The industry is currently facing a pivotal transition in 2026, bracing for the expected impact of Medicaid cutbacks, shrinking reimbursements, staffing challenges, and operational costs that continue to soar. With a predicted tsunami of uncompensated care expenses, many healthcare leaders are constantly forced to weigh financial survival (“margin”) against a commitment to serving vulnerable populations (“mission”). Here is the hard truth I shared at a recent HFMA Region 2 conference: You cannot simply cut your way to sustainability. When we ignore the widening gap between major health systems and rural providers, we ignore a multibillion-dollar drain on our industry. Solving health equity isn’t just a moral imperative anymore; it’s a financial necessity that requires a strong ROI

The Haves and the Have-Nots

We need to be honest about the digital divide in our industry.

On one side, we have the “Digital Haves.” These are the large Integrated Delivery Networks (IDNs) and hospitals running on sophisticated EHRs like Epic. They share data seamlessly—Epic to Epic. In most instances, it works beautifully.

On the other side, we have the “Digital Have-Nots.” These are our rural hospitals, Critical Access Hospitals (CAHs), skilled nursing facilities (SNFs), and behavioral health clinics. They might be using outdated, uncertified EHRs, homegrown solutions, or even paper-based processes.

Here is where the breakdown happens. When a patient is discharged from a high-tech “Have” facility to a low-tech “Have-Not” facility, the data often stops flowing. I’ve seen large IDNs threaten to stop referring patients to community clinics simply because those clinics couldn’t ingest digital discharge instructions.

The result? Delays in care and bad transitions ranging from 1 to 5 days. During that time, a patient’s health can deteriorate, leading to readmissions. Deloitte estimates that health inequities are costing the industry $320 billion annually. That is a cost we simply cannot afford to ignore.

The Unstructured Data Trap

A lot of well-meaning policy focuses on “Axing the Fax.” But we have to look at reality.

70% of all healthcare data remains unstructured, and nearly 50% of that is still sent via digital cloud fax and growing as providers are getting rid of paper.

When we tell rural providers they have to buy expensive, certified EHRs to participate in the modern ecosystem, we are asking them to climb a mountain without the right gear. They don’t have the funding. So, they stick to what they know: the fax machine.

This creates a massive bottleneck. Nurses are standing at fax machines instead of treating patients. Data is being manually entered, leading to errors. We are using highly skilled clinical staff for data entry, which is a terrible use of resources and a huge driver of burnout.

AI as the Great Equalizer

So, how do we bridge this gap without bankrupting rural health? The answer isn’t ripping and replacing infrastructure; it’s modernizing the workflow with intelligent data extraction.

We are now using AI – like machine learning and Natural Language Processing (NLP) – to turn “low-tech” inputs into “high-tech” value.

Imagine a rural clinic sends a digital fax, for example, a referral or a prior authorization request. Instead of that document sitting in a queue, AI intercepts it. It reads the image, extracting critical unstructured data like patient demographics, document type, and clinical results. It then wraps that data in a standard format (like FHIR or X12) and delivers it directly into the receiving hospital’s EHR.

The rural provider keeps their low-cost workflow. The large health system gets the structured data it needs to deliver care or for population health analytics. Everyone wins, and most importantly, the patient gets continuity of care.

The ROI is Real

For the financial leaders reading this, this expands far beyond doing right for the sake of the patient. The Return on Investment (ROI) is tangible.

• Data Entry Reduction: We’ve seen a 70% reduction in manual data entry tasks.
• Speed to Care: In a case study with the Symphony Post Acute Network, the time to process a single piece of information dropped from 5 minutes to just 30 seconds.
• Financial Impact: That same network realized $2.75 million in value through time savings and improved referral management.

When you automate the administrative burden, you free up your staff to do what they do best: care for patients. You also stop losing revenue from lost referrals and denied claims due to missing information.

A Moral and Financial Imperative

We are at a crossroads. As margins shrink, hospitals are making heartbreaking decisions to cut service lines like behavioral health—often the very services our underserved communities need most.

But there is hope. The Rural Health Transformation (RHT) program grants are allocating $25 billion to states, with specific provisions for technology modernization. This is an immediate opportunity to fund the kind of AI-driven interoperability that bridges the gap between the Haves and Have-Nots.We don’t need to leave rural America behind. By investing in tech equity, we can protect our margins and fulfill our mission. Let’s figure this out together.

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