As rural and regional hospitals head into 2027, their leaders are moving away from volume as the main path to revenue. Instead, many are focused on keeping care close to home, reducing outmigration and capturing the revenue they have already earned through stronger revenue cycle work, fewer denials and better documentation.
The 22 executives below also point to disciplined service-line growth, partnerships that extend services without building everything in-house and workforce stability as key levers, while several flag Medicaid eligibility changes, Medicare Advantage pullbacks and 340B pressure as headwinds for the year ahead.
The leaders featured below are speaking at Becker’s Rural Healthcare Leadership Summit, April 21-22, 2027, at the Hyatt Regency Chicago.
As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their perspectives on key issues in the industry.
If you would like to join the event as a speaker, please contact Scott King at sking@beckershealthcare.com.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are you thinking differently about revenue generation in preparation for 2027?
Candace Miller. President and Chief Executive Officer of Jackson General Hospital for WVU Medicine (Morgantown, W.Va.): For a critical access hospital, revenue generation in 2027 is more about keeping care that already belongs to us close to home. Every patient who drives an hour for a service we could provide well in Ripley is both a lost margin and, more importantly, a patient less likely to complete their care. So our growth strategy is deliberately local: opening our new cancer, infusion and therapy center in 2027, building and enhancing orthopedics, expanding walk-in access in our outlying communities, and furthering core campus growth so that the fullest range of care that belongs in a rural community can be delivered here.
We are also meeting patients where they are: in a Walmart clinic, in occupational medicine for our local employers, and through a transitions-of-care team that follows patients home because in rural West Virginia, the most sustainable revenue comes from prevention, follow-up and chronic disease management that keep people well and out of the emergency department. Increasingly, a meaningful share of our reimbursement is tied to exactly those outcomes through quality-based payment programs, so keeping people healthy and keeping the hospital financially strong are now the same job. None of it works without culture: a people-first team that owns the outcome and holds itself to a set of shared measures is what turns strategy into revenue. Our board’s 10-year charter puts it simply: dream big, get big, act small.
Kunal Khashu. Executive Director of Health Performance Analytics, EDI, EIS for Cedars-Sinai (Los Angeles): For 2027, we see significant opportunity beyond traditional revenue growth by unlocking capacity, throughput, and margin within our existing operations. Embedding intelligence directly into decision points such as OR scheduling, patient flow, supply chain allocation, and financial forecasting will enable clinicians and operators to act with greater speed and certainty. Better decisions mean more patients served, stronger resource utilization, and improved financial performance. One of the key focus areas for 2027 would be to build the operational intelligence infrastructure that makes these gains repeatable and scalable across the health system.
Morgan May, DNP, RN. Vice President and Associate Chief Nursing Executive for Ballad Health (Johnson City, Tenn.): As we prepare for 2027, I’m thinking differently about revenue generation by focusing less on volume alone and more on creating sustainable value through excellent clinical outcomes, workforce stability, and operational efficiency. Retaining and developing our nursing workforce remains one of the most important financial strategies available to us, as turnover, vacancies, and reliance on premium labor directly impact margin. I also believe we have opportunities to better leverage technology, care redesign, and interdisciplinary partnerships to improve throughput, access, and patient experience while reducing waste. Revenue growth will come from delivering the right care, in the right setting, with the right resources.
Rohith Saravanan, MD. Vice President of Medical Affairs and Chief Medical Officer of Midland Health (Midland, Texas): For 2027, we are thinking less about revenue generation as simply driving more encounters and more about building a sustainable model that captures value across the continuum of care. For a regional health system, that means expanding specialty and ambulatory access close to home, strengthening physician alignment and regional partnerships, and building the clinical and data infrastructure needed to succeed in value-based arrangements. We also have to reach patients earlier, before preventable disease progression results in an emergency department visit or hospitalization, and increasingly align the economics with that work. Ultimately, the opportunity is to diversify revenue while improving access, lowering total cost of care and keeping more care within the communities we serve.
