Chris Boukas, RN, is approaching healthcare uncertainty through a rural hospital lens.
Mr. Boukas became COO of Paris (Texas) Regional Health in December 2025 after previously serving as COO of St. Catherine of Siena Hospital in Smithtown, N.Y., part of Rockville Centre, N.Y.-based Catholic Health. He also spent several years in leadership roles at New Hyde Park, N.Y.-based Northwell Health, according to the hospital.
Now at Paris Regional, part of Brentwood, Tenn.-based Lifepoint Health, some of the challenges he is navigating are familiar across healthcare: uncertainty around reimbursement and coverage, affordability concerns and patients delaying care. But others are specific to operating a hospital in a rural market where the population has barely changed in 25 years and recruiting and retaining physicians remains a top concern. Nationally, 720 rural hospitals are at risk of closing.
Lamar County, where the hospital sits, grew 0.6% between the 2010 and 2020 censuses, to 50,088 residents. Mr. Boukas said the population has been essentially flat in recent years, including the population of women ages 15 to 44, and that the market rather contributes to the hospital’s growth strategy. Paris Regional, a 154-bed hospital serving northeast Texas and southeast Oklahoma, is the most complex hospital within at least 70 miles of Paris.
“Our priority is physician recruitment, we look to fill the gaps in service lines that we’re not providing to the community, but also to maintain what we have. In the current landscape, major growth and expansion takes a backseat to maintaining market share,” Mr. Boukas said.
Mr. Boukas told Becker’s that physician recruitment and retention is the hospital’s biggest operational concern heading into 2027. Service line decisions at the hospital are made by looking at patient need, referral patterns and out-migration, then identifying which gaps can realistically be filled.
“In rural healthcare, we have great docs, but we don’t have a very deep bench,” Mr. Boukas said.
Relationships also take on greater importance in the rural market, he said. Lamar County covers about 900 square miles with an average of roughly 50 people per square mile. He contrasted it with Nassau County, N.Y., where he previously worked, which he said is about a third the size at roughly 5,000 people per square mile.
“I see people that come to the hospital and that we work with at Walmart, shopping, or at Kroger, just out and about in town, at events and gatherings,” he said. “I see people who are patients, or who work here, or practice medicine in the community. So it’s a little bit different of a relationship, and you really have to pay attention to those relationships and understand the importance of them.”
Uncertainty around reimbursement and Medicaid coverage is also factoring into preparations for 2027. Texas hospitals spent nearly a year waiting on federal approval of three state-directed payment programs for fiscal 2027, including the Rural Access to Primary and Preventive Services program, worth a combined $9.8 billion. CMS approved the funding in September after the Texas Hospital Association projected the delay was costing hospitals $27 million a day. Under HR 1, state-directed payment rates in nonexpansion states such as Texas are capped at 110% of Medicare and will ratchet down over time.
Coverage changes are arriving on a separate track. HR 1’s community engagement requirement, which conditions Medicaid eligibility on 80 hours a month of work, school or community service, takes effect Jan. 1 and applies to adults covered through ACA Medicaid expansion. Because Texas has not expanded Medicaid, the requirement reaches far fewer patients there than in expansion states, though the law also moves eligibility redeterminations for the adult group to every six months, and physician groups and patients have sued CMS over the rule. Paris Regional’s more immediate exposure runs through patients losing marketplace coverage and through the payment reductions that follow.
Mr. Boukas said Lifepoint has a team working closely on the governmental and lobbying side, while his focus at the hospital remains on what it can control.
“There’s always uncertainty. It’s healthcare. It’s always changing,” he said. “If you can’t function with the ambiguity in healthcare, then you’re probably in the wrong industry.”
That includes monitoring expenses and contract labor, preparing for potential revenue declines and looking for opportunities to maintain or increase revenue.
“It’s the same response, just a different story,” Mr. Boukas said.
With the coverage changes approaching, Mr. Boukas said one priority is making sure patients understand what is changing and what they may need to do. Hospitals, he said, tend to assume that messages sent are messages received.
“We assume that because emails are being sent, people are receiving those emails and they’re taking action on it,” he said. “But the reality is, I don’t think that the messaging about all the things that are going on permeates throughout all of the communities. We need to find ways to get in front of the general public and provide an opportunity for them to receive the education and the information, and to ask questions about it.”
That could mean reaching patients in rural areas or working with local churches, he said.
“I think that’s probably the biggest thing I can say: don’t assume that your community is getting the information,” Mr. Boukas said. “Reach out to them. Be proactive about getting information to them in ways that make sense to them within their communities.”
Mr. Boukas is also seeing uncertainty affect patient volumes. Hospital volumes throughout the healthcare industry are down, which he said could reflect a combination of inflation and uncertainty around government, politics and coverage.
“People are just a little gun shy right now, as evidenced by our volumes,” he said. “If someone has a medical issue, or health issue, and they wait to seek care, those issues don’t get better over time. When they finally get to seek care or enter into our emergency department, sometimes folks are a little bit sicker, and that poses its own set of issues and problems.”
Despite those pressures, Mr. Boukas said decisions about which services to maintain start with the needs of the community.
“Whether something may have been more profitable or less profitable in the past, it’s about making sure that we are providing the right care for the patients in our community at the right time,” he said. “We need to make sure the finances work. We need to make sure we have a balanced sheet, and we need to make sure that we’re staying ahead of budgetary and financial components. But the bottom line for us is do the right thing for our patients.”
