The Center was created especially to provide specialized assistance and services for our state’s rural hospitals. This MHA Front Page is for our members seeking the latest news affecting rural and critical access hospitals.
The Joint Commission has revised several elements of performance for critical access hospitals (CAHs) - effective January 1, 2015 - to align with changes made by the Centers for Medicare & Medicaid Services (CMS). Learn more here.
The Louisville tornado on April 28 took both life and livelihood and it ravaged the southern and eastern parts of the city, including Winston Medical Center and the Natron Plywood Plant. This week, FEMA approved more than $43 million in federal money to go toward helping restore those businesses.
The Office of Rural Health Policy (ORHP) announces the availability of funding under the Rural Healthcare Services Outreach Program (Outreach), which is a three-year, non-categorical, community-driven program targeted to improve outreach and services delivery in local and regional rural communities.
For grantees, this funding provides an opportunity to implement new and innovative approaches to health care at a local level. Through the program, grantees have mastered the art of leveraging finances by using ORHP grants to catapult their sustained efforts; they have been able to combine federal funds with local and foundation dollars to support the continuation and development of health care services in rural areas. The previous cohort of Outreach grantees that closed out had a sustainability rate of 98%, demonstrating the importance of collaboration with other organizations in the community.
ORHP continues to focus on identifying rural evidence-based models and sharing them so that communities have an accessible resource when implementing a similar program. This has led to the development of the Rural Community Health Gateway, located on The Rural Assistance Center (RAC). It consists of a number of resources, including success program models and evidence-based toolkits that may be helpful in the development of an Outreach application.
This year critical access hospitals (CAH) have struggled to implement procedures to comply with both the "two-midnight" rule and the 96-hour physician certification requirement. The combination of both puts physicians in a difficult spot of trying to predict whether the patient will need inpatient care for at least two midnights, and in critical access hospitals, to certify that the patient will be discharged or transferred within 96 hours.
This article will focus on the 96-hour physician certification requirement. Unlike the two-midnight rule, it is not a new idea created by the Centers for Medicare and Medicaid Services (CMS). It is based on a statute that has been on the books for several years. What is new is that CMS actually intends to enforce the rule through audits and recoupments, which is very controversial.
The Obama administration plans to offer upfront cash to help small and rural health care providers build the infrastructure they need to succeed in Medicare's program for accountable care organizations. The advances will fund capital investment and hiring for ACOs that would manage the cost and care for fewer than 10,000 patients under the Medicare Shared Savings Program for ACOs.
ACOs that include a hospital are excluded unless the hospital is designated by federal officials as one that provides critical access or has fewer than 100 beds. The new program, called the ACO Investment Model, is administered by the CMS Innovation Center, the policy laboratory created by the Patient Protection and Affordable Care Act to test new ways to deliver healthcare and pay for it.
“The ACO Investment Model will give Medicare Accountable Care Organizations more flexibility in setting quality and financial goals, while giving them greater accountability for delivering quality care efficiently,” CMS Administrator Marilyn Tavenner, said in a statement. “We are working with these organizations to make necessary investments that encourage doctors, hospitals and other healthcare providers to work together to better coordinate care and keep people healthy.”
The application deadline for organizations that started in the Shared Savings Program in 2012 or 2013 will be December 1, 2014. Applications will be available in the summer of 2015 for ACOs that started in the Shared Savings Program in 2014 or will start in 2016.
Read more from Modern Healthcare here. A CMS Fact Sheet is available here.
For the second time in just over a year, federal watchdogs are calling for a review of critical access criteria for hundreds of small rural hospitals across the nation.
In August 2013, a report from the Office of the Inspector General for the Department of Health and Human Services recommended that Congress allow the Centers for Medicare & Medicaid Services to strip critical access designation from the nearly 1,000 hospitals with "permanent exemption" status under a state "necessary provider" designation. This month, the OIG quietly refloated the idea in a related report detailing the higher costs that Medicare beneficiaries pay for outpatient services at critical access hospitals, when compared with the same services at acute care hospitals.
Medicare pays for home health care for beneficiaries who require certain services but for whom travel to receive care is physically and/or mentally difficult or not medically recommended. Covered services include skilled nursing care; physical, occupational and speech-language pathology services; medical social services; and home health aide services. A beneficiary who has experienced a stroke and needs rehabilitative and support care during the recovery period is one example.
Home health care is both an important part of the care continuum for Medicare beneficiaries and a major program cost. However, little information about the actual health status and needs of the population receiving home health services has been published. Thus, the purpose of the analysis reported here is to provide a thorough, clinically based description of the health status and service needs of rural and urban Medicare home health patients based on a professional assessment of their condition at the start of care. The Centers for Medicare and Medicaid Services (CMS) requires that each home health care recipient be assessed at the start of care using a set of questions developed to reflect the specific needs of home health patients. Our report is based on a review of 1,468,465 unique beneficiary assessments from the 2010 Outcome Assessment Information Set (OASIS).
A bipartisan group of 34 senators this week asked the Centers for Medicare & Medicaid Services to better account for the unique circumstances of rural providers in its rulemaking process. Citing problematic policies such as the outpatient therapy supervision requirement and 96- hour rule, they asked CMS to share additional information on how the agency incorporates rural health care considerations into the rulemaking process and monitors the impact of final regulations on rural costs and access to care.
“The proportion of elderly rural Americans continues to grow, and even small policy changes or incremental payment adjustments have a significant impact on access to care in rural areas,” the senators wrote. “…[W]e are committed to ensuring federal policies recognize and incorporate the unique challenges rural providers face.”
The letter was initiated by Sens. Heidi Heitkamp (D-ND) and John Thune (R-SD) with support from the American Hospital Association.
A new model for stroke care is being studied in rural Alberta to reduce inequities in health across communities. This model, presented at the Canadian Stroke Congress, shows how hospitals in rural areas can mimic the type of care that's often only available in larger centres.
Mendal Kemp serves as the director of MHA's Center for Rural Health and is the Rural Hospital Flexibility Coordinator. He is a veteran health care facility administrator and regulator. He is charged with helping Mississippi's rural hospitals with strategic planning and performance improvement. He can be reached at (800) 289-8884, (601) 368-3384 or firstname.lastname@example.org.