Hospital ecosystem & closure risk

Which communities are one closure away from a care desert?

1,545 US hospitals are the only hospital in their county, and 1,319 are federally designated sole community providers. When one of those closes, the next-nearest hospital can be tens of miles away. This view ranks the single-hospital communities by a modeled closure-risk score and maps where the exposure concentrates. The desert flags are real, CMS-derived facts. The closure risk is modeled (survival_v3) and should be read as a prioritization signal, not a prophecy.

Question

The problem

Access does not fail evenly. It fails first in the counties served by one hospital, where a single closure converts a community into a care desert. These facilities are disproportionately rural, negative-margin, and Medicaid-heavy: exactly the ones federal payment starves and no early-warning system watches.

The recommendation

Stand up a closure early-warning function targeted at single-hospital communities. Rank sole-provider hospitals by modeled closure risk, monitor the highest-risk facilities in your state, and pre-position rural-emergency conversion and support before a closure forces patients into hour-long drives.

1,545

hospitals that are the only one in their county

of 5,426 US hospitals

1,319

federally designated sole community providers

1,376 are Critical Access Hospitals

hospitals whose Medicare patients use no other facility

median hospital competes with 6 others

11.2M

people more than a 30-minute drive from the nearest open acute hospital

3.358% of 335M residents

1.4M

people an hour or more from the nearest open acute hospital

0.405% · overwhelmingly rural

Where the single-hospital communities are

Count of only-hospital-in-county facilities per state. This is a real CMS-derived flag, not a model output.

Read it this way Bluer states have more counties dependent on a single hospital. Rural, low-density states carry the most exposure. Pick a state to spotlight it and re-slice the at-risk list below to that state. Use the single-hospital map to see where exposure concentrates, the closure-risk map and mix to see where failure is most likely, and the at-risk list to name the specific facilities. Then tie those to the recommended monitoring and support actions.

⊞ data table⬇ CSV

State	Only-hospital counties
TX	123
GA	84
IA	69
KS	68
KY	65
TN	55
MS	54
NC	53
NE	50
OK	49
VA	48
IN	47
MO	47
MN	46
MI	45
IL	44
OH	41
AL	38
AR	37
MT	37
SD	34
WV	32
CO	30
WI	28
ID	26
NY	24
ND	23
SC	22
PA	21
LA	19
OR	19
NM	17
FL	15
WA	15
WY	15
CA	14
UT	13
AK	12
NV	12
PR	11
MD	10
VT	9
ME	5
NJ	5
MA	3
NH	3
AZ	2
RI	2
VI	2
AS	1
MP	1

CMS Medicare patient-flow (HSA) + Care Compare + ACS/AHRF ecosystem pipelines · 2026-06-23 · source

Modeled closure-risk mix

Hospitals by modeled closure-risk band (high ≥60, medium 30–60, low <30).

Read it this way How the modeled risk spreads across all hospitals: most sit low, a smaller band is elevated. The elevated band is the watchlist, not a closure forecast. Use the single-hospital map to see where exposure concentrates, the closure-risk map and mix to see where failure is most likely, and the at-risk list to name the specific facilities. Then tie those to the recommended monitoring and support actions.

Caveat Closure risk is modeled (survival_v3) from financial, quality, and ecosystem features, calibrated on observed distress events. Treat it as prioritization, not prophecy.

⊞ data table⬇ CSV

Risk band	Hospitals
high	22
medium	187
low	5217

Off Label closure model (survival_v3) · 2026-06-23 · source

Modeled closure risk by state

Mean modeled closure-risk score across each state's hospitals.

Read it this way Average modeled closure risk per state (0–100). Read it alongside the single-hospital map: a state that scores high on both is where a closure is both likely and leaves no fallback. Use the single-hospital map to see where exposure concentrates, the closure-risk map and mix to see where failure is most likely, and the at-risk list to name the specific facilities. Then tie those to the recommended monitoring and support actions.

Caveat Modeled (survival_v3), not observed. State averages smooth over wide facility-level variation.

⊞ data table⬇ CSV

State	Mean closure risk
AS	21.5
WV	16.3
LA	14.2
MP	13.9
IN	12.7
OH	12.5
PR	10.9
MA	9.3
MI	9.3
PA	9.1
TN	8.9
RI	8.4
WI	8.1
SC	7.5
AR	7.2
HI	7.1
VA	6.9
KY	6.5
IA	6.3
MS	6.1
NM	6.1
CT	6
KS	6
NC	6
ME	5.9
NV	5.9
AL	5.8
AZ	5.8
NY	5.8
MO	5.7
VT	5.7
NE	5.5
OK	5.5
MD	5.3
MN	5.3
WA	5.2
DE	5.1
IL	5.1
SD	5
TX	5
MT	4.8
OR	4.7
FL	4.4
ID	4.3
GA	4.2
UT	4.1
DC	4
VI	4
CA	3.8
CO	3.8
ND	3.5
NH	3.5
WY	3.5
NJ	3.1
AK	3
GU	1.4

Off Label closure model (survival_v3) · 2026-06-23 · source

One closure from a care desert: highest-risk single-hospital communities

Top single-hospital communities by modeled closure risk. Filter by state to see yours.

