"most US hospitals are tiny outfits in small cities and rural areas."
That may be true, but I think you big city types fail to take into account the fact that most of these "tiny outfits" are now affiliated with, and subservient to, much larger hospitals in urban or semi-urban areas. The practices in these places are going to be those of whatever group with which they are affiliated. Independence is pretty much gone from the small hospitals, which are now simply "feeders" for the parent organizations. For what it's worth.
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