The rural hospital rescue program was met with suspicion from administrators

In West Texas, the small hospital in Crossbeaton has only two beds and they are not always occupied.

“We rarely admit patients,” said Steve Beck, the hospital’s chief executive, which is located 40 miles east of Lubbock and serves a town of about 1,500 residents.

The hospital is having trouble keeping staff, and “we lack technology and skills,” he said. And money.

The city has organized back sales and garage sales to keep its emergency rooms and primary care services open. On paper, Crossbeaton Clinic Hospital should not exist, Beck says, but it is – “by mere determination and commitment and work ethic.”

In many states, including rural hospitals – such as Texas, Kansas and Iowa – fewer than three hundred patients with these facilities stay overnight on any given day. The financial strain of hiring and maintaining those bed staff took a toll, and federal lawmakers responded to requests for help from hospital officials in places like Crossbeaton last year.

The Rural Emergency Hospital Program, set to launch in January, will offer payments to smaller, struggling hospitals to release their inpatient beds and focus only on emergency and outpatient care. It will be the first new federal funding program for rural hospitals in 25 years, and lawmakers hope it will stem the flow of rural hospital closures accelerated over the past decade.

A photo shows a hallway inside the Crossbeaton Clinic Hospital
A patient’s room was seen inside the Crossbeaton Clinic Hospital.(Annie Rice for KHN)

The law is “an unprecedented approach to maintaining access to emergency health care in these communities,” said Sen. Ron Wyden (D-Or.), Who chairs the Senate Finance Committee, which will oversee any changes to the law in the Senate, KHN said in a statement.

Yet state hospital leaders predict that the program could find very few recipients.

The plan would increase pay for the hospital’s Medicare patients and provide an extra flat “benefit”. But it is not clear whether the exact size of those payments and whether they will be enough for struggling hospitals, even after the US Center for Medicare and Medicaid Services released an initial proposed rule just before the weekend of the fourth holiday in July. This is expected to be a final rule this fall.

In Kansas, where an estimated 40 hospitals reported an average of one or two patients before the Covid-19 epidemic, no hospital is willing to lend a hand to join the program, said Jennifer Findley, vice president of education and special projects. Kansas Hospital Association. Findley said hospitals are “waiting and very concerned” for CMS officials to reveal more details about funding.

CMS’s chief medical officer, Dr. Lee Fleischer, responded to KHN’s question about the new program in an email statement in June, confirming that the agency was “on target” to launch the program by January 2023. Agency officials declined to comment further. .

Sen. Chuck Grassley (R-Iowa) confirmed this month that CMS will introduce new legislation “in a series of proposed regulations.” Grassley, who co-sponsored the law that led to the creation of the program, urged the agency to do so “in a timely manner.”

The model of rural emergency hospitals is based on Medicare’s title of “Critical Access Hospital”, for which hospitals have only signed up after a series of revisions. The existing program allows Medicare to provide additional funding to small, rural hospitals where there are no more than 25 inpatient beds and whose average patient stay is 96 hours or less.

Grassley said in an interview with KHN that the need for rural hospitals to maintain almost empty inpatient units is unreasonable. He wanted to offer “the option of shutting down health services and not providing any.”

Grassley stressed that the new program would be voluntary. He said the law was a compromise. Wyden objected to the cost of the original proposal, estimated at about $ 30 billion in 10 years. In the final version of the bill, Medicare’s boost was reduced, and cost estimates were reduced by more than two-thirds.

In his statement to KHN, Wyden said the law was designed to “fill certain gaps in existing federal protections.” Although Medicare’s pay is smaller than the original proposed, the law includes a benefit fee, which is paid regardless of how many patients are served in a hospital.

CMS officials have not yet revealed the size of that payment, but Brock Slabach, chief operating officer of the National Rural Health Association, said the hospital needs তাদের 2 million to $ 3 million a year. The amount of benefit provided is “lynching for the whole program,” he said.

A photo shows the water tower of Crossbitton at a distance framed by a tree in the front
Crossbeaton, Texas, which is 40 miles east of Lubbock, has organized back-to-back sales and garage sales to its only hospital not to close its emergency rooms and primary care services.(Annie Rice for KHN)

But politicians in Washington are concerned about the cost, and “there is general skepticism about the value of this program,” Slabach said.

The comments from rural health lawyers and hospital administrators indicate that they are also wary of the still-formidable structure of rural hospital rescue.

In a regulatory comment letter submitted last year, the health system and rural hospital organizations stressed the importance of providing facilities. They also asked about the possibility of participating in a federal discount drug program and overnight swing beds, beds that could be used for patients in need of intensive care after surgery or for illnesses such as pneumonia and for those in need of skilled nursing. Recovery They also asked how funding for outpatient services such as behavioral health and telehealth could be included or linked to the new payment program.

CommonSpirit Health, an Illinois-based Catholic health care system operating in 21 states, said in a letter that although a rural hospital “does not give birth to many children”, using telehealth in an emergency could save a child’s or mother’s life. Access Hospital has done it twice this year. “

Under the proposed rules, published June 30, flexible swing beds will not be allowed. Julia Harris, a senior policy analyst at the Bipartisan Policy Center, said the CMS should consider increasing the hospital’s capacity to allow “minimum number” of beds or to keep patients longer for observation.

The key to the program’s success is to “dress up the details” on the bed and ensure adequate compensation, Harris said.

James Roitman, longtime CEO of Pocahontas Community Hospital in North-Central Iowa, said that to allay any doubts among residents about the exclusion of inpatient beds, administrators need to reassure them that the new arrangement will pay enough to support and preserve their hospital emergency. Room and primary care services.

So far, Rothman says, it’s not clear if the program will do that.

“Unless something changes, there’s very little discussion about it among Iowa hospital administrators,” he said.

Chris Mitchell, CEO of the Iowa Hospitals Association, said the covid epidemic has made it less acceptable for the public to exclude inpatient beds in smaller hospitals.

During the growth of covid, many urban medical centers were overwhelmed by patients and they often asked outside hospitals to treat non-critical cases as much as possible, Mitchell said. The inpatient units of small hospitals have regained their importance, if only for a few weeks.

The rural community will need reassurance that under the rural emergency hospital program, the system will retain sufficient capacity to handle waves of critically ill patients, Mitchell said.

Until CMS final rules at least fall, hospitals may have trouble preparing for the transition in January, says George Pink, a senior research fellow at the Cecil G Shapes Center for Health Services Research at the University of North Carolina-Chapel Hill. Once federal regulators finalize the rules, many states will have to pass legislation to certify or license redefined benefits.

One picture shows a car parked in the parking lot of the Crossbutton Clinic Hospital
Crossbeaton Clinic Hospital(Annie Rice for KHN)

Still, when some hospital administrators and rural health lawyers talk about the law, they insist the situation is urgent. More than 130 rural hospitals have closed their doors since 2010, and the number of closures reached a 10-year high in 2020, of which 19 were closed.

Although the coronavirus relief fund has helped struggling hospitals over the past two years, the shutdown is expected to “start backing up with retaliation” as emergency aid declines, Slabach said.

The epidemic means “wounded and largely disappeared,” said Beck, a Texas hospital administrator. He hopes the new Medicare payment program will help keep CrossBiton open.

“We’ll survive until it happens,” Beck said. “We’re doing what we can.”

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