Rural healthcare officials like those at Minnesotas Office of Rural Health and Primary Care are finding relief for improving critical-access care by way of revised guidance from the CMS.
The Minnesota office recently took steps toward its goal of providing a critical-access hospital for the community of Walker in Cass County, largely as a result of the changes.
While the new guidelines do not portend massive growth in critical-access hospitals, they could result in existing hospitals rebuilding facilities, according to Tim Fry, government affairs manager at the National Rural Health Association in Washington.
They came out this last fall, but they have taken a while for everybody to take it all in, Fry said of the revised guidance, which amends what the CMS initially proposed in November 2005. The guidancewhich addresses mountainous terrain, secondary roads and a series of so-called 75% rules related to service areas, services provided and staffingwas a topic of interest at the NRHAs annual policy institute in Washington in late January. According to Fry, Deputy CMS Administrator Herb Kuhn was available to answer questions about it.
The policy institute also addressed the issue of critical-access hospitals reporting outpatient data. Until now, critical-access hospitals have reported only on inpatient data. In an e-mail message, the CMS said: The Tax Relief and Health Care Act of 2006 requires Medicare, beginning in Jan. 1, 2008, to reduce payments for outpatient services to hospitals that do not successfully report specified quality measures for their services. Because the payment implications do not apply to outpatient services furnished by CAHs, the agency has focused its resources first on implementing the outpatient quality reporting for those hospitals whose payments will be affected.
Critical-access hospitals have asked to participate in the outpatient quality reporting program, the message continued. Kuhn announced at the NRHA meeting that we plan to develop a way to bring critical-access hospitals into the program, probably toward the end of calendar year 2008.
With regard to the revised guidance, Minnesota has benefited from a change related to the secondary road rule. Based on the change in the CMS guidance on a definition of a secondary road, the location has been given preliminary approval, said Mark Schoenbaum, director of the states office of rural health in St. Paul.
A letter from the CMS to Schoenbaum on Jan. 28 said the office can begin the application process for an integrated medical campus in Cass County that is anchored by a 25-bed hospital. The facility would also include a provider-based medical clinic, Indian Health Service satellite clinic, long-term care, assisted- living and other ancillary healthcare services. The site now houses a state nursing home, but Schoenbaum said the state will convey the property for the new hospital to the county.
He also said the county has selected the newly formed not-for-profit Essentia Community Hospitals and Clinics, New Brighton, Minn., as the development partner in the deal, although there has been no final commitment. Last month, Benedictine Health System, Duluth, Minn., restructured its organization, taking its long-term-care operations but leaving behind eight acute-care hospitals with the creation of Essentia Community Hospitals and Clinics.
These are complex, multiyear projects with many decisions and commitments to be made, Schoenbaum said. However, 80 Minnesota hospitals have become critical-access hospitals and successfully navigated all of those steps, so there is every reason to expect that the collaborators working on this project will get to the finish line.