NORTH PLATTE, Neb.-A new program the state is touting as a way for rural hospitals to stay open in the wake of Medicare cuts is not helping many qualifying hospitals, Nebraska healthcare officials said.
"I'm sure there are hospitals that might benefit from the program, but we're not considering it an option here," said Marvin Neth, administrator of the Callaway (Neb.) District Hospital. "My concern is that the program is not in the best interest of our patients."
The Critical Access Hospital Program is in response to federal cuts in Medicare that threaten the survival of many smaller hospitals. Because of the cuts, payments for outpatient services provided to Medicare patients will be reduced by as much as 17% after 2000.
Congress has given states the option of designating smaller rural hospitals as necessary to the states' healthcare system. Under the program, those hospitals could qualify for higher Medicare payments.
But in order to qualify, hospitals must downsize services, eliminate long-term care and sign an agreement with a larger hospital to take patient transfers and a portion of emergency cases.
"We currently have no intention of becoming a critical access hospital," said Carol Abbuhl, chief executive officer of Perkins County Hospital in Grant, Neb. "The only way that would ever happen is if things got so bad for us after Medicare cuts that we couldn't stay open any other way."
Abbuhl said her hospital would have to quit offering surgical procedures, and many patients would have to be transferred. The nearest larger hospital with which Perkins County could sign is Great Plains Regional Medical Center in North Platte, about 60 miles away.
"That's quite a distance for our patients," she said. "Long-term-care patients have a right to remain in their own community. We want to be able to continue offering them that option."
The program's potential reduction in services to communities is the biggest concern for hospitals that qualify. Patients who require care for more than four days would have to be transferred, and a critical access hospital can provide no more than 15 beds.
"In reality, a critical access hospital is not much more than a medical clinic that offers limited inpatient care," Neth said.
Hospitals need to realize that the program is not meant for every small hospital in the state, said John Roberts, vice president of the Nebraska Association of Hospitals and Health Systems. It is intended, he said, as an alternative to financial ruin.
Nebraska now has 38 hospitals designated as critical access candidates.
Another 18 will qualify if the state Legislature rescinds a requirement that critical access hospitals be more than 20 miles from one another. Earlier this month, lawmakers voted 33-0 to advance the bill to the second of three rounds of debate.
Of those hospitals qualified for the program, only one, Harlan County Hospital in Alma, has become a critical access facility. The hospital agreed to become a critical access hospital as part of a pilot program designed to test the system.