Community hospitals and Critical Access Hospitals (CAHs) are essential to America’s healthcare system — providing emergency care, primary care, behavioral health services, and preventive care to millions of people in rural and underserved regions.
But today, these institutions are under sustained pressure across every dimension of operations: financial performance, workforce capacity, regulatory compliance, infrastructure, and service delivery.
While providing a comprehensive view of the forces shaping rural hospital viability, this guide explores those challenges in depth and outlines practical strategies for long-term sustainability.
Co-chair of Barnes & Thornburg’s
Private Funds and Asset Management Group
Scott Beal
A year and a half away from the FTX collapse, we’ve seen significant recoveries in bitcoin and other cryptocurrencies. The SEC’s approval of bitcoin ETFs is a big deal for the industry and may also increase the willingness of allocators to make investments in private crypto funds and other nonregulated products.
Barnes & Thornburg’s 2024 Investment Funds Outlook Report
Get the full Barnes & Thornburg Investment Funds Outlook Report
There are numerous instances where incorporating AI could benefit fund managers, from market analysis to automating research processes to simply freeing up managers’ time. It follows that such technologies will have a positive overall impact on fund performance.
Anchors Under Pressure
Across all areas, one reality is clear: challenges are interconnected and reinforcing:
Breaking this cycle requires coordinated action across policy, operations, and partnership models.
Financial Sustainability – Reimbursement pressures, rising costs, declining volumes, and policy and partnership strategies to stabilize rural hospital finances
Workforce Challenges – Staffing shortages, compensation gaps, and pipeline limitations, plus solutions like loan forgiveness, residency programs, telehealth, and advanced practice providers
Regulatory Burden – Compliance demands that strain small hospitals, including reporting, CMS requirements, cybersecurity, and shared-services approaches
Infrastructure and Technology – Aging facilities, Electronic Health Record (EHR) and interoperability costs, cybersecurity risks, and collaborative funding and procurement models
Access to Care – Service line reductions, declining volumes, and strategies like telehealth, mobile care, and regulatory reform to preserve local services
Governance and Partnerships – Board leadership, community engagement, and affiliation models that connect rural hospitals to larger systems while preserving local control
Rural hospital and health system executives
Healthcare strategy and planning teams
Payors and health plans
Community and economic development leaders
Who Should Read This
Explore the key drivers of rural hospital instability and operational risk.
What You’ll Learn
Key Themes in This Guide
Barnes & Thornburg stands out because of our deep healthcare and life sciences industry knowledge, paired with our practical and innovative advice. With more than 130 Healthcare Industry Practice attorneys in the firm, located across the country in 26 offices, we offer clients access to unmatched experience and subject-matter expertise.
Many of our healthcare attorneys have worked for federal and state regulatory and enforcement agencies, healthcare and life sciences companies, and hospitals and health systems. This allows us to understand the unique challenges of our clients and provide valuable guidance through the maze of complex statutes, shifting regulations, and compliance program needs on matters involving:
The Challenges Facing Community and Critical Access Hospitals and a Path Forward
DOWNLOAD THE guide
Financial pressure limits workforce investment.
Workforce shortages reduce service capacity.
Reduced services weaken revenue.
Infrastructure gaps compound inefficiency and risk.
Medicare and Medicaid
Internal and government investigations
Complex litigation (including commercial, criminal, and civil FCA litigation)
Data privacy and healthcare technology requirements
Managed care contracting
Payor disputes
Audits and reimbursement
Operational and regulatory questions
Mergers and acquisitions
Legal and compliance issues
We provide trusted guidance to your varied needs while minimizing risk and meeting business objectives. Our healthcare team includes more than 20 former U.S. Attorneys and Assistant U.S. Attorneys, along with a former supervisor and founding member of the DOJ’s Medicare Strike Force.
Additionally, we have significant experience representing healthcare providers, hospitals, health systems, clinical labs, pharmacies, PBMs, nursing homes, behavioral health organizations, health IT companies, pharmaceutical and medical device manufacturers, and others.