Eric Doherty. Chief Executive Officer of QC Healthcare/My Pediatric Doctor/My Adult Doctor/My Oncology Doctor (Charlotte, N.C.): At QC Healthcare, we are preparing for 2027 by building revenue streams that extend beyond traditional fee-for-service virtual visits. We are expanding payer, employer, health system, government, and strategic-partnership channels while developing specialized care platforms in pediatrics, adult care, veterans’ health, and oncology. We are also integrating AI-enabled screening, diagnostics, pharmacy services, care coordination, and clinical-trial matching into the patient journey to create additional value and improve outcomes. Our goal is a diversified, scalable model that generates revenue by expanding access, strengthening continuity of care, reducing unnecessary healthcare costs, and delivering measurable value — not simply increasing visit volume.
Glenn M. Simpson. Regional Operations Director for Daymark Recovery Services (Siler City, N.C.): Healthcare delivery is always evolving. In 2027, a major change in healthcare regulations resulting from HR 1 (aka the One Big Beautiful Bill Act) involves the way Medicaid will pay and who will now become ineligible. Organizations can expect a reduction in Medicaid beneficiaries and an increase in patients without the means to pay for services. Even organizations that are not Medicaid providers will experience a downstream effect.
However, HR 1 brings good news for behavioral health inpatient facilities as it permanently relaxes the exclusion of Institutes of Mental Disease (IMD) from Medicaid payments. States will now be allowed to cover inpatient behavioral stays in facilities larger than 16 beds (up to 30 days). The IMD rule has been long overdue for revision.
Also in 2027 there will be the reduction of Medicare Advantage policies from insurance carriers like Humana, Centene, and Molina. In the long term, these changes may benefit beneficiaries and providers alike, but 2027 will likely reduce revenue generation for providers as beneficiaries try to manage the changes.
Amy E. Lee. President and Chief Operating Officer of Nantucket Cottage Hospital, Mass General Brigham (Somerville, Mass.): As we look toward 2027, we are thinking about revenue generation in a way that is very connected to our mission. For us, it is not simply about adding volume or growing for the sake of growth. It is about making sure we are bringing the right services to the community and giving patients more opportunities to receive care close to home.
For a rural community hospital, access and sustainability really go hand in hand. When we strengthen a service, build a new program, or develop a partnership, we want to be able to clearly connect that work back to what our community needs.
That means being more intentional about where the opportunities are. We are looking at services our patients currently have to leave the area to receive and asking where it makes sense to bring that care closer to home. We are also looking at opportunities to expand specialty care, diagnostics, outpatient services, and other programs where there is a demonstrated community need.
Just as important, we need to make the most of the services and capacity we already have. That includes improving scheduling and access, strengthening referral relationships, reducing gaps in care, and making it easier for patients to move from primary care to diagnostics, specialty services, hospital care, and follow-up. Sometimes the opportunity is not about creating something new. It is about making what we already provide easier to access, better connected, and more responsive to patients.
Partnerships that expand the continuity of care strengthen our ability to care for patients across the full spectrum of their needs, while bringing more services and expertise closer to home. They also allow us to create stronger connections across primary care, specialty care, diagnostics, hospital services, and follow-up care. In some cases, partnerships can help us bring expertise into the community without having to build every service independently, which allows us to expand access in a thoughtful and sustainable way.
We are also looking closely at the fundamentals of revenue performance. That includes strengthening revenue cycle processes, improving documentation, reducing avoidable denials, making sure services are appropriately captured and billed, and evaluating reimbursement models that better reflect the realities of rural healthcare. These areas may not be as visible as launching a new service, but they are an important part of making the hospital financially sustainable.
There is also an important workforce component to this work. When physicians, nurses, and staff understand how their work connects to access, quality, patient experience, and the financial health of the hospital, it creates a greater sense of ownership and accountability. People understand not only what they are being asked to do, but why it matters.
That connection to mission is also critical to our ability to retain and recruit talented people. Providers and staff want to feel that their work has meaning and that they are part of building something important for the community. When teams have a voice in identifying opportunities, improving services, and helping shape how care is delivered, it strengthens engagement and creates a shared responsibility for the organization’s success.
