Rural critical-access hospitals are in “precarious territory” in terms of the future cuts they could face from a Medicare cost-control board beginning in 2014, HHS Secretary Kathleen Sebelius told lawmakers. That is because these hospitals, unlike most others, would fall under the immediate jurisdiction of the Independent Payment Advisory Board that was established by the Patient Protection and Affordable Care Act to cut future Medicare spending.

Sebelius pledged at a Senate budget hearing on HHS funding to work with senators to protect those types of hospitals from major cuts.

Sebelius told Sen. Jerry Moran (R-Kan.) that she was “supportive of taking a look at” proposals to exempt such hospitals from IPAB cuts until 2019, when all hospitals would become eligible for its cuts. “I share your concern that critical-access hospitals are vitally important,” Sebelius told Moran.

Among other “significant looming issues” for hospitals that employ their own physicians, Sebelius said, are cuts they could face if Congress does not approve a replacement for Medicare's physician payment formula, which has slated a 30% cut for the end of the year. A permanent so-called doc fix could be included in long-term deficit-reduction talks, she said.

Additionally, Sebelius pledged not to launch a long-term-care insurance program created by the healthcare law unless her actuaries determine that a redesign she led will leave it sustainable.