More as­sis­tance on the way?

Modern Healthcare - - Special Report -

Based on the reg­u­la­tions re­leased so far for the Pa­tient Pro­tec­tion and Affordable Care Act, the law’s ma­jor com­po­nents aren’t likely to be adopted very soon by more than a few providers in ru­ral ar­eas.

And at least one of its cre­ations, the In­de­pen­dent Pay­ment Ad­vi­sory Board, threat­ens to make life harder for crit­i­calac­cess hos­pi­tals than for other types by ex­pos­ing those hos­pi­tals to cost-cut­ting re­view be­fore oth­ers.

How­ever, ru­ral providers may even­tu­ally be the sub­ject of demon­stra­tion projects that could be ex­panded if deemed a suc­cess. The crit­i­cal-ac­cess hos­pi­tal pro­gram, which uses en­hanced Medi­care re­im­burse­ment to re­ward qual­i­fy­ing hos­pi­tals, is one of the ru­ral suc­cess sto­ries in that re­gard, hav­ing been cre­ated out of demon­stra­tion projects. And Medi­care has shown a propen­sity over the years to try to help ru­ral hos­pi­tals with spe­cial needs (See chart).

One group of hos­pi­tals un­der the mi­cro­scope even be­fore the re­form law was passed are fron­tier crit­i­cal-ac­cess hos­pi­tals, which are very small crit­i­cal-ac­cess hos­pi­tals. They are at the cen­ter of the fed­er­ally funded Fron­tier Com­mu­nity Health In­te­gra­tion Demon­stra­tion Pro­gram. By the pro­gram’s def­i­ni­tion, a fron­tier hos­pi­tal must have an av­er­age daily in­pa­tient cen­sus of five or less, be in a state that is sparsely pop­u­lated and of­fer at least one of physi­cian ser­vices, home health or hospice.

“The crit­i­cal-ac­cess world is just not work­ing with a real small hos­pi­tal,” says Larry Put­nam, pro­ject di­rec­tor for the Fron­tier Com­mu­nity Health demo work­ing through MHA, an As­so­ci­a­tion of Mon­tana Health­care Providers, He­lena.

The goal of the pro­ject is to come up with a plan to re­struc­ture re­im­burse­ment and sim­plify reg­u­la­tion for the tiny hos­pi­tals, he says. “We’re


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