As a lifelong rural resident, and in my dual roles as CEO of a rural hospital and COO of Java Medical Group, a rural hospital management company, I have witnessed firsthand how rural healthcare facilities not only provide essential medical services but also anchor the economies of small towns.
Yet today, many rural hospitals face unprecedented challenges. An analysis by Becker’s Hospital Review reveals that nearly 750 rural U.S. hospitals are at risk of closure due to financial instability, with many facing immediate threats. For example:
Georgia: 22 hospitals are at risk, with 31–40% facing potential closure.
Tennessee: Over 41% of rural hospitals are vulnerable.
Alabama: Between 26–30% of rural hospitals face risk.
New Mexico: 21–25% of rural hospitals are at risk.
The closure of many of these rural healthcare facilities would not only mean the loss of critical healthcare services but also trigger significant economic downturns. Hospitals rank among the largest employers in rural areas. When a hospital closes, the ripple effect can lead to widespread job losses, diminished household income, and the collapse of other local businesses, all of which would adversely impact the community’s vitality. For example, Williamson Memorial Hospital in Williamson, West Virginia closed in April 2020, causing a loss to more than 200 hospital staffing jobs overnight. The facility was the largest employer in Williamson and the closure was followed by small pharmacies, cafes and other closures. Furthermore, the younger working population in Williamson began to leave the community to look for alternate jobs, causing a demographic shift and rise in average age within the population.
To ensure the viability of rural hospitals, we must advocate for targeted, bipartisan policy interventions that address the unique challenges they face. As stakeholders, hospital leaders and rural residents, we can rally behind several key strategies:
Advocate for sustainable funding and reimbursement models. Many rural hospitals operate on thin margins, making them vulnerable to financial instability. Advocating for the permanent extension of programs like the Medicare-Dependent Hospital (MDH) and Low-Volume Hospital (LVH) programs is crucial. These programs ensure that eligible rural hospitals receive reimbursements that reflect their operational realities and provide financial stability. Legislation such as the bipartisan Rural Hospital Support Act aims to address these issues by extending and modernizing critical Medicare programs. Supporting this act will result in direct aid for hospitals facing closure.
Reduce regulatory burdens. Rural hospitals often face regulatory requirements designed for larger, urban facilities, leading to disproportionate administrative burdens. Tailoring regulations to the unique circumstances of rural providers can alleviate unnecessary strain. For instance, adjusting staffing mandates and reporting requirements to align with the capacities of rural hospitals can enhance operational efficiency without compromising care quality.
Expand telehealth services. Telehealth has proven to be a vital tool in bridging access gaps in rural areas. Advocating for the permanent extension of telemedicine coverage under Medicare can ensure that rural residents continue to receive timely care. This includes supporting legislation to make telehealth services a standard component of rural healthcare delivery.
Strengthen the rural healthcare workforce. Recruiting and retaining healthcare professionals in rural areas remains a persistent challenge. Programs that offer scholarships, loan forgiveness, and grants to healthcare providers willing to serve in rural and tribal communities can bolster the workforce. For instance, financial incentives could be used to recruit thousands of new healthcare professionals to rural areas. Currently, the National Health Service Corps (NHSC) offers a national loan repayment program that provides financial support in exchange for a two-year job commitment in an underserved area. In addition, the NHSC offers a scholarship program that further incentivizes healthcare professionals to pursue careers in rural communities. Tennessee also offers its own loan repayment option, the Tennessee State Loan Repayment Program, which works in tandem with the NHSC repayment program and provides up to $50,000 for healthcare professionals who commit to working in rural areas.
Secure key rural healthcare programs, ensuring the continuity of essential rural healthcare programs is vital. Permanent authorization or long-term extension of programs that support rural hospitals, such as the Medicare Rural Hospital Flexibility Program, an initiative that strengthens financial stability and care services for Critical Access Hospitals, can provide the stability needed for these institutions to thrive.
Engage in collaborative policy development. Building coalitions with policymakers, healthcare providers and community leaders can amplify advocacy efforts. Participating in task forces and working groups dedicated to rural health policy can lead to the development of comprehensive strategies that address the multifaceted challenges faced by rural hospitals.
Promote public awareness and community engagement. Educating the public and engaging community members on the important role of rural hospitals and involving them in advocacy efforts can generate grassroots support for rural healthcare initiatives. Highlighting the critical role of rural hospitals in local economies and public health can mobilize community action and influence policymakers.
Most importantly, don’t underestimate the power of your voice. Every call, every conversation, and every effort matters. These hospitals are more than healthcare providers; they are lifelines for their communities. Together, we can ensure they remain open, accessible, and equipped to save lives for generations to come.
Martha Henley is the COO of Java Medical Group and CEO of Unity Medical Center in Manchester, Tennessee. She can be reached at martha@javamedicalgroup.com.
