The case for saving rural hospitals took center stage in Congress this week, with critical access hospital (CAH) administrators asking the House Ways and Means Health Subcommittee for relief from federal regulations that they say cause more harm than good.
CAH administrators urged Congress to pass the Critical Access Hospital Relief Act to end the requirement that doctors certify that a Medicare beneficiary can expect to be discharged from a CAH or transferred to another hospital within 96 hours, AHA News reported. They also called for flexibility from rules that doctors or non-physician practitioners directly supervise certain routine outpatient therapies such as splinting a broken finger, according to the article. The Protecting Access to Rural Therapy Services, or PARTS Act, would lift the restriction.
"CAHs simply do not have the manpower and resources to abide by these arbitrary regulations," Shannon Sorensen, CEO of Brown County Hospital in Ainsworth, Nebraska, testified, according to the article. She said her hospital has just one full-time primary care doctor and two mid-level providers.
Rural hospital advocates made similar pleas during a hearing in June, warning that more hospitals were at risk of closing without the relief provided by the two bills.
Not surprisingly, the Affordable Care Act (ACA) took center stage during the debate this week.
Texas Republican Kevin Brady blamed "over-regulation and bureaucracy" for limiting rural access to healthcare, MedPage Today reported. Ranking committee member Jim McDermott, M.D., (D-Wash.), pointed the finger at red states that declined to expand Medicaid, leaving rural hospitals with huge bills for uncompensated care. "Not coincidentally, 80 percent of the hospitals that have announced recent closures ... are in states that didn't expand Medicaid," he said, according to MedPage Today.
Another bill in Congress, the bipartisan Rural Hospital Access Act, would increase Medicare reimbursements to 105 percent and end cuts to reimbursement for bad debt, WNCT-TV in Greenville, North Carolina, reported. Reimbursements for local hospital system Vidant Health are about 80 percent at the system's noncritical regional hospitals and 85 percent for inpatient care at the flagship hospital in Greenville, according to the report.
The problems are widespread. In Georgia, where four rural hospitals have closed in less than three years, a poll commissioned by the Healthcare Georgia Foundation found that more than three-fourths of respondents cited a shortage of medical providers, with half saying their community's most urgent need is a medical clinic, according to a Columbus Ledger-Enquirer opinion piece.
It's not just declining Medicare reimbursements and federal regulations that are hurting rural hospitals, according to a recent Washington Post analysis. Other factors include a declining patient base, increases in elderly and uninsured patients, high physician wages, the expense of medical equipment and challenges in providing specialty services.