This article explores the use of a new governance approach in the context of American acute care hospital regulation, specifically focusing on the core regulatory process of licensure. This article calls for the alteration of current command and control regulations through the adoption of a four-part revisionist licensing model. The model seeks to reinvigorate the licensing process by making it not only more relevant to efficient operations, but also adaptable to current industry challenges. Based generally on alternative regulatory models such as responsive regulation, meta-regulation, and management-based regulation, the revisionist licensing proposal is driven by the broad goals of bureaucratic reduction, participatory regulation, and more focused obligations. Elements of the model include refocusing on baseline requirements, problem identification and correction, negotiated obligations, and alteration of the structure of oversight. Specific application examples are provided in the areas of charity care and health planning.