Read it this way The only-hospital-in-county facilities with the highest modeled closure risk: the communities that would lose all local inpatient care first. Pick a state to rebuild this list for your own delegation. Use the single-hospital map to see where exposure concentrates, the closure-risk map and mix to see where failure is most likely, and the at-risk list to name the specific facilities. Then tie those to the recommended monitoring and support actions.

Caveat Ranked by modeled closure risk (survival_v3). Facility names and 'only hospital' status are CMS-derived facts. Scoped to general-acute hospitals (Acute Care, Critical Access, Rural Emergency), because a closed general hospital is what turns a county into a care desert. Specialty and federal facilities are excluded.

⊞ data table⬇ CSV

Hospital	Type	State	County	Closure risk	Nearest hospital (mi)	Sole community
ASSUMPTION COMMUNITY HOSPITAL	Rural Emergency Hospital	LA	ASSUMPTION	80.9	10.5	yes
CROSBYTON CLINIC HOSPITAL	Rural Emergency Hospital	TX	CROSBY	78.6	37.3	yes
WEBSTER MEMORIAL HOSPITAL	CAH	WV	WEBSTER	76.5	23.8	yes
SAINT THOMAS HICKMAN HOSPITAL	CAH	TN	HICKMAN	51.8	23.9	yes
REGIONAL WEST MEDICAL CENTER	Acute Care	NE	SCOTT BLUFF	51.7	29.3	yes
ANSON GENERAL HOSPITAL	Rural Emergency Hospital	TX	JONES	50.5	18.5	yes
ASCENSION ST VINCENT SALEM	CAH	IN	WASHINGTON	49.4	20.5	yes
UNION HOSPITAL CLINTON	CAH	IN	VERMILLION	49	12.9	yes
LAFOLLETTE MEDICAL CENTER	Acute Care	TN	CAMPBELL	47.9	23.8	yes
STONES RIVER HOSPITAL	Acute Care	TN	CANNON	47.1	15.7	no
JEFFERSON COUNTY HOSPITAL	Rural Emergency Hospital	MS	JEFFERSON	46.1	18.5	yes
CAMERON REGIONAL MEDICAL CENTER	Acute Care	MO	CLINTON	46.1	28.3	no
FALLS COMMUNITY HOSPITAL AND CLINIC	Rural Emergency Hospital	TX	FALLS	45.2	22.8	yes
GREENE COUNTY HOSPITAL	Acute Care	AL	GREENE	40.9	25.3	no
POINTE COUPEE GENERAL HOSPITAL	CAH	LA	POINTE COUPEE	39.7	12.9	yes
GENESIS MEDICAL CENTER, ALEDO	CAH	IL	MERCER	37.4	19.9	yes
ALLIANCE HEALTHCARE SYSTEM, INC	Acute Care	MS	MARSHALL	36	22	yes
MAGRUDER HOSPITAL	CAH	OH	OTTAWA	34.9	25.8	yes
VALLEY HEALTH WAR MEMORIAL HOSPITAL	CAH	WV	MORGAN	33.4	14.7	yes
TRISTAR ASHLAND CITY MEDICAL CENTER	Rural Emergency Hospital	TN	CHEATHAM	33.2	17.5	yes
ASCENSION BORGESS LEE HOSPITAL	CAH	MI	CASS	31.8	12.6	yes
MEDINA MEMORIAL HOSPITAL	CAH	NY	ORLEANS	31.2	17	yes
GRAFTON CITY HOSPITAL, INC	CAH	WV	TAYLOR	30.9	9.1	yes
WILLIAMSON MEMORIAL INC	Acute Care	WV	MINGO	29.8	3.8	yes
KALKASKA MEMORIAL HEALTH CENTER	CAH	MI	KALKASKA	29	21.8	yes
ST ELIZABETH GRANT	CAH	KY	GRANT	28.7	21	yes
PAUL OLIVER MEMORIAL HOSPITAL	CAH	MI	BENZIE	28.6	26.7	yes
SAINT MARY'S STANDISH COMMUNITY HOSPITAL	CAH	MI	ARENAC	28.4	26.5	yes
ST BERNARDS FIVE RIVERS MEDICAL CENTER	Rural Emergency Hospital	AR	RANDOLPH	28	20.4	yes
ASCENSION ST VINCENT CLAY	CAH	IN	CLAY	27.9	14.4	yes
DAVIS MEDICAL CENTER	Acute Care	WV	RANDOLPH	27.7	20.8	yes
ST CHARLES MEDICAL CENTER PRINEVILLE	CAH	OR	CROOK	26.5	27.3	yes
WARM SPRINGS MEDICAL CENTER	CAH	GA	MERIWETHER	26.4	23	yes
DICKENSON COMMUNITY HOSPITAL	CAH	VA	DICKENSON	26.4	22.1	yes
BROADDUS HOSPITAL ASSOCIATION, INC	CAH	WV	BARBOUR	26.3	13.6	yes
HOLMES COUNTY HOSPITAL AND CLINICS	CAH	MS	HOLMES	24.8	27.4	yes
GOODALL WITCHER HOSPITAL	CAH	TX	BOSQUE	24.1	26.5	yes
SANFORD WHEATON MEDICAL CENTER	CAH	MN	TRAVERSE	23.6	18.2	yes
MINNESOTA VALLEY HEALTH CENTER INC	CAH	MN	LE SUEUR	23.6	8.4	yes
COBLESKILL REGIONAL HOSPITAL	CAH	NY	SCHOHARIE	23.6	18.6	yes

