The 96-hour rule and a possible direct-supervision policy are a danger to critical-access hospitals, rural health leaders said at a congressional hearing Tuesday.
They also told members of the House Ways and Means Committee's Health Subcommittee that graduate medical education slots need to be more fairly allocated to help rural areas recruit providers.
Shannon Sorenson, CEO of Brown County Hospital in Ainsworth, Neb., said the 96-hour rule is arcane and creates unnecessary red tape. The rule requires physicians at critical-access hospitals to certify that Medicare and Medicaid patients may reasonably expect to be discharged or transferred to another hospital within 96 hours of admission.
“It impedes rural providers their ability to focus on their patients,” she said.
Dr. Daniel Derksen, director of the Arizona Center for Rural Health, said doctors may need to change a patient's treatment after lab testing and that can change the patient's estimated length of stay.
“It's unreasonable and unfair to make it a condition of payment,” he said.
He also criticized the two-midnight rule, which states Medicare will pay inpatient prices only when a doctor says the patient should spend at least two nights in the hospital.
Sorenson said critical-access hospitals should continue to be exempt from a policy that requires a supervising physician or nonphysician practitioner to be physically on-site when a Medicare patient is receiving outpatient therapeutic services such as infusions or vaccinations.
Some staffs at critical-access hospitals where a physician is not always present might have to cut services if the direct-supervision rule is enforced, she said.
A solution to that shortage of providers in rural areas was brought up during Tuesday's hearing.
Tim Joslin, CEO of Community Medical Centers in Fresno, Calif., said graduate medical education is a critical pipeline for rural areas with a physician shortage.
Where a doctor receives medical education and training can influence where he or she eventually practices, so rural areas need to be treated more fairly when it comes to GME slots, he said.
“We believe this will directly lead to more efficient and effective healthcare in our rural, underserved region,” he said.
Rep. Kevin Brady (R-Texas), chairman of the subcommittee, said there should be less bureaucracy governing physician Medicare and Medicaid payments.
The hearing also addressed the existential threat to rural hospitals: Fifty-five have closed since 2010 and 283 more are on the brink of closure, according to the National Rural Health Association.
Rep. Jim McDermott (D-Wash.) said some of his colleagues lay the blame on the Affordable Care Act, but the biggest problem lies in states that have refused to expand Medicaid.
About 80% of hospitals that have closed in the past five years have been in states that opted not to expand, he said.