New research from The University of Texas at Arlington examines the widening health care gap between rural and urban communities and how the Centers for Medicare and Medicaid Services' Rural Emergency Hospital (REH) program, launched Jan. 1, 2023, is helping address the crisis.
"We need to continue to spotlight the challenges faced by our rural communities so that these persistent problems can be addressed," said Suzanne B. Daly, assistant professor of research at UT Arlington.
Dr. Daly, along with UTA nursing professor Elizabeth Merwin and statistician Wei You, published their findings in The Journal for Rural Health. The study highlights the severity of the rural health crisis: 111 rural hospitals have closed nationwide since 2005. Texas, home to the nation's largest rural population, about 3 million residents, has seen 20 closures during that time, and 13% of the state's 159 remaining facilities are at "immediate" risk of closing, according to the Center for Healthcare Quality and Payment Reform.
"Many rural hospitals close due to serious financial challenges," Daly said. "The driving idea for the REH program is that the REH model will provide rural hospitals with financial stability while also ensuring rural communities have access to basic health care via the emergency department and certain outpatient services."
Under the REH program, rural hospitals eliminate inpatient care and focus solely on emergency and outpatient services. Participating hospitals must have been open and licensed Medicare providers on Dec. 27, 2020, maintain a transfer agreement with a Level I or Level II trauma center, and meet specific emergency department staffing requirements.
The model still faces obstacles. Eliminating inpatient services can be a barrier for some rural hospitals, particularly in areas with older populations where the local hospital is often the only inpatient provider. Transportation also remains a significant hurdle for patients in remote regions.
In Texas, five hospitals have converted to REH status, but one closed entirely just nine months after making the switch.
"A lot of this comes down to funding, and, unfortunately, rural communities generally have less funding," Daly said.
She added that more research is warranted to understand the REH program's impact.
"We really need a true understanding of what is happening in the new Rural Emergency Hospitals and the communities they serve," Daly said. "Are we seeing access-to-care issues? What is happening with transportation? What is happening with the hospitals themselves? Are they financially stable or do they continue to experience problems? What is driving hospital leaders' decisions to convert or not convert?
"There are many unknowns with this program. We need more time and in-depth research to determine its effects on rural communities and health care access."
About The University of Texas at Arlington (UTA)
Celebrating its 130th anniversary in 2025, The University of Texas at Arlington is a growing public research university in the heart of the thriving Dallas-Fort Worth metroplex. With a student body of over 42,700, UTA is the second-largest institution in the University of Texas System, offering more than 180 undergraduate and graduate degree programs. Recognized as a Carnegie R-1 university, UTA stands among the nation's top 5% of institutions for research activity. UTA and its 280,000 alumni generate an annual economic impact of $28.8 billion for the state. The University has received the Innovation and Economic Prosperity designation from the Association of Public and Land Grant Universities and has earned recognition for its focus on student access and success, considered key drivers to economic growth and social progress for North Texas and beyond.