So as we think about revenue in 2027, the strategy is really about several things working together: keeping more appropriate care local, expanding services where there is a clear need, strengthening partnerships and referral relationships, improving access to the services we already provide, and making sure we are appropriately reimbursed for the care we deliver.
Ultimately, financial sustainability gives us the ability to reinvest in our people, strengthen the services available locally, and continue to meet the needs of our patients and families. That is what makes the revenue strategy meaningful for us. It supports the mission and helps ensure that our community can continue to rely on high-quality care close to home.
Joshua Elder, MD. Vice President of eHealth Clinical Operations for SCP Health (Atlanta): In many communities, a hospital’s financial health determines whether patients can get care close to home. For us, appropriate revenue for clinical services supports appropriate patient access to care. For 2027, to address the challenges that traditional revenue models have encountered, we’re focused on helping hospitals care for more of their own patients locally instead of transferring them elsewhere solely because the right clinical expertise isn’t on site. That means that bedside clinicians, virtual hospitalists and critical care teams must act as one team. When patients get the right care in the right place, access and financial sustainability reinforce each other.
Yvette Riker, DNP. Chief Operations Officer of Reeves Regional Health (Pecos, Texas): As a rural hospital COO, I’m thinking about revenue in 2027 less as simply increasing volume and more as maximizing the value of every service we provide. Rural hospitals must become more intentional about service-line growth, reducing revenue leakage, strengthening payer strategy, and keeping appropriate care within our communities. I’m also looking beyond traditional reimbursement toward partnerships, technology, and new models of care that can create sustainable revenue while expanding access. Every operational decision — from workforce and technology investments to which services we grow — has to be viewed through both a patient-access and financial-sustainability lens. In 2027, revenue strategy is ultimately about building a rural healthcare model that is financially resilient enough to continue serving the community for the long term.
Darrell Bodnar. Chief Information Officer of North Country Healthcare (Berlin, N.H.): In preparation for 2027, I think rural healthcare organizations need to think about revenue generation more broadly than simply creating new sources of revenue. We need to optimize the revenue we have already earned by strengthening revenue cycle processes and leveraging advanced technologies, including AI, to improve coding accuracy, charge capture, charge optimization and to identify deficiencies earlier. At the same time, service-line growth needs to be intentional and aligned with community health needs assessments and demonstrated local demand.
The other side of the equation is cost optimization and financial stewardship. Technology, analytics and leading practices can help us better understand where resources are being used and identify opportunities to reduce unnecessary variation and expense. Just as importantly, financial stewardship cannot belong only to finance; everyone in the organization has a role in understanding how their decisions and everyday practices contribute to the long-term sustainability of rural healthcare.
Desireé R. Stumpf. Vice President of Nursing and Regional Chief Nursing Officer for Deaconess Illinois (Marion, Ill.): As we prepare for 2027, I’m thinking differently about revenue generation. In rural healthcare, growth isn’t just about increasing volume. It’s about ensuring patients can access the care they need close to home and having the workforce in place to provide that care. We’re focused on strengthening our nursing pipeline, retaining experienced caregivers, reducing unnecessary burdens on clinicians through technology, and improving how patients move through the healthcare system. When we invest in our people and make it easier for patients to receive timely, high-quality care, both outcomes and financial sustainability improve.
Tammy Dahl, DNP. Chief Nursing Officer of Pullman Regional Hospital (Pullman, Wash.): In preparation for 2027, Pullman Regional Hospital (PRH) is approaching revenue generation by deliberately managing our service portfolio, capacity, and resources rather than simply adding volume.
Like many critical access hospitals (CAH), our historical focus has been on preserving and growing essential access; we are now moving toward a more disciplined service-line strategy that considers community need, quality, workforce, capacity, financial performance, and growth opportunities.
