By Patrick Quinlan, MD

Nearly $10 billion in first-year Rural Health Transformation Program (RHTP) funding has been awarded, and states have already obligated approximately $4 billion of it, according to a new CMS report highlighted by Becker’s Hospital Review.

That’s a significant amount of money moving into rural healthcare. But having spent more than a decade leading Ochsner Health, one of the nation’s largest health systems, I would argue that the most important question isn’t how much has been allocated, obligated or spent.

It’s what rural hospitals will be able to do differently as a result.

If we spend billions modernizing rural healthcare but patients still can’t access specialist expertise, hospitals still lose revenue from avoidable transfers, and clinicians still struggle to deliver services their communities need, what exactly have we transformed?

Spending money is the easy part

The Becker’s article reveals just how differently states are approaching the first year of RHTP. Ten states had obligated at least 75% of their awards as of July 31, while 15 had obligated less than 10%. Two reported no obligations at all.

Perhaps more revealing, all reported obligations in six states were directed toward program operations, including staffing, administration, contracting and grant management.

Of course, building the infrastructure to administer a program of this scale takes time and resources. And CMS rightly cautions that the figures don’t provide a complete picture of state progress. A state that has obligated 80% of its funding isn’t necessarily further along in transforming rural care than one that has obligated 10%.

That’s precisely the point. We are tracking the movement of money because it’s relatively easy to measure. But dollars obligated tell us very little about whether healthcare is actually improving.

What should we be measuring?

If I were sitting in a rural hospital boardroom today, I would want to know how every major RHTP investment will improve three things: clinical capability, patient outcomes and financial sustainability.

Clinical capability: Can our clinicians deliver services they couldn’t deliver before? Can they access specialist expertise when and where it’s needed? Are we increasing the effective capacity of our existing workforce rather than depending entirely on recruiting clinicians who may never come?

Patient outcomes and access: Are patients receiving more appropriate care closer to home? Are we reducing avoidable transfers, unnecessary travel and delays in treatment? Can we demonstrate improvements in quality, safety and patient satisfaction?

Financial sustainability: Are we retaining more patient volume and revenue within the community? Are we improving the financial viability of essential clinical services? And, critically, will these improvements survive when RHTP funding ends in 2030?

These are the measures that should determine whether an investment is working. Technology installations, equipment purchases, training sessions and project milestones all have their place, but they are steps toward an outcome, not the outcome itself.

Accountability needs to go beyond compliance

A recent Government Accountability Office report describes CMS’s plans to monitor RHTP implementation through progress reviews, audits, site visits and performance reporting. Future funding will also depend in part on states demonstrating satisfactory progress toward approved initiatives.

That’s appropriate. With $50 billion in public funding at stake, rigorous oversight is essential. But implementing a project according to plan is no guarantee that it will improve rural healthcare.

A hospital can successfully install a new technology platform without increasing the number of patients it treats. A state can meet its workforce training targets without meaningfully improving access to specialist care. A new facility can open on schedule and on budget while the underlying clinical and financial challenges remain.

None of those investments is necessarily wrong. But unless we measure their impact on care delivery and hospital performance, we may not know whether they were the right investments.

Invest in capability, not just infrastructure

At Hippo Virtual Care, we’ve focused on one of the most persistent barriers to rural healthcare: the limited availability of specialist expertise.

Our Coactive Care™ model enables a local clinician or healthcare worker to collaborate with a remote physician or specialist at the patient’s point of care. Using voice-activated augmented reality technology, the specialist sees what the local clinician sees and can provide guidance in real time.

The potential impact can be measured in practical terms: how many patients can now receive appropriate care locally, how many avoidable transfers can be prevented, how much additional clinical capacity is created, and what that means for hospital revenue and operating performance.

Equally important, when specialists work alongside rural clinicians, they help develop local skills and confidence, building capability that can continue delivering value long after the initial investment.

This is the kind of transformation I believe RHTP should be encouraging: investments that change what clinicians and hospitals can accomplish, with results that can be tracked from implementation onward.

What will we have to show for $50 billion?

By 2030, every state should be able to answer some straightforward questions. Do rural patients have better access to care? Can rural hospitals deliver more services safely and sustainably? Are clinicians better supported? Have we strengthened the financial viability of rural healthcare?

The answers won’t come from expenditure reports alone.

We have an extraordinary opportunity to rethink how rural healthcare is delivered, and states are right to invest in the infrastructure, technology and workforce required to support that change. But we should establish the measures of success now, while there is still time to direct resources toward approaches that demonstrate results.

The real measure of rural health transformation won’t be how much of the $50 billion we spend. It will be how much better rural healthcare becomes because we spent it.

To learn more about how Hippo Virtual Care is helping rural hospitals expand clinical capability, improve access to specialist expertise and strengthen rural care delivery, contact me at pat@myhippo.life.