CMS Medicare patient-flow (HSA) + Care Compare + ACS/AHRF ecosystem pipelines · 2026-06-23 · source

Share of residents more than 60 minutes from a hospital, by state

Percent of each state's population beyond a 60-minute drive of the nearest open acute hospital.

Read it this way A rural-West story: Alaska (12.6%), New Mexico, Wyoming, the Dakotas, and Montana lead. Dense states sit near zero. Pick a state to spotlight it, and read it against the single-hospital-county map. A state dark on both is where distance and dependence compound. Use the single-hospital map to see where exposure concentrates, the closure-risk map and mix to see where failure is most likely, and the at-risk list to name the specific facilities. Then tie those to the recommended monitoring and support actions.

Caveat Drive time is a routed road-network isochrone (Valhalla over OpenStreetMap), so catchments follow real roads and speeds. See the methodology note.

⊞ data table⬇ CSV

State	% beyond 60 min	People beyond 60 min	Hospitals
AK	18.832	138113	21
WY	15.886	91636	27
MT	6.301	68318	61
NM	4.888	103512	40
SD	4.14	36711	57
HI	2.576	37482	20
AZ	2.334	166950	81
ID	2.167	39856	43
ME	2.01	27380	31
ND	1.747	13608	44
CO	1.407	81265	83
NV	1.335	41446	35
OR	1.059	44883	57
UT	1.005	32877	45
WA	0.862	66429	84
WV	0.417	7483	46
MN	0.388	22130	123
MO	0.357	21992	97
NH	0.307	4234	25
PR	0.307	10100	46
LA	0.296	13773	110
CA	0.283	111814	315
AR	0.23	6915	76
NE	0.185	3636	87
TX	0.154	44837	380
VT	0.146	939	14
WI	0.134	7889	123
RI	0.128	1410	10
NC	0.125	13076	99
MI	0.121	12167	125
FL	0.12	25779	180
OK	0.115	4571	118
AL	0.094	4700	88
NY	0.091	18418	150
MA	0.082	5745	59
TN	0.078	5365	95
VA	0.058	4964	78
KY	0.041	1850	88
GA	0.027	2872	125
SC	0.025	1297	54
MS	0.024	716	94
PA	0.024	3171	149
MD	0.019	1178	43
OH	0.009	1069	151
IL	0.008	985	169
CT	0	0	25
DC	0	0	6
DE	0	0	6
IA	0	0	112
IN	0	0	115
KS	0	0	129
NJ	0	2	61

Valhalla 3.8.1 auto-costing isochrones over OpenStreetMap (Geofabrik US regional extracts, 2026-07-06 vintage); CMS hospital_master + provider_of_services (staffed beds); U.S. Census Bureau 2020 block-group population-weighted centroids · 2026-07-07 · source

If this hospital closed, who loses adequate access

People who would fall below the access-adequacy threshold if the named hospital closed (top 10).

Read it this way An E2SFCA model of who would fall below the access-adequacy threshold if a given hospital closed. Large metro hospitals hovering near the adequacy line top the list, not only rural ones (a reminder that access is a supply-vs-population ratio, not distance alone). Use the single-hospital map to see where exposure concentrates, the closure-risk map and mix to see where failure is most likely, and the at-risk list to name the specific facilities. Then tie those to the recommended monitoring and support actions.

Caveat E2SFCA closure-impact estimate built on the valhalla_isochrone drive-time model. It ranks people-at-risk, not certainty of loss.

