Critical-access hospitals, which have 25 beds or fewer, have seen at least three closings in three states this year. Extending the program that provides extra resources for small hospitals enabled the number of critical-access hospitals to jump from 836 in 2003 to 1,302 in 2009, according to the federal Health Resources and Services Administration. Overall, there have been 57 rural hospital closures since January 2010, according to data from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.
Support for critical-access hospitals has been in the Obama administration's crosshairs for several years. This past year, the president's budget proposed eliminating the extra 1% of payment over costs that go to the hospitals. The extra money is justified on the basis of their unstable volumes and high rates of lower-income patients. Eliminating the extra payments, as well as critical-access status for several hospitals, would save taxpayers $2.5 billion over the next decade.
But experts say keeping access to care in remote areas is crucial. With a high rate of uninsured people in rural areas and the lack of Medicaid expansion in some states, a solution must be found, said Alan Morgan, CEO of the National Rural Health Association.
Several legislators have proposed solutions, but their bills stand little chance of passage (see “Legislation languishes as rural hospitals struggle,” p. 20). The Save Rural Hospitals Act, introduced in July by Rep. Sam Graves (R-Mo.), would stabilize provider payments by eliminating Medicare sequestration and reversing cuts to reimbursement of bad debt for critical-access and rural hospitals.
The bill is also attempting to free up critical-access hospitals from regulatory burdens, and calls for elimination of the 96-hour physician certification requirement, with respect to inpatient critical-access hospital services. Currently, physicians at critical-access hospitals must certify at the time of admission that a Medicare patient will not be at the facility for more than 96 hours.
The 96-hour rule is a financial decision driven by government regulations, said Rep. Chris Stewart (R-Utah), a co-sponsor of the bill. “You can't ignore financial considerations, but the efficiency in this is missing,” he said.