“It’s Harder Than Ever”: Tina Burbine on The Myriad Challenges Facing Rural Health Facilities - And How One Organization Is Addressing It
Tina Burbine, co-founder of the Rural Health Community, offers a ground-level view of what is happening in facilities that serve rural America — and what health system leaders need to know.
When CMS announced the Rural Health Transformation Fund in December of 2025, there was a sense that a turning point had arrived. And while there was a lot of excitement initially about what it could mean for communities lacking in resources, there were also questions.
Tina Burbine, co-founder of the Rural Health Community and long-time advocate for underserved communities, was happy to provide context.
The funds, in fact, “are a really small percentage overall compared to the Medicaid cuts that are directly impacting the rural health facilities. It’s a math game we’re still trying to solve,” she said.
Unfortunately, it’s just one of many. “Not only do we have all of these barriers around the hospital closures, the payer mix being complicated, and critical services closing more and more, but the reimbursement landscape continues to change and shift,” she noted. “It’s harder than ever to keep the doors open.”
Recently, Burbine shared insights with This Week Health about the complex funding picture, the rapidly growing AI gap, and the changes she’d like to see to vendor models in order to better serve those in rural areas.
Funding Complexities
“One of the biggest misconceptions I would love to help demystify is that the funding has been pushed from CMS to the states,” she noted. “The states had to choose back in Q3, Q4 of 2025 what initiatives they wanted to bring forward, which had to align with the five pillars that CMS outlined. And things are moving a lot slower than most people anticipated.”
Further, funding doesn’t go directly to facilities; it flows through states, which have the autonomy to greenlight certain initiatives – for example, expanding EMS services – that may not directly impact rural facilities.
State hospital associations are another variable, Burbine said, as they “don’t always have the same priorities that our rural health facilities do. And so, that creates added complexity in all of these conversations.”
That complexity was a key impetus behind the Rural Health Community. Established three years ago in partnership with Microsoft Elevate, the organization is provider-led and focuses on five primary areas: infrastructure, satellite bandwidth, AI and innovation, cybersecurity, and business continuity.
The Growing AI Gap
Of those priorities, the most that generates the most excitement is AI, which is most commonly tapped for clinical documentation in rural settings. In other cases, however, adoption lags compared with larger organizations – for unsurprising reasons.
“Oftentimes, rural health providers don’t have the time or budget to filter through what makes sense for their environments,” Burbine explained. Instead, they’re seeing what their current vendors are offering in terms of AI, and they have to wait and understand what’s going to be made available to them through the ecosystem they’ve invested in. Those two things combined really make it challenging.”
For the Rural Health Community, this solidified the need to provide clarity around AI. To that end, they surveyed providers, and learned that claims denial – and specifically, the manual work it required – was a major roadblock. And so, the nonprofit developed a tool that analyzes denial patterns across different EHR and revenue cycle platforms and provides data for frontline teams.
“We Have to Move Fast”
They’ve also developed an AI Launchpad toolkit that includes tailored governance structures, charters, and policies to help guide organizations, and is beta-testing an application that tracks active AI use cases and monitors ROI. “If metrics aren’t being met over time, there are decision points that can get documented explaining why,” Burbine said. “We have to move fast and be able to decide, if something’s not valuable to the team, let’s not continue investing in it.”
Because there are enough areas that do need the investment. One of those, she noted, is AI-assisted retinopathy screening, which some organizations are leveraging to more quickly analyze images and reserve specialist referrals – often a two-hour drive – for patients who actually need them. “The fact that we can focus on the patients that only absolutely require it is what’s beneficial to our rural communities,” she said. “We’re trying to drive out tools, best practices, policies, and frameworks that our rural health friends need to function.”
Infrastructure First
Of course, before rural facilities can modernize, the foundational gaps have to be addressed – one of which is connectivity. “We don’t have the infrastructure outside of the urban areas for redundancy,” Burbine said.
To that end, the Rural Health Community provides heavily discounted satellite bandwidth, which has become one of its most commonly requested services – and has yielded improvements for many facilities.
“We’ve heard all kinds of success stories from mobile health units, mobile dental units, virtual care access points being set up in schools, libraries, senior citizen centers,” she said. “It brings tears to my eyes when I hear teams say, ‘because of this, it was feasible to budget, and here’s what we’ve been able to do as a result.’”
Another challenge for resource-strapped organizations is cybersecurity, Burbine noted, adding that most rural health organizations don’t have a dedicated CISO. “We may have an IT director and a COO trying to wear multiple hats and work through that responsibility together,” despite having dozens of other tasks on the docket. “That’s a major weak spot for almost every rural health facility right now.”
“A Whole Different Approach”
And it’s one that isn’t often recognized, despite the spotlight that’s been shone on rural health in recent years. “I’m still surprised by a lot of our technology partners that don’t understand the complexities of how our rural health systems have to function,” she said.
Although there are grants available to jump-start programs, the funding eventually dries up, leaving organizations back at the starting line. “Most don’t understand how tight the margins are,” Burbine said. “When you think about a rural health facility having to decide, do we keep the lights on or do we buy that $100,000 switch – odds are the choice is going to be made to keep the lights on. That’s part of the challenge.”
It’s one she understands well, having lived and worked in a small mountain community in Colorado for several years. “In rural health, we’re not just worrying about the facility. We’re engaged in the community every day. It’s a whole different approach.”
For more information about the Rural Health Community, click here.
