Conference Agenda

Rural hospitals are at risk. One study reported 46% of rural hospitals are in the red, with 432 vulnerable to closure due to reimbursement and service issues (Chartis, 2025). A 2025 study by Becker’s Hospital Review reported that 332 hospitals are at immediate risk of closure (Beckers, 2025). If current financial pressures and reimbursement trends continue, there is a wide consensus that hundreds of rural hospitals in the U.S. are likely to close or become financially unsustainable over the next few years. Given the accelerating risk of rural hospital closures across the U.S., advanced telecommunications infrastructures can represent a critical strategy to avert a large-scale public healthcare crisis for the 60 Million Americans residing in rural communities.

Over the last several decades, innovative models of healthcare delivered to patients have emerged outside of traditional brick-and-mortal facilities such as hospitals. These innovative models of health care include new technologies such as remote patient monitoring (telemetry), wearables and biosensors (evolved telemetry), remotely-enabled medical devices (telemetry), and artificial intelligence-driven diagnostics/health assistants (AI in healthcare). Innovative telecommunication solutions enabling telehealth and Hospital-at-Home (HaH) can be game-changing as access and capacity multipliers— while not substituting for the parts of a hospital that are inherently physical (emergency departments, imaging, surgery, obstetrics, trauma acute care stabilization, etc.).

Telehealth is an umbrella term for a care modality whose main feature is to support delivering care remotely – using telecommunication technologies to deliver health care at a distance (Rabbani, 2025 ). HaH provides hospital-level care for acutely ill patients in the patient’s home as a direct substitute for traditional inpatient hospital care for patients who would otherwise meet clinical criteria for, and be cared for, in a traditional brick-and-mortar hospital (Desai, 2024).

Both Telehealth and HaH care models expanded dramatically during the COVID19 pandemic as health systems looked for safe, efficient alternatives to traditional in-person visits (Gutierrez, 2021). A systematic review (Pandit, 2024) found that telehealth achieved clinical outcomes comparable to in-person care, while also reducing missed appointments and maintaining strong medication adherence across a range of clinical settings. Analyses by RAND (2024) indicate that telehealth utilization has remained above pre-pandemic levels, particularly for mental health services, supported in part by temporary federal policy waivers that broadened reimbursement and access. In agreement, a review of telehealth adoption from 2020 to 2025, reported clinical outcomes similar to face-to-face visits continued into the post-COVID19 era (Rabbani, 2025). By 2026, HaH programs had been implemented in 366 hospitals across 37 states, reporting lower mortality, reduced costs, and high patient satisfaction (AHA, 2026).

Unfortunately, there are limitations to the use of telehealth and HaH; specifically broadband access, workforce capacity, and restrictive payment rules. Recent Federal laws are critical for U.S. rural hospital sustainability because these rural hospitals depend heavily on Medicaid payment stability which has created large uncertainty. In addition, several Medicare payment rules directly related to telehealth and HaH are scheduled to sunset within the next few years creating risk for technology investments (Medicare telehealth flexibilities, Acute Hospital Care at Home (AHCAH) waiver flexibilities, Medicare in-person requirements).

In this paper we provide analysis showing telehealth and HaH can play a significant role in affecting a more positive outcome for many rural hospitals. For example, telehealth can meaningfully expand access, retain revenue, and stretch scarce specialists—if broadband and payment are stable. HaH can add capacity and improve experience for a subset of patients, however it demands significant initial sunk costs for logistics and workforce that most rural hospitals lack. We end by sharing innovative solutions for telehealth and HaH that are currently being developed to overcome challenges to help prevent rural hospitals from closing. Strategically deployed, telehealth and HaH infrastructure can function as a distributed care network that stabilizes rural hospital ecosystems, sustains rural health continuity of care, mitigates widening disparities in healthcare access/outcomes between urban and rural communities, and increases overall healthcare system resilience.