Many Medicare Dependent Hospitals (MDHs) and Sole Community Hospitals (SCHs) are unknowingly leaving significant money on the table through underutilization of the Volume Decrease Adjustment (VDA) — a Medicare benefit designed to offset revenue loss from declining inpatient volume.

If your hospital has seen a volume drop of more than 5%, you may be eligible.

RubinBrown reviewed the filed cost reports from 2022-2023 and identified 152 hospitals with an opportunity to claim a VDA.

However, as of the second quarter of 2025, only 61 show a VDA payment on their cost report—meaning 91 hospitals potentially missed out.

Those 61 payments received nearly $69 million—averaging $1.1 million per request—a significant benefit to SCH and MDH providers struggling with declining inpatient volume.

It is important to review inpatient volumes throughout the year, but for MDH and SCH providers, it is especially important to review when preparing the cost report.

Providers can request a VDA immediately after filing their cost report, and they have until 180 days after the Notice of Program Reimbursement (NPR) is issued. While the process can seem daunting, with many steps involved, RubinBrown can help simplify it. Our team brings decades of experience assisting providers with VDA reimbursement and is ready to assist your facility every step of the way.

Published: 08/19/2025

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