⊞ data table⬇ CSV

Hospital	State	People at risk	Staffed beds
SHARP MEMORIAL HOSPITAL	CA	1825774	881
SCRIPPS MERCY HOSPITAL	CA	1498807	700
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER	CA	1438414	631
KAISER FOUNDATION HOSPITAL - SACRAMENTO	CA	1409465	628
UNIVERSITY OF UTAH HOSPITAL AND CLINICS	UT	1348807	1013
SANTA CLARA VALLEY MEDICAL CENTER	CA	1341355	1337
SWEDISH MEDICAL CENTER	WA	1223335	697
ST DAVID'S MEDICAL CENTER	TX	1188411	625
KAISER FOUNDATION HOSPITAL - SAN DIEGO	CA	1142379	659
METHODIST HOSPITAL	TX	1126199	2465
MEMORIAL HERMANN HOSPITAL SYSTEM	TX	1103968	1515
LEHIGH VALLEY HOSPITAL	PA	1096467	996
SUTTER MEDICAL CENTER, SACRAMENTO	CA	1090810	523
SPECTRUM HEALTH	MI	1084951	1135
UC SAN DIEGO HEALTH HILLCREST - HILLCREST MED CTR	CA	1064466	600

Why this matters

Federal payment rewards volume and scale, which structurally disadvantages the low-volume hospitals that are the only option for their catchment. Closures are reported after the fact, so support arrives too late. The data to predict them (financial distress, quality, isolation, market structure) already exists and is not being used as a watchlist.

Recommended actions

Build a state-level watchlist from the at-risk list: the only-hospital-in-county facilities with the highest modeled closure risk are the ones to monitor first.
Pre-position Rural Emergency Hospital conversion and sole-community-provider payment support for the highest-risk facilities before they fail, not after.
Pair the closure-risk map with the single-hospital map: prioritize states that score high on both, where a closure is both likely and leaves no fallback.
Treat the modeled score as a trigger for a human financial review, not as an automatic verdict: confirm distress before acting.

The recommendation

Therefore, run a closure early-warning function on the single-hospital communities. Rank sole-provider hospitals by modeled closure risk, watch the highest-risk facilities in your state, and move support upstream of the closure so no community loses all local care with no warning.

Demographic slice Facility level, national. 'Only hospital in county' and 'sole community provider' are CMS-derived flags. Flow-based catchment marks hospitals whose Medicare patients use essentially no other facility. Closure risk is modeled from financial, quality, and ecosystem features.

Sources

CMS Medicare patient-flow (HSA) + Care Compare + ACS/AHRF ecosystem pipelines · 2026-06-23
CMS Care Compare / Provider of Services (hospital identity, CAH, sole-community flags) · 2026-06-23
Off Label closure model (survival_v3), see docs/CLOSURE_MODEL_V3.md · 2026-06-23

State	Only-hospital counties
TX	123
GA	84
IA	69
KS	68
KY	65
TN	55
MS	54
NC	53
NE	50
OK	49
VA	48
IN	47
MO	47
MN	46
MI	45
IL	44
OH	41
AL	38
AR	37
MT	37
SD	34
WV	32
CO	30
WI	28
ID	26
NY	24
ND	23
SC	22
PA	21
LA	19
OR	19
NM	17
FL	15
WA	15
WY	15
CA	14
UT	13
AK	12
NV	12
PR	11
MD	10
VT	9
ME	5
NJ	5
MA	3
NH	3
AZ	2
RI	2
VI	2
AS	1
MP	1

State	Only-hospital counties
TX	123
GA	84
IA	69
KS	68
KY	65
TN	55
MS	54
NC	53
NE	50
OK	49
VA	48
IN	47
MO	47
MN	46
MI	45
IL	44
OH	41
AL	38
AR	37
MT	37
SD	34
WV	32
CO	30
WI	28
ID	26
NY	24
ND	23
SC	22
PA	21
LA	19
OR	19
NM	17
FL	15
WA	15
WY	15
CA	14
UT	13
AK	12
NV	12
PR	11
MD	10
VT	9
ME	5
NJ	5
MA	3
NH	3
AZ	2
RI	2
VI	2
AS	1
MP	1

State	Only-hospital counties
TX	123
GA	84
IA	69
KS	68
KY	65
TN	55
MS	54
NC	53
NE	50
OK	49
VA	48
IN	47
MO	47
MN	46
MI	45
IL	44
OH	41
AL	38
AR	37
MT	37
SD	34
WV	32
CO	30
WI	28
ID	26
NY	24
ND	23
SC	22
PA	21
LA	19
OR	19
NM	17
FL	15
WA	15
WY	15
CA	14
UT	13
AK	12
NV	12
PR	11
MD	10
VT	9
ME	5
NJ	5
MA	3
NH	3
AZ	2
RI	2
VI	2
AS	1
MP	1