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Yesterday, members of SBL Architecture attended a webinar hosted by the University of Texas at Arlington’s Rural Health Department, titled “The Ever-Changing Rural Hospital Landscape: What is the Role of the New Rural Emergency Hospital Designation Program.”

The discussion centered on one of the most pressing challenges in healthcare today: how rural hospitals can continue providing essential care while maintaining financial stability.  Since 2005, 110 rural hospitals have closed, with eight of those just since 2024. The newly established Rural Emergency Hospital (REH) designation was created to help address this issue.

Under the REH program, participating hospitals must maintain a staffed emergency department 24/7 and have a transfer agreement with a Level I or II trauma center.  These facilities do not provide acute inpatient care (other than skilled nursing services), but they do receive a monthly facility payment from Medicare of $285,625.90 in 2025, regardless of hospital size or patient volume.  This funding aims to help sustain emergency and outpatient services for vulnerable rural populations.

Since the program’s inception in 2023, 42 hospitals across the country have chosen to convert, including five in Texas: Crosbyton Hospital (the first in Texas and the nation to convert), Falls Community Hospital, Anson General Hospital, St. Luke’s Memorial Hospital in San Augustine, and St. Mark’s Medical Center. In total, over 1,700 hospitals nationwide are eligible for conversion.

While the benefits include preserving access to emergency care and expanding outpatient services such as imaging and mammography, the transition is not without challenges.  Rural communities often face difficult tradeoffs, including the loss of inpatient services, workforce reductions, and community concern over the change in available care.  Hospitals must also manage logistical questions related to patient transfers, follow-up care, and continuity of services.

As a firm deeply engaged in healthcare planning and design, SBL Architecture remains committed to understanding these evolving models of care.  We believe that informed, responsive design can help rural hospitals adapt to new realities, preserving access, promoting efficiency, and supporting the sustainability of healthcare in every community.