Crit­i­cal-ac­cess hos­pi­tals see lit­tle growth

Modern Healthcare - - CLASSIFIED MARKETPLACE - By Michael San­dler

De­spite the out­cry on Capi­tol Hill over ru­ral hos­pi­tal clos­ings, the num­ber of crit­i­cal-ac­cess hos­pi­tals in the U.S. grew slightly in the past year, ac­cord­ing to Mod­ern Healthcare mag­a­zine’s an­nual re­view of CMS data.

The uptick—there were 1,333 crit­i­cal-ac­cess hos­pi­tals as of Sept. 1, 2015, up from 1,321 in 2014—could be a prod­uct of hos­pi­tals in some states drop­ping in size to en­able them to switch their pay­ment des­ig­na­tion from the prospec­tive pay­ment sys­tem to crit­i­cal-ac­cess, said Sally Buck, CEO of the Duluth, Minn.-based Na­tional Ru­ral Health Re­source Cen­ter. The num­ber of crit­i­cal-ac­cess hos­pi­tals has hov­ered around 1,330 for sev­eral years with only mi­nor ad­just­ments be­cause of clo­sures and con­ver­sions, she said.

Crit­i­cal-ac­cess hos­pi­tals, which have 25 beds or fewer, have seen at least three clos­ings in three states this year. Ex­tend­ing the pro­gram that pro­vides ex­tra re­sources for small hos­pi­tals en­abled the num­ber of crit­i­cal-ac­cess hos­pi­tals to jump from 836 in 2003 to 1,302 in 2009, ac­cord­ing to the fed­eral Health Re­sources and Ser­vices Ad­min­is­tra­tion. Over­all, there have been 57 ru­ral hos­pi­tal clo­sures since Jan­uary 2010, ac­cord­ing to data from the Ce­cil G. Sheps Cen­ter for Health Ser­vices Re­search at the Univer­sity of North Carolina at Chapel Hill.

Sup­port for crit­i­cal-ac­cess hos­pi­tals has been in the Obama ad­min­is­tra­tion’s crosshairs for sev­eral years. This past year, the pres­i­dent’s bud­get pro­posed elim­i­nat­ing the ex­tra 1% of pay­ment over costs that go to the hos­pi­tals. The ex­tra money is jus­ti­fied on the ba­sis of their un­sta­ble vol­umes and high rates of lower-in­come pa­tients. Elim­i­nat­ing the ex­tra pay­ments, as well as crit­i­cal-ac­cess sta­tus for sev­eral hos­pi­tals, would save taxpayers $2.5 bil­lion over the next decade.

But ex­perts say keep­ing ac­cess to care in re­mote ar­eas is cru­cial. With a high rate of unin­sured peo­ple in ru­ral ar­eas and the lack of Med­i­caid ex­pan­sion in some states, a so­lu­tion must be found, said Alan Mor­gan, CEO of the Na­tional Ru­ral Health As­so­ci­a­tion.

Sev­eral leg­is­la­tors have pro­posed so­lu­tions, but their bills stand lit­tle chance of pas­sage (see “Leg­is­la­tion lan­guishes as ru­ral hos­pi­tals strug­gle,” p. 20). The Save Ru­ral Hos­pi­tals Act, in­tro­duced in July by Rep. Sam Graves (R-Mo.), would sta­bi­lize provider pay­ments by elim­i­nat­ing Medi­care se­ques­tra­tion and re­vers­ing cuts to re­im­burse­ment of bad debt for crit­i­cal-ac­cess and ru­ral hos­pi­tals.

The bill is also at­tempt­ing to free up crit­i­cal-ac­cess hos­pi­tals from reg­u­la­tory bur­dens, and calls for elim­i­na­tion of the 96-hour physi­cian cer­ti­fi­ca­tion re­quire­ment, with re­spect to in­pa­tient crit­i­cal-ac­cess hos­pi­tal ser­vices. Cur­rently, physi­cians at crit­i­cal-ac­cess hos­pi­tals must cer­tify at the time of ad­mis­sion that a Medi­care pa­tient will not be at the fa­cil­ity for more than 96 hours.

The 96-hour rule is a fi­nan­cial de­ci­sion driven by gov­ern­ment reg­u­la­tions, said Rep. Chris Stewart (R-Utah), a cospon­sor of the bill. “You can’t ig­nore fi­nan­cial con­sid­er­a­tions, but the ef­fi­ciency in this is miss­ing,” he said.

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