{"id":1056,"date":"2019-06-30T20:12:30","date_gmt":"2019-07-01T03:12:30","guid":{"rendered":"http:\/\/danschmidtforsenate.com\/blog\/?p=1056"},"modified":"2019-06-30T20:12:30","modified_gmt":"2019-07-01T03:12:30","slug":"critical-access","status":"publish","type":"post","link":"https:\/\/danschmidtforsenate.com\/blog\/?p=1056","title":{"rendered":"Critical Access"},"content":{"rendered":"\n
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Back before we got into a stalemate when talking about\nhealthcare costs, long ago when I had good knees and my hair wasn\u2019t grey,\nfunding for small town hospitals was recognized as a problem. After Montana\ndemonstrated they could support critically needed remote hospitals with a\nfederal project, Congress rolled the \u201cCritical Access Hospital\u201d designation\ninto the Balanced Budget Act of 1997. Do you remember when we had balanced\nbudgets?<\/p>\n\n\n\n

Medicare had been working hard to cut hospital spending\nsince the 1980\u2019s and had instituted a payment system to hospitals based on a\nglobal fee. If a patient was admitted for pneumonia, the hospital got paid a\nflat amount, whether it took 2 days or 7 days to get the patient back on their\nfeet. But the value of having small hospitals especially in remote areas could\nnot be ignored, so the \u201cCritical Access\u201d designation called for a different\npayment system to such hospitals. These hospitals were paid on a cost-plus\nbasis. Whatever it cost, Medicare would pay for the services based on their fee\nscale, plus a small percent; currently it\u2019s +1%. <\/p>\n\n\n\n

But the hospitals had to fulfill certain criteria. They were\nsupposed to be more than 17 miles by primary road, or more than 35 miles by\nsecondary road from another hospital. They were also supposed to have less than\n25 hospital beds. <\/p>\n\n\n\n

Here\u2019s the catch, and it\u2019s a big one. No congressman wanted\nto go home having voted to close Podunk Hospital in their district, so the bill\nallowed states to declare a hospital a \u201cnecessary provider\u201d and escape the\ndistance requirement. And states opened the barn doors. <\/p>\n\n\n\n

As it stands, approximately 65% of CAH\u2019s are between 17 and\n35 miles from another hospital. I live in a town with a CAH 8 miles from\nanother CAH; but it\u2019s across the state line into Washington. Just down the hill\nfrom me another CAH is less than 5 miles from a regional medical facility, also\nacross the state line. <\/p>\n\n\n\n

Most small-town hospitals in Idaho serve remote and rural\ncommunities. They deserve such payment consideration. But I walk past one every\nday I go to work that is abusing the critical access system.<\/p>\n\n\n\n

I guess what bothers me the most about this abuse is the\nbillboards and radio ads I see and hear every day for my town hospital AND for\nthe CAH just 8 miles away across the border. The hospital in my town has a\nfull-time director of \u201cpromotion\u201d; I suspect the same is true across the\nborder. If they both are so critical, why do they need the media blitz?<\/p>\n\n\n\n

Many see this problem. The Obama administration made\nproposals to reduce Medicare payments to CAH\u2019s to a flat 100% of costs and\neliminate CAH designation for hospitals less than 10 miles from another\nhospital. It was met with howls of protest from the American Hospital\nAssociation; didn\u2019t get far. The Trump administration has revived another Obama\nrule that would require more patient protections and documentation; more\nregulations, more costs. We\u2019ll see how far it can go. <\/p>\n\n\n\n

I don\u2019t see the advertising by CAH\u2019s as a huge cost. It just\ntells me their designation as \u201ccritical\u201d might be more a political favor than a\ncommunity reality.<\/p>\n\n\n\n

One thing is for sure; if a small-town hospital has to\ncompete against the big city mega-medical centers on a level payment field,\nmost of us in rural Idaho will end up driving a long way for hospital care. <\/p>\n\n\n\n

It\u2019s time to start analyzing just what care should be given\nin small hospitals, then paying appropriately for it. The \u201ccritical access\u201d\ndesignation system needs a big overhaul.<\/p>\n","protected":false},"excerpt":{"rendered":"

Back before we got into a stalemate when talking about healthcare costs, long ago when I had good knees and my hair wasn\u2019t grey, funding for small town hospitals was recognized as a problem. After Montana demonstrated they could support … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[23,22,19],"_links":{"self":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1056"}],"collection":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1056"}],"version-history":[{"count":1,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1056\/revisions"}],"predecessor-version":[{"id":1058,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1056\/revisions\/1058"}],"wp:attachment":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1056"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1056"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1056"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}