This Blog post is written as part of a rural advocate dialogue in how best to respond to proposals circulating in Washington to end or limit Medicare’s Critical Access Hospital (CAHs) program.
“When your house is threatened by fire, its not the time for talking about which parts to protect and which to let go.”
As my house is within walking distance of four hospitals in Madison, Wisconsin that have benefited by Medicare policies favoring urban based providers for over forty years, I am not willing to throw the “Ten Milers” (Critical Access Hospitals within ten miles of another hospital) to the wolves–we are either for CAHs or we are not. This is not the time to talk policy.
CAHs and rural health are not so much a target as at risk of becoming collateral damage as the “Titans” battle over the role of government and their own partisan political futures.
As a practical matter we are most likely to see a dead-locked Super Committee and the 2% sequestration take place.
This is a just one chapter in a longer term fight to protect the hard fought gains of the the last twenty-five years.
The President’s proposal, as a whole, is obviously “dead on arrival.” We need to push back broadly as bad ideas are put in circulation from various sources.
Below is a summary I did for the RWHC Board re NRHA’s excellent counter to the House Ways and Means Health Committee Minority staff’s circulation of the CBO option of putting CAHs back into PPS.
We have our work cut out for us–this is not a moment of nuanced negotiation but standing united for all rural hospitals.
Be well.
Text of NRHA Response to Policy Options Sent to the Super Committee by House Ways & Means Committee Democratic Staff
TS: 9/28/11
Background
The Congressional Budget Office released a report in January 2011 outlining “possible sources of savings in mandatory programs.” This huge compendium of any and all options included an analysis of abolishing all rural hospital payment programs—CAH, SCH, MDH. CBO estimates that this would save $62.2 billion over 10 years; $3.8 billion in 2012 increasing to $9.5 billion in 2021.
From the Commonwealth Fund (reported 9/7/11): “The House Ways and Means Democratic staff has prepared a list of possible cuts to the Medicare program totaling more than $500 billion over 10 years, according to documents obtained by CQ HealthBeat. Sarah Baldauf, a spokeswoman for California Democratic Rep. Pete Stark, the top Democrat on the Ways and Means Health Subcommittee, said the cuts are for “internal” use and that the list does not represent an endorsement of such reductions. The list is being circulated among Democrats to prepare them for possible cuts that will be considered by the Joint Committee on Deficit Reduction.”
NRHA Response to House Ways & Means Minority Staff List of Policy Options
“Elimination of rural hospital designations will annihilate the rural health care safety net and access to care in rural America. Recent recommendations to the Joint Select Committee on Deficit Reduction erroneously claim that these designations and their accompanying payment formulas discourage efficiency and value in health care. This is simply untrue. Many rural counties where Critical Access, Sole Community and Medicare Dependent Hospitals are located rank in the bottom quartile in Medicare spending. Furthermore, hospitals carrying these designations care for 16.4% of all Medicare hospital patients while receiving only 12.4% of the total Medicare hospital budget in payments (note that these figures are adjusted for case complexity to reflect net patient days).”
“The true purpose of these payment formulas is to prevent hospital closures. During the 1980s and early 1990s, 360 rural hospitals closed and rural Americans lost access to health care. These hospitals struggled to maintain financial stability under the urban-centric Medicare Prospective Payment System because of their small size and unpredictable patient mix. In response, Congress created the Critical Access Hospital (CAH) designation. This designation was designed to prevent hospital closures by allowing CMS to pay CAHs for inpatient and outpatient services on the basis of reasonable costs. This allows for more flexible staffing options relative to community need, simplifying billing procedures and creating incentives to develop local integrated health delivery systems, including acute, primary, emergency and long-term care. Sole Community Hospital and Medicare Dependant Hospital designations were created for the same reasons.”
“Forcing rural hospitals into a prospective payment system modeled on care in urban environments is completely unsuitable for the rural delivery system, will lead to hospital closures, and will compromise access for millions living in rural areas. This is an unacceptable result. NRHA and its 22,000 hospital, physician, practitioner and patient members call on you to protect the rural health care safety net. It is vital that you oppose any and all efforts to decimate the rural delivery system.”
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