ANALYSIS AND COMMENTARY
The Concho County Hospital District’s board of directors in Eden voted to apply for a Rural Emergency Hospital (REH) designation, changing from the current status as a Critical Access Hospital (CAH), meaning they will no longer offer inpatient services.
The change comes after several years of the hospital running on steep negative margins, of minus 16 percent in 2023 according to Center for Medicare and Medicaid Services data.
Rural hospitals in Andrews, Brady, Colorado City, Del Rio, Eden, Fort Stockton, Lamesa, Sweetwater, and Winters are also operating on negative margins. According to statewide data, 69 rural hospitals report a two-year average negative margin.
According to CCHD trustees, the hospital will offer “24/7 emergency care as well as all clinic, pharmacy, lab, imaging, physical therapy, and other services available on an outpatient basis. Patients whose illness or condition requires an inpatient hospital stay will be transferred to another facility for continued treatment and care.”
Ultimately, the change in designation is a survival measure for hospitals who cannot make ends meet under a normal Critical Access Hospital designation.
According to government rules, Critical Access facilities can be reimbursed at 101-percent of Medicare’s share of “reasonable costs” for inpatient care and services, such as ambulance or emergency care.
On the other hand, Rural Emergency Hospitals are paid a standard monthly amount — $285,625 in 2025, but are ineligible for larger value-based reimbursements through Medicaid.
According to information from Concho County Hospital, the facility receives nearly 1,500 emergency department visits a year, while there were just 10 inpatient hospitalizations for the year.
Who’s Next?
Many rural hospitals in surrounding counties are operating on negative total margins. The following data sourced from CMS might give an indication on which rural hospitals are likely to change designation next:
- Permian Regional Medical Center, Andrews Co. – Sole Community Hospital – Total Margin: -1.9%
- Mitchell County Hospital District, Colorado City – Critical Access Hospital – Total Margin: -1.3%
- Val Verde Regional Medical Center, Del Rio – Sole Community Hospital – Total Margin: -0.8%
- Pecos County Memorial Hospital, Fort Stockton – Critical Access Hospital – Total Margin: -6.3%
- Medical Arts Hospital, Lamesa – Sole Community Hospital – Total Margin: -17.5%
- Rolling Plains Memorial Hospital, Sweetwater – Sole Community Hospital – Total Margin: -13.0%
- North Runnels Hospital, Winters – Critical Access Hospital – Total Margin: -14.6%
Portions of this report first appeared in August 2025 as “Many Rural WT Hospitals Operating In The Red” (read here).
