HJAR Nov/Dec 2025

44 NOV / DEC 2025 I  HEALTHCARE JOURNAL OF ARKANSAS RURAL HEALTH COLUMN RURAL HEALTH RURAL HOSPITALS are the lifeline of healthcare access in much of Arkansas, yet many are struggling to survive due to low patient volumes and unrelenting financial pressures. Over the past decade, rural hos- pital closures have become a national con- cern, with nearly 140 rural hospitals across the United States closing since 2010, thereby undermining local access to care and desta- bilizing regional economies. Arkansas is not immune to these chal- lenges. Most counties in the state have only one hospital, and some have none at all. To address this growing crisis, policy- makers and hospital leaders are exploring federal hospital designations that can tailor services and funding to the needs and ge- ography of rural communities. In Arkan- sas, three designations define the hospital landscape: traditional Prospective Payment System (PPS) hospitals, Critical Access Hos- pitals (CAHs), and the new Rural Emergency Hospitals (REHs). The newest designation — the REH — has already begun reshaping access in rural Ar- kansas. The state’s first Rural Emergency Hospital opened in late 2023, and as of late 2025, five hospitals operate under the REH model. One example is DeWitt Hospital and Nursing Home inArkansas County, a Delta- region facility that converted from CAH to REH in 2024. The administrator reports that the conversion has been entirely successful, citing the additional Medicare funding as a key boost to the hospital and its attached nursing home. With REH designation, De- Witt introduced new outpatient services such as cardiology and wound care — bet- ter meeting local needs while maintaining financial stability. This article examines the pros and cons of these designations and proposes a strategic, data-driven approach to aligning hospital size and status with the unique character- istics of Arkansas’s rural and Delta regions. DETERMINING THE MOST APPROPRIATE DESIGNATION Choosing the appropriate designation — CAH, REH, or remaining a standard PPS hospital — comes down to aligning each hos- pital’s capabilities with community health- care needs and geographic realities. There is no one-size-fits-all solution. Healthcare leaders in Arkansas recognize that these decisions require data and dialogue, taking into account several essential metrics and community characteristics that shape both access and financial sustainability. Distance to other hospitals is one of the Aligning &Optimizing Arkansas’s Hospital Designations: POLICY, AUTHORITY, AND ACCESS