Rural Transformation Dollars Should Fuel Real-Time Capacity Systems—Not the Status Quo

Here we are, December 1st. Over the past several months, I’ve been in conversations with dozens of states as they prepare for the next significant milestone in rural health policy: the CMS Rural Hospital Transformation (RHT) Program. With awards expected to be announced by the end of the year, states are about to enter a rapid and consequential planning process—one that will determine not only how dollars are spent, but whether those investments position rural hospitals for long-term success or prolong the status quo.

This moment matters. The decisions states make in the first quarter after awards land will shape their trajectory for the next decade. And one of the most innovative, most future-proof uses of these funds is investing in real-time capacity systems. This statewide infrastructure lets rural and urban facilities operate as a coordinated, patient-centered network.

Real-time capacity systems deliver measurable benefits for rural communities.

Most rural hospitals today rely on phone trees, spreadsheets, and manual workarounds to manage patient flow. That’s not a system—it’s improvisation. And improvisation is neither efficient nor sustainable, especially as rural hospitals face staffing shortages and increasing clinical complexity.  Did we learn anything through COVID?

When states implement a real-time capacity platform, the change is immediate. Rural transfers move faster. Emergency departments spend less time holding patients who should be admitted or transported. Swing-bed use increases as rural capacity finally becomes visible. Urban DRG hospitals can repatriate stabilized patients sooner, improving recovery and outcomes while reducing avoidable length of stay. These aren’t theoretical benefits—they’re real outcomes from states and regions that have already made this investment.

As CMS announces awards, states will need to choose partners wisely.

The RHT program gives states the resources to rethink system design—not just for rural hospitals, but for entire statewide care pathways. But with that comes a critical decision: who to partner with.

Today, several vendors operate in the real-time capacity space. Some offer partial visibility; a few offer holistic, statewide, future-ready platforms that support care coordination, predictive analytics, and alignment with federal interoperability efforts. States evaluating vendors must look far beyond feature lists and instead examine scalability, clinical workflow integration, governance models, and genuine operational impact.

Most important: this investment cannot be viewed solely as technological procurement. Technology without commitment to governance, workforce support, and process design won’t work.

Technology alone won’t transform rural care—people and governance will.

If there is one message I’ve heard consistently across states, it’s this: rural hospitals need help, not more complexity. Investing in a platform without investing in the ecosystem around it is a recipe for underuse.

States should be thinking now—well before the CMS dollars arrive—about four foundational elements:

• Training and clinical workflow alignment

• Thoughtful onboarding and change management

• Equitable, statewide shared governance

• Long-term sustainability strategies focused on outcomes, not one-time fixes

These elements are what separate successful statewide implementations from expensive but underutilized systems.

This is not a “build it, and they will come” moment.

This is not a “build it, and they will come” moment. Hospitals will not adopt statewide capacity tools simply because they exist; they will adopt them only when those systems clearly reduce manual work, streamline patient throughput, strengthen coordination, support clinicians, and deliver real value from day one. In most hospitals today—especially in rural settings—clinicians spend a substantial portion of their shift navigating manual workflows, making phone calls, updating spreadsheets, and coordinating bed placement, all of which pulls their time and attention away from direct patient care. Interfacility transfers can take many hours, sometimes stretching well beyond a single shift, and these delays are consistently associated with worse patient experiences and outcomes. At the same time, health systems that have implemented modern real-time capacity tools—whether in the U.S. or internationally—regularly report improvements in transfer times, reductions in avoidable inpatient days, and better use of available beds across the continuum, including swing beds and community hospital capacity.

The lesson is straightforward: a real-time capacity platform cannot be treated as a simple software installation. It only succeeds when it is paired with robust clinical training, shared governance, workflow redesign, and real operational support. A statewide capacity system is not just technology—it is an operating model that aligns people, processes, and purpose around better, faster, more coordinated patient care.

A rare opportunity for meaningful, lasting change

The CMS Rural Hospital Transformation Program represents one of the most significant opportunities in more than a decade to redesign rural care delivery. When the awards are announced at year-end, states will have a choice:

• Invest in short-term survival strategies, or

• Build the infrastructure that finally brings rural and urban hospitals together into a unified, resilient, real-time network.

  
  

If states take the long view—if they use these dollars to build the connective tissue of their health care ecosystem—they will see faster transfers, better outcomes, stronger local recovery, and a system that operates with clarity rather than chaos.

This is the moment to be bold. The RHT program is the catalyst. Real-time capacity systems are the foundation. And rural communities across the country are counting on all of us to get this right.