This year, we will partner with our Board during our annual strategic planning process to use service lines as the framework for decisions about where to invest, grow, redesign, partner, or potentially redirect resources. We are also developing a comprehensive capacity management strategy — including reducing ED and Birth Place diversion and improving procedural throughput — because every time we lack capacity to care for a patient locally, there are both access and financial impacts. For rural hospitals, I believe sustainable growth will increasingly come from using the capabilities we already have more effectively while being more intentional about where we invest next.
Kimberly Reddish, PhD, RN. Chief Operating Officer and Chief Nursing Executive for Forrest Health System (Hattiesburg, Miss.): At Forrest Health, our 2027 revenue strategy is centered on regionalizing care and achieving profitable growth without proportional growth in cost. Our goal is to expand access, capture additional market opportunity, and increase capacity by redesigning how and where care is delivered — not simply by adding inpatient beds.
We will shift appropriate care into ambulatory, virtual, and home-based settings, allowing us to serve more patients while preserving inpatient capacity for those requiring higher-acuity care. By expanding virtual care, care-at-home services, and ambulatory access across our regional network, we can recapture volume that has historically left the Forrest Health system while growing our hub-and-spoke network.
At the same time, we will strategically invest in high-value service lines that meet important community needs and contribute to sustainable margin growth. Priority opportunities include neurosciences, infusion services, and surgical services, with an emphasis on reducing outmigration, expanding regional access, and retaining more of the patient’s healthcare journey within Forrest Health.
Ultimately, our strategy is to grow the regional network, move care to the most appropriate setting, retain patients within the system, and expand high-value clinical capabilities—all while leveraging our existing infrastructure more efficiently.
JohnRich R. Levine, DNP. Chief Nursing Officer for Reeves Regional Health (Pecos, Texas): For 2027, I’m focusing on revenue generation by asking a simple question: What are our patients leaving our community to get that we could provide here? At Reeves Regional Health, we have been expanding services, including but not limited to ophthalmology, orthopedics, and pain management, based on what our community actually needs. For a rural hospital, every service we can appropriately bring closer to home means better access for our patients, less care leaving the community, and another opportunity to strengthen the hospital financially. I think that is where much of the opportunity is for us going into 2027.
Justin D. Harris. Chief Executive Officer of Daviess Community Hospital, Deaconess Health System (Washington, Ind.): Revenue generation in PPS hospitals is much more than increasing your inpatient census and seeing how many surgeries are on for the day. While that still holds weight, we have to think outside the box as the healthcare market evolves with direct-to-employer plans, retail and specialty pharmacies, and freestanding ambulatory care models. Think of unearned income opportunities and HOPD conversions that need to be evaluated. Think outside the norm of normal admissions and create developments that move the strategic needle not just inside the facility but across your city, state, and region.
Nicole Centers. Administrative Director of Oncology Service Line for SGMC Health (Valdosta, Ga.): For 2027, I’m thinking about revenue generation less as “finding new revenue” and more as making sure we are fully realizing the value of the care we already provide. I believe revenue generation is only truly sustainable when it is paired with disciplined cost mitigation and full optimization of the programs and resources already in place. In a rural health system, that means tightening revenue capture, reducing denials and authorization delays, improving throughput, and making better use of existing capacity before simply adding more resources. We are also looking closely at service-line growth, medication and 340B opportunities, and where care can be kept locally rather than sending patients outside the market. Revenue generation is not linear; it is a complex, interconnected strategy in which cost mitigation, program optimization, operational efficiency, and growth must work together. The goal is sustainable growth that improves access for patients while strengthening the financial performance of the organization.
Ginger J. Raya, EdD. Center Director and Associate Professor for George McMillan Fleming Center for Healthcare Management, UTHealth Houston School of Public Health (Dallas): As we prepare for 2027, I’m thinking differently about revenue generation because our work with rural hospital leaders has reinforced that growth is not always about finding a new revenue stream. We need to help hospitals better capture the revenue they have already earned through stronger denial and prior authorization management, accurate Medicare cost reporting, and improved payer reimbursement. For rural hospitals especially, we also need to think differently about how we provide these resources. Every hospital does not need to build every capability on its own. We should be looking at shared resources and partnerships, clinically integrated networks, for example, that give rural hospitals access to the financial expertise and tools they need without having to carry the full cost internally. In 2027, revenue strategy should be measured not only by new revenue generated, but by how much existing revenue is protected, recovered, and optimized.
