Rural hospitals face greater challenges Image By Tom Morris This is a lightly edited excerpt of testimony recently provided to the U.S. House of Representatives’ Energy and Commerce Health Subcommittee during the hearing “Legislative Proposals to Maintain and Improve the Public Health Workforce, Rural Health and Over-the-Counter Medicines.” Rural communities across the United States continue to face longstanding health challenges that affect access to care, quality of services and health outcomes. HHS data shows that rural areas experience lower life expectancy and higher mortality, including elevated rates of avoidable or excess deaths from the five leading causes: cancer, chronic lower respiratory disease, unintentional injury, heart disease and stroke. Geographic isolation, aging infrastructure and persistent workforce shortages make it difficult for rural residents to receive timely, coordinated care. Access to maternal and behavioral health services is especially strained, and many rural hospitals and clinics are forced to operate under growing financial pressure. These realities leave too many communities without consistent access to primary care, specialty services, or coordinated systems of support. These challenges underscore the need for targeted, community-driven solutions. That is why HRSA’s rural health programs are so critical. They help build local capacity, strengthen partnerships, support quality improvement, and expand telehealth — ensuring that rural communities have the tools and infrastructure they need to deliver high-quality care and improve health outcomes over the long term. Congress showed great foresight in creating the Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement Programs, building in flexibility that allows communities to determine how best to use the funds to meet local needs. This structure reflects a clear recognition by the original authorizers that while rural communities face a wide range of challenges, they also bring forward innovative, locally driven solutions. The Outreach Program provides start-up funding to support partnerships that address issues such as maternal health, chronic disease, behavioral health and workforce shortages. In Fiscal Year 2023, Outreach Program grantees served over 522,000 individuals across 345 rural counties. Economic analysis shows that for every dollar invested, these programs generate approximately $2 in community economic benefits, demonstrating their dual impact on health outcomes and local economies. A leading example is the recent effort to improve access to and coordination of maternal health services. HHS-funded research has documented the continued loss of inpatient obstetric services in rural hospitals, alongside persistent challenges related to preterm birth, maternal mortality and infant mortality. In response, HHS launched a new approach in 2020 through the Rural Health Outreach program — the Rural Maternity and Obstetrics Management Strategies (R-MOMS) initiative — which aimed to connect rural hospitals, clinics and tertiary care providers to deliver coordinated maternal care. The success of this model led Congress to authorize the Rural MOMS program in 2022 under section 330A-2 of the Public Health Service Act. The Network Development Program fosters collaboration among health care providers, public health entities and social service organizations. These networks improve care coordination, enhance service delivery and strengthen sustainability. Notably, 98% of FY 2023 Network Development grantees reported they would sustain all or part of their projects beyond the period of federal funding. In FY 2023, 100% of Delta States Rural Development Network grantees reporting on clinical measures showed improvement in at least one area, including diabetes control, blood pressure, tobacco use and BMI. These outcomes are especially meaningful in regions with elevated rates of chronic disease and avoidable mortality. The Small Health Care Provider Quality Improvement Program strengthens the capacity of rural clinics and health centers to implement evidence-based quality improvement strategies and transition toward value-based care. Grantees use funding to improve clinical performance, patient engagement, and care coordination, with a focus on priority areas such as maternal and infant health, diabetes management, hypertension control and behavioral health integration. These investments ensure that rural providers remain viable and that high-quality care is available close to home for all Americans. HRSA is deeply grateful for the committee’s bipartisan support and its long-standing commitment to rural and underserved communities. The timely reauthorization and continued investment in our rural and telehealth programs will make a measurable difference in the health and well-being of millions of Americans living in rural areas. Read his complete statement here. Listen to an excerpt of his testimony here. Tom Morris is the associate administrator for Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services. *The opinions expressed in this column are those of the author and do not necessarily reflect the views of HealthPlatform.News.
