Financially challenged rural hospitals are seeking out partnerships with larger medical centers or making difficult decisions about which services to scale back as they try to keep their doors open. It is a trend that accelerated in 2014 and is expected to continue this year in Western New York. Of the dozen rural hospitals in the region, nine have an affiliation agreement of some kind with a hospital system in Buffalo, Rochester or Erie, Pa., with two of the hospitals – United Memorial Medical Center in Batavia and Medina Memorial Hospital – forming the agreements in 2014.