Readers Write: RHTP is Money for Rural Hospitals, But States Say Maybe Not

RHTP is Money for Rural Hospitals, But States Say Maybe Not
By Mike Lucey

Mike Lucey, MBA is president of Community Hospital Advisors.

What happened to “hospital?”

“Protecting Rural Hospitals and Providers” is the title of Chapter 4 (section 71401) of the Big Beautiful Bill, which defines the Rural Health Transformation Program (RHTP). It is six pages of clear instruction on how $50 billion will be funneled into rural healthcare over five years. It outlines who gets it and how they can spend it.

This is an impressive economy of words for a federal document with such a bold objective. The word “hospital” appears 15 times in those six pages. The longer federal Notice of Funding Opportunity (NOFO), which calls on states to submit applications for this funding, includes about 80 instances of “hospital,” which reveals an understanding that rural hospitals are the main access points for a wide variety of care, services, and resources for these communities.

But in many state applications, the word “hospital” fades or completely disappears. How is it possible that a law that was written to protect rural hospitals can morph into a series of state programs and agencies with no explicit mention of hospitals in their objectives?

Delivering rural healthcare faces two key challenges: too much space and too little money. When it comes to money, things are clear. The AMA reports that half of rural hospitals are operating at a deficit. The reasons are complex and varied, but location is intrinsic to all of them.

Too much space makes it less profitable to provide healthcare in a rural setting. Rural patients are, on average, two to three times farther from care than urban or suburban patients. The farther people are from anything, the less they do it. It doesn’t matter whether it is a gym, a bar, a parent, or a doctor. Distance becomes a reason or an excuse for why we can’t get there.

Can RHTP Help? Yes!

RHTP provides an opportunity to address these challenges by providing hospitals with the resources to hit new standards for how they provide care, especially in how they use technology. Nothing is going to change the length of a mile. But technology can close the access and contact gaps that distance creates.

Telehealth and home medical devices are great care tools that continue to get better over time. Full-access portals allow scheduling and reminders, and make messaging clinicians as easy as texting. Transportation can be scheduled and managed for patients with mobility issues through a fully functioning patient portal.

Once technology is in place to increase frequency and consistency of patient contact, technology can enhance these interactions and the quality of care with AI-augmented applications for notes, orders, and coding. These improve provider workflow, decrease burnout, allow better physician-patient interaction, and set the stage for AI clinical guidance. Finally, robust analytics and data management systems will improve the exchange of clinical data between facilities and providers, allowing high quality care regardless of location or specialty.

This vision for better rural care through technology is at the heart of RHTP, and these objectives are stated plainly in those six pages of section 71401. They are worthy and important goals. Improving just these three areas: patient contact, care delivery, and data exchange, improves care for every patient accessing every service the hospital provides. This care foundation can then expand to improve chronic care, nutrition, behavioral health and substance use disorder services, all of which are stated goals of RHTP.

RHTP exhibits a good understanding of the rural “too much space, too little money” challenge. It identifies the problems that space causes and then offers solutions and the money that is needed to deliver those solutions.

But somewhere between the authoring of the original bill and the allocation of funds from the states, many programs veer off course. Money wakes the bureaucratic beast, and the word “hospital” begins to fade.

But that doesn’t mean that the Rural, Critical Access, and Community Hospitals that serve one in five Americans, should accept defeat.

How Do Hospitals Stay at the Table?

My first encouragement to hospitals: don’t be complacent. Don’t take it as inevitable that this money is going to get siphoned off by large and connected entities. States vary widely in how friendly or not they are toward hospitals, but all will make some funds available directly. The difference in how much may well depend on how many hospitals are presenting well-constructed, justifiable projects.

Second: don’t be patient. States are just now assembling staff and drafting processes that will eventually become a method to distribute funds. Now is the time to get to work.

• Create your project list. Not the list every rural hospital has, which includes things you will get to when you have the money. It is that list plus all the things that you have not even let yourself think about because the budget was so restricted.
• Tie each project to your state initiatives and to the federal Use of Funds. Include estimated cost, timeline, and metrics.
• When your state publishes its protocols, format your request to be compliant.
• Whenever possible, team up with other sites. A collective of voices is harder to ignore.

Finally, don’t get discouraged. These processes are intentionally painful. OK, that is my opinion, but I find the process painful and have come to believe it is meant to cull the number of applicants and leave just the group that makes the process a profession. Stick with it.

Patients in rural communities are being left behind. RHTP is an opportunity to change that. There will always be too much space in rural healthcare, but with the right investment and execution, hospitals can close the gap and make a meaningful difference.