urban

hospitals  that  closed,  there  were  16 Medicare  patients  on an  average  day.

WHEN  HOSPITALS  CLOSED,

HOW  MANY  MEDICARE  PATIENTS  WERE  AFFECIED?

Rural  Hospitals  Urban  Hospitals 
Average  Patient  Census  7.4  37.0 
Average  Medicare  Utilization  Rate  48.6%  42.9% 
X  X 
Average  Number  Medicare  Patients  3.6  25.9 
7
 Are Inpatient  Clue and Emeqyncy  Services Avaihble 
We  assessed  availability  of inpatient  and  emergency  medical  care  in miles  from  the 
closed  hospitals  to the  nearest  inpatient  and  emergency  facilities. 
Irmatient  Care:  In most  communities  where  a hospital  closed  in  1991, inpatient  hospital 
care  was available  nearby. 
Rural:  Residents  in 23 of the  36 rural  communities  (64 percent)  where  a hospital  closed 
could  get  inpatient  hospital  care  within  20 miles  of the  closed  hospital.  Residents  of 4 
rural  communities  had  to travel  more  than  30 miles  for  inpatient  hospital  care. 
Urban:  Residents  in 14 of the  21 urban  communities  (67 percent)  where  a hospital 
closed  could  get  inpatient  hospital  care  within  3 miles  of the  closed  hospital.  The 
remaining  7 communities  are  within  20 miles  of an  inpatient  hospital. 
NEAREST  INPATIENT  CARE  TO  CLOSED  HOSPITALS 
NUMBER  OF  CLOSED 
HOSPITALS 
DISTANCE  Rural  Urban 
Within  3 Miles  4 (11%)  14 (67%) 
4-10 miles  4 (11%)  3 (14%) 
11-20 Miles  15 (42%)  4 (19%) 
21-30 Miles  9 (25%)  o (o%) 
More  than  30 Miles  4 (11%)  o (o%) 
Totals  36 (100%)  21 (loo%) 
L 
Emer~encv  Sexvices:  When  a hospital  closed,  the  community  lost  not  only inpatient  beds, 
but  also  emergency  services. 
Rural:  In three-quarters  (27 of 36) of the  communities  where  rural  hospitals  closed, 
emergency  care  facilities  were  available  within  20 miles  of closed  hospitals.  Residents  of 
2 communities  had  to travel  more  than  30 miles  for  emergency  care. 
.  Goldwaith,  Texas  32 miles 
Mansfield,  Missouri  45 miles 
 
Both  communities  have  a physician,  outpatient  clinic and  an  ambulance  sewice  to 
transport  residents  to 24-hour  emergency  care  facilities. 
8
 Urban:  In~o-thtids  (140f21)  of theurban  co~utities  where  a hospital  closed, 
emergency  care  facilities  were  within  3 miles  from  the  closed  hospital.  The  remahing  7 
communities  are  within  15 miles  of an emergency  care  facility. 
11 
~T  EMERGEN~  SERVIm  TO  CLOSED  HOSPII 
NUM13ER  OF  CLOSED 
HOSPIT~ 
Rural  Urban 
DISTANCE 
9 (25%)  14 (67%) 
Within  3 Miles 
4 (11%)  3 (14%) 
4-10 Miles 
14 (39%)  4 (19%) 
11-20 Miles 
7 (19%)  o (o%) 
21-30 Miles 
2 (6%)  o (o%) 
More  than  30 Miles 
36 (100%)  21 (loo%) 
Totals 
What  Is the Building  Used For Now 
At the  time  of our  review,  32 of the  57 closed  hospital  buildings  (56 percent)  were  being 
used  for health-related  semices.  For  example: 
b	 Prairie  Community  Hospital  in Terry,  Montana  was converted  to  a Medical 
Assistance  Facility.  It provides  24-hour  emergency  services,  outpatient  care  and 
up  to  4 days of inpatient  care. 
Enterprise  Hospital  in Enterprise,  Alabama  and  Heron  Lake  Municipal  Hospital 
	
in Heron  Lake,  Minnesota  became  nursing  homes. 
Yolo  General  Hospital  in Woodland,  California  was converted  to  an  outpatient 
F	
and  urgent  care  clinic. 
St. Dominics  Hospital  in Jackson,  Mississippi  purchased  Doctors  Hospital  located 
b	
across  the  street.  The  Doctors  Hospital  facility  closed  for  general  acute  care  and 
currently  offers  chemical  dependency  services. 
Martha  Washington  Hospital  in Chicago,  Illinois was purchased  by nearby 
b	
Ravenswood  Hospital  and  converted  to a mental  health  facility. 
9
 The  following  chart  illustrates  the  use  of all 57 hospital  facilities  after  closure  in 1991. 
USE  OF  CLOSED  HOSP~~

