AHA opens the door to hospital access strategies

The integration of rural hospitals with health clinics and the use of technology to provide 24/7 care are among the strategies developed by an American Hospital Association task force to assist hospital leaders with preserving access to health services in vulnerable rural and urban communities. The strategies set out in the task force’s report are designed to assist providers amidst growing pressures on the health care sector. The report recommends reforms for health care delivery and payment designed to identify and provide the essential health care services individuals need. The report also considers policies which may serve as a barrier to implementation of the strategies.

Status quo

The country has nearly 2,000 rural community hospitals and more than 2,000 urban community hospitals. Because of their location, the hospitals are what the AHA calls “the anchor for their area’s health-related services.” The report notes, however, that the hospitals face challenges in the form of: remote location, limited workforce, constrained resources, and financial instability. The survival of the hospitals is important because the hospitals serve as a critical health care access point in vulnerable communities.


To assist the hospitals, the task force identified: characteristics and parameters for vulnerable communities, essential health care services, and emerging strategies to ensure the hospitals are able to provide those essential services. The nine strategies include:

  • addressing the social determinants of health (housing, utility needs, food insecurity, interpersonal violence, education, employment, low income);
  • implementing global budget payments, which provide greater financial certainty for vulnerable hospitals;
  • shifting inpatient resources to resources devoted to outpatient care;
  • the use of emergency medical centers to allow existing facilities to provide emergency medical services without having to maintain inpatient beds;
  • the use of urgent care centers as a viable outpatient alternative to emergency medical centers and inpatient hospitals;
  • implementing virtual care strategies like telehealth;
  • the creation of local, integrated health care organizations (called Frontier Health Systems) for very small, isolated frontier communities;
  • integration between rural hospitals and health clinics like Federally Qualified Health Centers (FQHCs); and
  • improved coordination between Indian Health Service (IHS) facilities and other providers.


The task force acknowledged several barriers to the implementation of its strategies, including federal statutory and regulatory barriers. Additionally, the task force noted that certain facilities may have difficulty transitioning to new payment models or novel care delivery mechanisms like telehealth. The AHA acknowledged that the ability to attract and retain health care providers will continue to be a difficulty at the community level. To be successful, the AHA report notes that communities will need to expend time, effort, and finances, while hospitals will need to improve technology infrastructures and care planning.