More assistance on the way?
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