NUMBER  OF  FORNfER  HOSP~~* 
Urban 
Rural 
USE  OF  BUILD~G 
Specialty  Treatment  Facility  2 
o 
(e.g.  chemical  dependency) 
2 
o 
Reopened  Hospital 
2 
11 
Long  Term  Care  Facility 
5 
12 
Outpatient  Semites/Clinic 
1 
4 
Offices 
10 
15 
Vacant 
d. 
*Duplicate  count.  In 5 of the  57 former  hospitals  more  than  1 service  is now offere 
At the  time  of our  review,  plans  were  being  made  to use  10 of the  remaining  25 vacant 
For  example,  Southwest  Dallas  Hospital  in Dallas, 
hospitals  for health-related  services. 
Also, plans  were  being  made  for four 
Texas  will be  converted  to  a psychiatric  hospital. 
of the  closed  facilities  to reopen  as acute  care  hospitals. 
FOLLOW-W  STUDY 
The  OIG  is gathering  data  on actions  that  rural  communities  can  take  to maintain  access 
The  study will identify  and  describe  a 
to medical  care  in the  face  of hospital  closure. 
variety  of initiatives  local  communities  have  developed  and  implemented  to maintain  or 
even  improve  access  to health  care  services  after  a hospital  has  closed. 
A report  summarizing  the  successful  initiatives  to meet  health  care  needs  after  a hospital 
closes will provide  useful  models  other  communities  could  emulate  when  faced  with  the 
same  problem. 
SUMMARy 
Fifty-seven  hospitals  closed  in  1991, one  more  than  in the  previous  year.  Their 
characteristics  were  very  similar  to hospitals  that  closed  in 1987, 1988, 1989 and  1990: 
Most  hospitals  that  closed  in 1991 were  small  and  had  low occupancy.  When  a hospital 
Although  residents  of a few communities  had  to 
closed,  few patients  were  affected. 
travel  greater  distances  for  hospital  care,  most  had  emergency  and  inpatient  medical  care 
available  within  20 miles  of the  closed  hospital. 
10

  ENDNOTES

1.	 Hospital  occupancy  rate  is defined  as the  actual  number  of patient  days divided  by 
the  total  bed  days available.  National  occupancy  rate  is defined  as the  sum  of all 
hospitals  occupancy  rates,  divided  by the  number  of hospitals. 
2.  Average  Medicare  utilization  of closed  rural  and  urban  hospitals  is defined  as the 
percent  of Medicare  patient  days compared  to the  total  patient  days for  each 
hospital,  summed  anddivided  bythenumber  of hospitals.  National  average 
Medicare  utilization  is the  percent  of Medicare  utilization  of each  hospital, 
summed  and  divided  by the  total  number  of hospitals. 
3.  Medicaid  utilization  is calculated  in the  same  way as Medicare  utilization. 
11
 APPENDIX  A
METHODOLOGY 
Extentof  Hqpital  Closure 
To  determine  how many  hospitals  closed  in  1991, we surveyed  State  licensing  and 
certification  agencies,  State  hospital  associations  and  State  health  planning  agencies.  We 
also compiled  Health  Care  Financing  Administration  (HCFA)  data  on terminated 
providers  in  1991.  When  a closed  hospital  met  the  studys definition  or when  there  were 
questions,  we contacted  officials  associated  with  the  closed  hospitals,  officials  associated 
with hospitals  nearest  to the  closed  hospital  and  local  public  officials. 
To  determine  the  number  of hospitals  in the  United  States,  we used  the  Hospital  Cost 
Report  Information  System  (HCRIS)  maintained  by HCFA.  We  included  only general, 
short-term,  acute  care  hospitals  under  Medicares  Prospective  Payment  System  (PPS)  in 
the  universe.  There  were  5,334 hospitals  listed  on HCRIS  as short-term,  acute  care, 
general  hospitals  for  the  seventh  year  of PPS  (PPS  7). 
Characttitics  of H~ital  Closure 
To  analyze  characteristics  of closed  hospitals,  we used  HCFAS HCRIS  data.  We  used 
the  latest  pre-closure  cost reports.  For  example,  if a hospital  closed  in May  1991 and  its 
accounting  year  was on a January-December  cycle, we used  the  providers  January  1, 
1990 to December  31, 1990 report. 
Impact  of Hqital  Closure 
We  limited  our  impact  analysis  to the  distance  from  a closed  hospital  to  the  nearest

still-operating  hospitals  and  to  emergency  services.  We  obtained  data  for  our  analysis

from  interviews  with  the  following  sources

b  Former  hospital  administrators,  board  members,  and/or  staff  of closed  hospitals

