The study, however, suggests that the government could help reduce risk by passing the Rural Emergency Acute Care Hospital (REACH) Act. Reintroduced in 2017, the legislation would create a new Medicare classification under which critical access hospitals could reduce excess inpatient beds and focus more on outpatient services. The Act has yet to be voted on by the appropriate committee.

It also recommends that providers collaborate with state legislators to develop state-based Medicare demonstration waivers that alter local and regional rules around inpatient beds and emergency designation. In addition, many should seek out partnerships with tertiary and academic health systems to scale their enterprises; invest in telehealth, revenue cycle, EHRs, human capital, physician training and clinical optimization; and work with board members and community leaders to promote and sustain local hospitals and retain outmigrating patients.


"The pandemic has shown the power of state-level responses to healthcare issues, and now is the time for elected officials at all levels to dig into a crisis of care that has been lingering for decades," said Gaskell.

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