Kelly Macken-Marble. Chief Executive Officer of Administration for Osceola Medical Center (Osceola, Wis.): We are closely tracking changes to Medicaid reimbursement, eligibility requirements, as well as the regular threat to the 340B program. Changes in these programs as well as rising labor and supply costs really drive our focus on the need to diversify revenue streams as well as consider service lines that bring less risk and meet the needs of the community — which is our priority. Outside of our core services, we are focusing on high-need services highlighted in our community health needs assessment and looking to bring new services that also meet the needs of a diverse population in the areas of wellness.
Tiffany Means, DNP, RN. Chief Executive Officer of Eureka Springs Hospital (Eureka Springs, Ark.): I think we have to stop asking small rural hospitals to operate like smaller versions of large health systems. For 2027, I’m focused on designing an economic model around what being small allows us to do differently.
At Eureka Springs Hospital, we are building a rural health ecosystem around the whole health of the patient. Our Hybrid ED/Urgent Care model is one example. We are also connecting specialty and geriatric care, technology and community resources around the hospital without assuming ESH has to own every component of care to create value from it.
That thinking extends beyond clinical care. We are rebuilding revenue capture from the encounter through collections, exploring purchasing partnerships that allow smaller organizations to create leverage without carrying inventory their volumes cannot support, and forming an ESH Community Health Coalition so the people we serve have a voice in defining what healthcare close to home should become.
I’m not trying to make ESH a bigger hospital. I’m building a smarter ecosystem around a small one by using our size to move faster, connect differently and create sustainable revenue in places a traditional hospital model may overlook.
Roy Browning, BSN. Director of ER, ICU and Medical-Surgical for Reeves Regional Health (Pecos, Texas): Our strategy to increase revenue for 2027 involves the introduction of new service lines. This includes certifying nurses for PICC line placement, a procedure our patients travel an hour for. Additionally, we are considering a mobile clinic to reach out to underserved areas of the county. A recent surge in the local population has also led us to evaluate the construction of an urgent care clinic as a new service line. Furthermore, we will expand our training program to incorporate immersive ICU/critical care refresher training at regional facilities to bolster admissions. Vision and teamwork are central to our success and the key to our future.
Cynthia Hardy, DNP, RN. Chief Nursing Officer of Haak’u Health Center (Acoma Pueblo, N.M.): As we prepare for 2027, we are thinking differently about revenue generation by looking beyond traditional clinical services and identifying opportunities that align with the needs and culture of our community. One significant opportunity is expanding our traditional healing services and developing the infrastructure necessary to appropriately bill Medicaid for eligible services through technology and standardization of nursing documentation and template establishment. New Mexico is one of only four states approved by CMS to provide Medicaid and CHIP coverage for certain traditional health care practices through Tribal, IHS, and Urban Indian Health programs. This creates an opportunity to strengthen our nursing clinical traditional visits and sustain culturally sensitive healthcare while also bringing in new revenue into the health system to support the care our community values.
Craig Williams. President and Chief Executive Officer of Speare Memorial Hospital (Plymouth, N.H.): At Speare, we are trying to approach revenue generation in 2027 through an “abundance mindset” to grow by meeting more community needs locally, keeping patients within Speare, and leveraging the unique economics of a Critical Access Hospital where we believe that each additional patient event contributes 90% to covering our fixed costs. Our strongest path to long-term financial sustainability will not come from cost reduction alone, but strategic growth that expands access, retains patients locally, and takes advantage of partnership opportunities within our region. By focusing on high-demand service lines, reducing outmigration, and strengthening the primary care foundation, Speare will generate meaningful revenue growth while expanding access to our community for services so that they do not have to travel an hour to receive care.
