AHA panel warns of threats to CAHs, rural providers

A panel of healthcare experts discussed threats to the future of rural hospitals as part of a broader discussion about the state of rural healthcare at the American Hospital Association's (AHA) Annual Membership Meeting Sunday.

"Rural hospitals' low-patient volumes make it difficult for these organizations to manage the high-fixed costs associated with operating a hospital," the AHA's 2013 Annual Report on Small or Rural Hospital states. "This in turn makes them particularly vulnerable to policy and market changes, and to Medicare and Medicaid payment cuts."

Rural healthcare is "a little bit tricky on the legislative side, because there are multiple bills that are ongoing at the same time," said panelist Lisa Kidder, AHA's vice president of legislative affairs.

"There are members of Congress who ... are not open to looking at critical access hospitals [CAHs] with an open mind," Kidder said. "We continue to hear a drumbeat, whether it's against CAHs, rural hospitals… we continue to hear a momentum [against them] out there particularly at the federal level.

In the past, the Congressional Budget Office garnered a lot of attention when it looked at eliminating critical access hospitals, MDHs [Medicare-dependent hospitals] and sole community hospitals. While the elimination of all three kinds of hospitals was always unlikely, Kidder said, it got people talking about how narrowing the rural hospital field could produce significant cost savings. 

"The bigger threat is not CMS and their anti-CAH or anti-rural bias, but members of Congress beginning to catch on and spread that thought," Kidder said. "They stand up for their hospitals, and they don't want their hospitals within 10 miles to close--but they understand why that hospital in the next state should close."

Other hospitals cannot see the problems of rural and critical access hospitals as someone ele's problem, panelist Paul R. Bengtson, chief executive officer of Northeastern Vermont Regional Hospital in St. Johnsbury, said. "If we're truly patient-centered, I don't think we should be saying things like ... 'I don't care about a critical access hospital,'" he said, adding that patients need access to those services. 

"We all have something incredible to learn from each other as we go through many of these pilot projects. To say CAHs and small hospitals can't do this, that or the other thing--I'm not enamored of that approach at all."

Despite their financial and regulatory struggles, a recent study found that rural hospitals provide equal quality outcomes at lower costs, FierceHealthcare previously reported.

To learn more:
- read the AHA report (.pdf)

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