Harper County Hospital’s profitable conversion to a Rural Emergency Hospital
Located three hours from the nearest urban centers, Harper County Hospital grappled for years with steep financial declines. Harper County Hospital is one of six rural hospitals managed by SSM Health St. Anthony Hospital in Oklahoma City. The hospital’s service area has a population of 3,200 and is dominated by farmland, ranches, and feedlots, with the nearest alternative hospital 35 miles away. By early 2022, the facility averaged only 1.5 to 2 inpatient and swing bed cases per day, and it had operated at a loss for 10 consecutive years.
When Medicare introduced the Rural Emergency Hospital (REH) provider type on Jan. 1, 2023, the hospital’s board asked CEO Kevin O’Brien to assess this option. The REH designation allows eligible hospitals to focus on 24/7 emergency and outpatient services while receiving a monthly facility payment and enhanced Medicare reimbursement.
Engaging stakeholders through transparency
Community leaders worried that the hospital might close or cut jobs. Drawing on best practices provided by the REH Technical Assistance Center (REH-TAC), O’Brien and his board held town hall meetings in each municipality. By explaining that no positions would be eliminated and that the conversion would add services, such as dietary and diabetic education and at-home sleep studies, they built trust and secured broad support.
A streamlined conversion Timeline
- January 2023: The Centers for Medicare and Medicaid Services released REH regulations
- March 2023: Harper County Hospital begins the TAC’s REH assessment process
- September 2023: Application submitted to CMS
- October 2023: REH designation approved and conversion begins
The speed with which the conversion was accomplished underscores both the hospital’s preparation and CMS’s commitment to sustaining rural providers.
Realigning services to meet local needs
After conversion, Harper County Hospital rapidly expanded its outpatient offerings, including:
- Pulmonary rehabilitation, which was operating at full capacity with a waiting list
- Wound care, now provided one day each week
- Sleep studies, including at-home testing
- Dietary and diabetic education programs
- Continued Meals on Wheels deliveries by hospital staff
- Ongoing ambulance services with eight EMS personnel
Future plans include adding infusion therapy, pain management, and targeted outreach to the county’s 25 percent Hispanic population. By matching new service lines with both patient demand and clinical capacity, the hospital has reinforced its role as a versatile, essential health hub.
Demonstrated financial turnaround
Most notably, the conversion yielded sustained positive cash flow. “We have made money every month since the change except one — and we’ve never done that before,” O’Brien says.
This performance represents a positive swing of almost $300,000 from the prior year’s deficit, providing resources to support planning future expansions and strengthening community partnerships.
Addressing early challenges
Not all metrics rose immediately. Emergency department visits fell by 20 percent due to community misconceptions about the hospital’s status. To counteract this, leadership launched a targeted outreach campaign informing area physicians, pharmacies, schools, and even local movie theaters about the hospital’s new capabilities. Previously, no budget existed for public relations; post-conversion, marketing has become a routine activity.
Key takeaways for rural hospitals
Harper County Hospital’s experience offers a practical framework for any facility considering REH conversion:
- Use data to build credibility. Robust financial models help boards and communities see the path forward.
- Communicate with transparency. Town hall meetings staffed by trusted local leaders help dispel rumors and build consensus.
- Engage CMS decisively. A clear, well-documented request can expedite regulatory approval.
- Align services strategically. Choose outpatient lines that reflect both community need and clinical expertise.
- Leverage no-cost technical assistance. From compliance to stakeholder facilitation, the TAC’s support is a crucial resource.
Learn more & get support
Harper County Hospital’s journey illustrates how rural health matters — and how informed, community-centered strategies can preserve essential services. To explore the REH provider type or request confidential assistance, contact the REH Technical Assistance Center.
NRHA adapted the above piece from Rural Health Redesign Center, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.
 | About the author: Hope Burch, MHS, is a passionate leader and advocate for rural health care with more than 25 years of public health experience. A lifelong rural resident in Hayesville, N.C., Hope understands the barriers to health care access and is committed to innovative solutions. Hope has held leadership roles at the Kansas and NC Departments of Public Health, Mission Hospital Healthcare Foundation, and Buncombe County Department of Public Health. Dedicated to improving rural health care. |