Rural Health Transformation # The Distress Watch Critical-access and rural hospitals ranked by financial-distress risk — pairing the Clinical Terminal entity graph with **live CMS cost-report margins**, so a buyer sees *who is exposed* and *who would sell the fix* in one view. 2,810 Critical-access hospitals tracked 2,628 With a CMS operating-margin figure 71% Negative operating margin (1,854) -7.1% Median CAH operating margin ## Distress Watchlist · worst 8 by operating margin Hospital Beds Op. margin Risk RCM fit † Iraan General Hospital District Iraan, TX · Critical Access · FY2023 14 -96.6% HIGH Coding/CDI Beds **14**-96.6%HIGHRCM Coding/CDI Beaver County Memorial Hospital Beaver, OK · Critical Access · FY2023 24 -95.3% HIGH Denials Beds **24**-95.3%HIGHRCM Denials Throckmorton County Hospital Throckmorton, TX · Critical Access · FY2022 14 -93.5% HIGH Eligibility Beds **14**-93.5%HIGHRCM Eligibility Izard County Medical Center Calico Rock, AR · Critical Access · FY2023 25 -90.2% HIGH Coding/CDI Beds **25**-90.2%HIGHRCM Coding/CDI Lady of the Sea General Hospital Cut Off, LA · Critical Access · FY2023 23 -85.2% HIGH Denials Beds **23**-85.2%HIGHRCM Denials Williamsburg Regional Hospital Kingstree, SC · Critical Access · FY2023 25 -60% HIGH Eligibility Beds **25**-60%HIGHRCM Eligibility Pecos County Memorial Hospital Fort Stockton, TX · Critical Access · FY2023 25 -59.2% HIGH Coding/CDI Beds **25**-59.2%HIGHRCM Coding/CDI Kiowa County District Hospital Eads, CO · Critical Access · FY2023 25 -59% HIGH Denials Beds **25**-59%HIGHRCM Denials **Real CMS figures.** Operating margins are actual CMS cost-report data, matched to each hospital’s profile. Of 2,628 critical-access hospitals with a reported figure, 1,854 (71%) run negative; median -7.1%. † RCM-fit is an editorial mapping, not a CMS field. The Anchor Story Who Would Sell the Fix - R1 RCM origin - Waystar - Ensemble Health - Savista supplier\_to **Editorial guardrail.** Named-facility distress claims never auto-publish — every row links to its CMS source and routes through Producer review (on the app) before a story names a hospital as distressed.