Hospital requesting CAH designation
Designation could improve reimbursement rates, allow for flexible staffing, services and more at Colusa Medical Center
The Colusa Medical Center will be submitting an application this week requesting that the facility receive a Critical Access Hospital designation.
According to Amy Micheli, chief nursing and operations officer at the Colusa Medical Center, a CAH designation would improve hospital reimbursement rates, allow for flexible staffing and services as well as provide access to the Medicare Rural Hospital Flexibility (Flex) Program, which provides funding that encourages the development of cooperative systems of care at rural hospitals to increase the efficiency and quality of care in those areas.
“Ultimately we want to be able to provide easily accessible care to residents of rural areas who normally face healthcare service barriers and offer additional services to patients,” said Micheli.
The CAH program was established in 1997 as part of the Balanced Budget Act to allow small hospitals in rural areas to serve
residents that would otherwise have to travel long distances to receive emergency care.
Currently there are 1,349 CAH facilities nationwide, 34 of which are in California.
According to the American Hospital Association, to qualify for Critical Access Hospital status a hospital must be located in a rural area and be more than 35 miles from another hospital, or 15 miles by secondary roads or in mountain terrain, or have been certified before Jan. 1, 2006 by the state as being a necessary provider of health care services.
Colusa Medical Center is located 25.4 miles from Adventist Health/rideout Hospital in Marysville via State Route 20, 35 miles from Glenn Medical Center in Willows, 39 miles from Orchard Hospital in Gridley and 46.5 miles from Enloe Medical Center in Chico.
The Colusa County Board of Supervisors has voiced their support for Colusa Medical Centers CAH request, stating in a letter written to Caltrans that travel to other hospitals that are closer than 35 miles include travel on State Route 20 and other routes that meet the definition of a secondary road.
Gilbert Mohtes-chan, Caltrans District 3 public information officer, clarified this definition, stating, “a two-lane highway is a secondary road to a larger multi-lane state highway or interstate highway such as Interstate 5.”
The Colusa County Board of Supervisors site that in addition to serving as secondary roads, the routes used to access other hospitals within 35 miles of the Colusa Medical Center are heavily impacted by flooding and other disasters that close these roads and limit access to other facilities.
Caltrans District 3 officials agreed and have also issued their support of the CAH request.
“Although State Route 20 is a primary route according to the National Highway System in California, in the vicinity of Colusa, it may act as a collector road,” wrote Amarjeet S. Benipal, Caltrans District 3 Director. “We agree that recent devastating natural events may be creating access challenges to nearby hospitals.”
Micheli said Colusa Medical Center staff remain optimistic that the application will be approved based on hospitals with similar demographic challenges receiving approval.
According to Micheli, Orchard Hospital in Gridley is a CAH that is located 16.9 miles from Oroville Hospital, 19.2 miles from Adventist Health/rideout and 30 miles from Enloe.
“Not only are they closer to three major hospitals than Colusa Medical Center, they are located directly on Highway 99 with much easier access to surrounding hospitals,” said Micheli.
Additional CAH qualifications include: the hospital must have an emergency room that operates 24 hours a day, seven days a week using either on-site or on-call staff, 25 inpatient beds used for either inpatient or swing bed services and must meet a 96hour, or four-day, limit on the average length of stay for a patient.
According to Micheli, the Colusa Medical Center currently meets all of these requirements.
Micheli said it’s even more important that Colusa Medical Center be approved as a CAH now that changes will be made to the county’s current ambulance services.
Enloe Medical Center announced earlier this month that starting Nov. 15, they will be reducing Advanced Life Support Ambulance services in Colusa County to just one round the clock ambulance to serve the approximately 22,000 residents that live within the county’s 1,200-square miles.
In a letter penned by Marty Marshall, Director of Emergency Medical Services at Enloe Medical Center, reimbursement rates lower than the direct costs of the program transport basics were cited as the reason for the cut, claiming the current rates are causing Enloe EMS to lose more than $440,000 annually in Colusa County.
According to Marshall, the current deployment plan’s direct cost per transport is now approximately $1,360 while the average reimbursement is $670 per transport and Medicare and Medi-cal averages $589 and $174 per transport. Marshall said Medicare and Medi-cal represent approximately 75 percent of the transport volume.
“It is clear that the current deployment plan, which provides two ALS ambulances, is economically unstable,” wrote Marshall. “With Colusa ambulances’ existing cost structure, patient volume is marginally adequate to support one ALS ambulance.”