Hospital  administrators  and/or  staff  at the  nearest  hospitals

b 
b  Local  police  and  health  officials

k  Local  government  officials

b  State  health  planning  agencies

b  State  certification  and  licensing  agencies

b  State  hospital  associations

A -1
 APPENDIX  B 
B-1  I 
lurall 
Urban 
State 
City 
lspital  Name  rural 
AL 
~nterprise 
urban 
[erprise  Hospital  AL 
~iedmont 
rural 
AR 
dmont  Hospital  and  Nursing  Home  :Orning 
urban 
CA 
rning  Community  Hospital
 Perns 
urban 
CA 
ristian  Hospital  Medical  Center
 ~ng  Beach 
urban 
CA 
~mingquez Medical  Center
 LOSAngeles 
urban 
CA 
Ida Vista  Community  Hospital
 San Diego

urban 
CA 
n Diego  General  Hospital
 Woodland

rural 
co 
)1o General  Hospital
 morence

urban 
DC 
. Joseph  Hospital
 Washington

urban 
FL 
~pitol Hill Hospital
 Hollywood

rural 
GA 
umana  Hospital-South  Broward
 Buena  Vista

rural 
IA 
[arion Memorial  Hospital
 Monticello

urban 
]hn McDonald  Hospital
 Chicago
 IL 
urban 
akeside  Community  Hospital
 Chicago
 IL 
rural 
lartha  Washington  Hospital
 Attica
 Ks 
rural 
Ks 
dtica  District  Hospital  One
 Baxter  Springs

rural 
kixter Memorial  Hospital
 Emporia
 KS 
rural 
t. Marys Health  Center  KY	
Liberty

urban 
;asey  County  War  Memorial  Hospital  Worcester

urban 
Worcester  Health  and  Hospital  Authority  Baltimore

urban 
-Iomewood  Hospital  Center  South  Detroit
 MI 
rural 
~outhwest  Detroit  Hospital  Edmore
 MI 
rural 
h-i-County  Community  Hospital  Greenbush
 MN 
rural 
Greenbush  Community  Hospital  Heron  Lake
 MN 
rural 
Heron  Lake  Municipal  Hospital  Mountain  Lake
 MN 
rural 
Mountain  Lake  Community  Hospital  parkers  prairie
 MN 
rural 
Parkers  Prairie  District  Hospital  Trimont
 MN 
rural 
Trimont  Community  Hospital  Milica  MN 
rural 
Fairview  Milica  Hospital  Lochood  MO 
rural

Dade  County  Memorial  Hospital  Mansfield  MO 
rural

Mercy  Hospital  MO 
Chaffee 
rural

Chaffee  General  Hospital  Sweet  Springs  MO 
rural

Community  Hospital  Pittsboro  MS 
urban

Community  Hospital  of Calhoun  County  Jackson  I MS  I 
1Doctors  Hospital 
c-1 
_  1991HOSPITfi  CLOSURES  BY NAME  AND  LOCATION  (emt.) 
Rural/ 
Hospital  Name
 City
 State  Urban 
Greene  County  Hospital
 Leakesville
 MS  rural 
Tunics  County  Hospital
 Tunics
 MS  rural 
Baldwyn  Satellite  Unit
 Baldwyn
 MS	 rural 
Prairie  Community  Hospital
 Terg
 rural 
City Hospital
 New Rockford
 rural 
Golden  Valley  County  Hospital
 Beach
 ND  rural 
St. Gerards  Community  Hospital
 Hankinson
 ND  rural 
Fullerton  Memorial  Hospital
 Fullerton
 NE  rural 
Wewoka  Memorial  Hospital
 Wewoka  
 OK  rural 
Mercy  Forest  Glen  Hospital
 Canyonville
 OR  rural 
Philipsburg  State  General  Hospital  Philipsburg
 PA  urban 
Divine  Saviour  Hospital  York
 Sc  urban 
Methodist  Hospital  Mitchell
 SD  rural 
Forum  Hospital  Trenton  Trenton
 TN  rural 
Caprock  Hospital  District  Floydada
 Tx  rural 
Childress  General  Hospital  Goldthwaite
 Tx  rural 
Community  Hospital  of Tyler  Tyler
 Tx  urban 
Mesquite  Physicians  Hospital  Mesquite
 Tx  urban 
Southwest  Dallas  Hospital  Dallas
 TX  urban 
West  Texas  Hospital  Lubbock
 Tx  urban 
Winter  Garden  Medical  Center  Dilley
 Tx  rural 
Lutheran  General  Hospital  San Antonio
 Tx  urban 
c-2