A live, side-by-side calculator built for hospital CEOs and CFOs evaluating REH designation. Adjust your volume, payer mix, and rates — see the monthly and annual revenue swing instantly.
Walk through these eight quick questions. Answer honestly — there are no wrong answers, just a clearer picture of which path fits your hospital.
How much of your revenue currently comes from inpatient admissions?
Enter your numbers below to see a side-by-side comparison.
All non-REH inputs are blank
Toggle to prefill volume and reimbursement rates with reasonable rural averages.
Industry range: 8–15%
Typical rural ED: 5–8%
CAH only — enter swing bed days, not patients. Leave blank if not applicable.
OPPS APC blend; rural avg $700–$950
APC 8011 + G0378; avg $1,800–$2,800
CAH only; 101% of cost; avg $5,500–$8,000
CAH only; Medicare avg $450–$600/day
CY2025: $285,625.90 — indexed annually to hospital market basket
REH receives OPPS + this % on all qualifying outpatient/ED/OBS services (42 CFR §419)
For informational purposes only. Verify rates against your payer mix and current CMS fee schedules.
A April 2026 JAMA Network Open study found that only 42 of 1,270 eligible rural hospitals (3.3%) had converted to REH by December 2025 — and most that did were already in deep financial distress (operating margins of −17.2%).
The researchers framed this as evidence that REH is a last resort.
Our read: the hospitals waiting until they're bleeding out are the ones converting. The hospitals running the numbers earlier are finding the math works long before crisis hits.
Use these as benchmarks when evaluating your own numbers.
| Benchmark | REH converters (avg) | Non-converters (avg) |
|---|---|---|
| Operating margin | −17.2% | −8.0% |
| Total margin | −5.7% | +0.9% |
| Total annual revenue | ~$22M | — |
| Annual ED visits | ~4,200 | — |
| Annual outpatient visits | ~20,500 | — |
| Bed size: 25–50 beds | 50% | — |
| Located in the South | 68.4% | 29.0% |
| Non-CAH (rural PPS) hospitals | 52.6% | 14.3% |
The same JAMA study notes: "without further action, rural hospitals are likely to continue struggling financially, which may lead to more hospitals pursuing REH." Even the researchers expect adoption to accelerate.