Opinion: The Rural Health Transformation Program could fail patients like mine

STAT News · Feb 25, 2026 · Collected from RSS

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I always feel a heightened awareness as I navigate a catheter through the right side of the heart and into the pulmonary artery, the blood vessel carrying blood flow into the lungs. It’s a three-dimensional trip, tracked in two dimensions on fluoroscopy. Because of the strain a pulmonary embolism puts on the heart, the anatomy is distorted. While watching on the screen, I make small movements and slowly advance to find the right trajectory. The catheter jumps into position. The rest of the procedure feels calm in comparison. I use a wire to save the position and shift to a different catheter. This one is essentially a fancy vacuum. Once it is in place, I suction the clot out from the large branches that provide blood flow to the lungs. My patient’s racing heart rate returns to normal before we leave the operating room. He is home within a couple of days. This advanced procedure is the most exciting part of the story, but it is not the most important. Like in much of life, the pivotal moments in medicine are quiet and unassuming. Two hours before the drama in the operating room, this patient showed up at his local emergency department in North Georgia complaining of chest pain and trouble breathing. After a promptly obtained scan showed an extensive clot in the main pulmonary artery and straddling the branches into the right and left lungs, the emergency physician started blood thinners and called me. The quick evaluation and initiation of medications made the advanced procedure he received later that night possible. This doorway to advanced procedures is closing for rural populations as their local hospitals close. Pulmonary embolism doesn’t receive as much attention as heart attack and stroke, but it is the third leading cause of cardiovascular mortality. (Actress Catherine O’Hara recently died from a pulmonary embolism caused by rectal cancer.) Until recently, the only treatment available was blood thinners, and, in severe cases, clot busting medications. In 2018, the FDA approved the first device to clear clot and interventional treatment began gaining popularity. Blood thinners have remained the standard of care, however. An industry-funded trial published in November 2025 showed the superiority of mechanically clearing clots over use of blood thinners alone in certain high risk patients with evidence of heart strain. Further data are crucial, but this is an important first step in support of improving the technology and options available to treat this condition. The technology is only part of the story, however. Amazing tools that cannot reach the patients who need them are futile. My patient went to the emergency department closest to him. The hospital did not have the tools to suction out the clot. Even if it did, it doesn’t have the infrastructure or specialists to deploy them. It was, however, able to rapidly make a diagnosis and start blood thinners. Starting these medications quickly has a large impact on survival. After that important step, he was transferred to me for definitive care. If his local hospital were closed, he would have been forced to make a 90-mile trek before getting any treatment. He might not have survived the trip. According to a Center for Healthcare Quality and Payment Reform report, 756 hospitals in the rural United States are at risk for closure based on inadequate financial reserves. That’s more than a third of rural hospitals in the country. Of these, 323 are at risk of closing within the next three years. Despite limited resources that can prevent access to the most advanced technology, these hospitals serve as a critical entry point for patients with emergency conditions who are far from large tertiary centers. Maintaining the capacity to provide care close to home for rural patients is critical, but it’s under threat. I have seen some optimism in the wake of Centers for Medicare and Medicaid Services Administrator Mehmet Oz’s announcement on Dec. 29 regarding funding awards for all 50 states under the Rural Health Transformation (RHT) Program. Many hope that this funding will save rural hospitals that serve patients like mine. I remain skeptical. While this program allocates $50 billion to rural health over five years, the One Big Beautiful Bill Act (OBBBA), which created the program, will result in $58 billion in Medicaid cuts over the next decade. When paired with the failure to extend Affordable Care Act tax credits, this increases to an $87 billion loss in revenue for rural hospitals. While these losses, related to a high proportion of uninsured and underinsured patients, are ongoing, the RHT program is set to end after those initial five years. At best, this program will delay ongoing rural hospital closures. Because the funds cannot be used to stabilize struggling hospitals, it may not even do that. The RHT program was created as a response to the Medicaid cuts in the OBBBA. The proposed policy changes to Medicaid were predicted to result in substantial harm to rural communities and hospitals. The RHT program was added to the final bill as a compromise, with the goal of modernizing and stabilizing rural health care. States were required to submit a one-time application with details about their rural health transformation plans to CMS, which then distributes the grants. These plans had to detail specific initiatives, workforce strategies, and technology investments with the goal of improving rural health. Specifically, the funds must be used to address five pillars. Make Rural America Healthy Again is focused on preventative care and improved management of chronic disease and behavioral health. Sustainable access involves finding new operating models, such as coordination with larger regional systems, to avoid closure. Workforce development refers to investment in recruiting and retaining health care workers. Innovative care models encourages value-based care which rewards improved outcomes rather than increased volume. Finally, technology innovation focuses on funding to expand telehealth, remote monitoring, and robotics. There are promising aspects of the program. The focus on improved management of chronic disease may reduce the need for preventable high cost care. Investments in technology and infrastructure can improve access. When paired with a focus on developing the workforce and retention incentives, we may be able to offer specialized care in more remote areas. Finally, the state-led nature of the program allows for flexibility and innovations. Empowering local communities to devise plans that suit their needs will maximize impact. What works in Georgia may not be the same thing that works in Alaska. It is unfortunate that these good ideas were paired with a bill that will undermine them by taking more funding than it gives. This will fuel an already ongoing crisis. Putting money toward improving infrastructure and modernization won’t go very far in hospitals that are barely scraping by. Even if this succeeds, deploying innovating technology requires a specialized workforce. While the RHT program allows for initiatives to recruit this workforce, retention will be a problem in five years when the funds run dry. I worry that we’ll fall short on expanding the reach of innovation while also accelerating hospital closures. Even when some technology isn’t available, these hospitals provide a local entryway into the system and a route to access advanced techniques by transfer to regional centers. Without these local entry points, access will be restricted for rural residents. I spent part of my surgical training in rural eastern North Carolina, and the first few years of my career as a vascular surgeon in rural southwestern Virginia. These days I’m in North Georgia and continue to see a significant number of patients from rural areas. The ability to provide equitable care regardless of personal characteristics including socioeconomic status and geography isn’t just a pillar of health care quality. It is a moral imperative. The ability to pull a clot out of the blood vessels to the lung with nothing more than a small incision in the groin is remarkable. This technology is rapidly evolving and I am excited to see how it continues to change in the coming years. However, none of it means much if we cannot get it to the patients in need. Daniel Torrent is a vascular surgeon with the Longstreet Clinic at Northeast Georgia Health Systems.