Survey of rural hospital executives reveals new insights on Rural Health Transformation Program (RHTP) and OBBBA impacts.
MOBILE, Ala.–(BUSINESS WIRE)–TruBridge, Inc. (NASDAQ: TBRG) (“TruBridge”), a leading provider of revenue cycle management and technology solutions for rural and community healthcare organizations, released a report today assessing how rural hospital executives view federal funding opportunities and shifting reimbursements. The report, “Rural Health at a Crossroads: How RHTP and OBBBA are Reshaping Local Healthcare,” details rural leaders sentiment surrounding the RHTP and the broader financial challenges shaped by the One Big Beautiful Bill Act (OBBBA).
The report’s results are based on live polling conducted during the Rural Health Collaborative event at the TruBridge National Client Conference in April 2026. Participants included rural and community hospital chief executive officers, chief financial officers, chief information officers, clinical leaders, and other senior executives representing critical access, community and rural hospitals.
The findings show broad support for the goals of the RHTP, with executives viewing the initiative as a stabilizing tool to improve care in underserved communities. However, respondents expressed concern that workforce shortages, reimbursement instability, coverage disruptions, and operational pressures could hinder the program’s success if left unaddressed.
Among the report’s key findings:
- Engagement in RHTP: Seven in ten respondents (70%) are either actively or moderately engaged in RHTP discussions.
- Influence and visibility: Many leaders are looking for more influence over planning and funding opportunities and seek clarity from states into how transformation will affect day-to-day care.
- Net financial impact: Forty-one percent (41%) believe it is too early to assess the net financial impact of the RHTP funding when weighed against reimbursement shifts, while 35% believe state Medicaid cuts will outpace RHTP subsidies over the five-year period.
- Operational priorities: Rural executives are prioritizing operational stability and financial resilience with a specific focus on service line stability in primary care, chronic disease management, and behavioral health.
- Workforce shortages: A quarter of respondents (24%) report service line impacts due to workforce fragility with only 18% possessing a steady clinical workforce.
According to the report, rural providers are actively participating in RHTP discussions. However, the report also highlights the challenge of aligning long-term policy ambitions with the operational realities of rural healthcare. While executives note that states are communicating RHTP plans, respondents emphasized that being informed about a program is not the same as having the power to shape decisions. A rational wait-and-see posture amid uncertain policy impacts leads to current-day sentiment.
The report found that rural leaders are most concerned about protecting the foundational services that sustain long-term community health, noting that primary care, chronic disease management and behavioral health are the most vulnerable. Executives warned that losing these preventative care services will inevitably drive-up patient acuity and costs overtime. Respondents are prioritizing investments in revenue cycle technology and billing automation to protect their financial stability amid rising uncompensated care pressures.
“The findings point to a critical reality in rural healthcare policy discussions today: transformation efforts cannot succeed if operational stability erodes faster than support arrives,” said Chris Fowler, CEO of TruBridge. “Rural providers are engaging in the process and want to help shape the future of care delivery, but they are also signaling that workforce sustainability, reimbursement stability and preservation of essential services must remain central to implementation decisions.”
Successful rural transformation efforts will require continued collaboration among providers, states and federal policymakers to help rural communities maintain access to essential services while long-term reforms take shape. The report includes analysis and recommendations for CMS, state policymakers and rural healthcare executives.
Rural Health at a Crossroads: How RHTP and OBBBA are Reshaping Local Healthcare is available at: https://trubridge.com/report
About TruBridge
TruBridge proudly supports rural and community hospitals and providers in their efforts to stay strong, independent and deeply rooted in the communities they serve. Backed by more than 45 years of healthcare experience and trusted by over 1,500 clients nationwide, TruBridge offers a mix of technology, services and strategic expertise, including revenue cycle management, electronic health records (EHR) and analytics, all designed singularly for the realities of rural and community healthcare. With a steadfast commitment to keeping care local, TruBridge helps hospitals flourish as the economic heart of their communities, delivering high-quality, personal care close to home. For more information, visit www.trubridge.com.
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Jamie Gier
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