Four New Hampshire hospitals are among the more than 700 across the United States at risk of closing due to financial struggles, according to a December report from the Center for Healthcare Quality and Payment Reform.
The report does not identify which hospitals. Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, acknowledged in an email exchange with the Bulletin that some of the data is not up to date, due to reporting delays, and a lot can change in a few years for a small hospital. Miller also said the report didn’t take into consideration which hospitals are part of larger health systems that can insulate them from financial challenges.
The center’s data shows four rural hospitals with negative operating margins. Concord Hospital-Laconia, Concord Hospital’s affiliate in the Lakes Region, was operating at a minus-7.7% margin, as of 2024, the most recent data available. Littleton Regional Healthcare, which recently announced plans to be acquired by Dartmouth Health, was operating at a minus-6.9% margin. Cheshire Medical Center in Keene, which has been affiliated with Dartmouth Health for over a decade, was operating at a minus-2.6% margin. And Cottage Hospital in Woodsville was operating at a minus-0.1% margin.
The Bulletin reached out to all four hospitals for comment.
“Although Cheshire Medical Center has had operating losses, we closed FY25 with a positive operating margin due to increased clinical volumes across the organization,” Joe Perras, CEO & President of Cheshire Medical Center, said in a statement to the Bulletin. “In our case, fortunately, Cheshire is a member of the Dartmouth Health system, which puts us in a stronger position, albeit challenged. Barring some unforeseen circumstance impacting the entire health system, the risk of closure is of no concern due to our affiliation with the Dartmouth Health system.”
Bob Nutter, CEO of Littleton Regional Healthcare, said in an email that the implementation of a new electronic health records system made their fiscal year 2024 “challenging,” but maintained “our overall financial footing remains solid.”
“The challenges LRH experienced were anticipated to some degree and not atypical,” he said. “In most instances, organizations can expect to experience similar challenges while navigating the complexities of converting EHRs (electronic health records).”
Nutter said financial challenges were not the motivation behind the hospital deciding to join Dartmouth Health.
“At the very beginning and through the affiliation process, our goal has been to ensure that high-quality, local health care remains strong for generations to come,” he said. “We are moving towards affiliating with Dartmouth Health because they share our vision, mission, and values. Financial issues have never been a driver for affiliating.”
Across the nation, more than 100 rural hospitals have closed over the past decade, according to the report. The 756 rural hospitals currently at risk of following suit, per the report, represent a third of all rural hospitals in the country. Of the 756, the report identified 323 at “immediate risk” of closing, including three of the four in New Hampshire.
The Center for Healthcare Quality and Payment Reform, which is based in Pittsburgh, blames health insurance companies for the hospitals’ financial challenges. Private health insurance plans, the report argues, are paying too little for patient services. The center also reports that hospitals lose money treating uninsured patients and those on Medicaid, though at a lower rate than privately insured patients.
The report emphasized how, in rural communities, many hospitals are a patient’s only option within their local community for services such as imaging or laboratory tests and primary care. That means when a rural hospital closes, patients are often forced to travel far for care, even in life-threatening situations.
While he acknowledged the challenging financial position rural hospitals are in, Steve Ahnen, president of the New Hampshire Hospital Association, told the Bulletin he wouldn’t go as far as the report in his own estimation.
“I don’t know enough about the methodology relative to who’s at risk of closure,” Ahnen said. “Financial challenges are very, very real, but I don’t know that there is a hospital in New Hampshire that is at risk of closure today. ”
Ahnen believes the more realistic threat is that hospitals are forced to reduce services.
The New Hampshire Hospital Association put out a report of its own in 2025 about the financial challenges Granite State hospitals are facing. That report found that seven hospitals, both rural and nonrural, had negative operating margins. It also reported that operating expenses rose 44% from 2019 to 2024 and labor costs rose 36.1%.
Ahnen cited a number of factors making it difficult for rural hospitals to function.
He decried how private insurers covering Medicare Advantage patients are denying coverage that traditional Medicare plans cover. Indeed, the U.S. Health and Human Services Office of the Inspector General has repeatedly cited Medicare Advantage insurers for delaying or denying services that should be covered.
Ahnen also noted the difficult labor market in New Hampshire. The hospital association’s report highlighted that across the state’s health care industry, hospitals had a 13.1% vacancy rate for all positions. For registered nurses, the rate was 16.8% and for certified or licensed nurse assistants it was 15.9%. He urged policy makers to work on creating talent pipelines for these communities.
Lastly, Ahnen noted that challenges with rural EMS systems mean that hospitals often have to absorb the costs of housing patients who are waiting for ambulances or other transportation to move them. Once they’ve completed care, the hospital is no longer paid for their care