My Turn: Small, rural hospitals at risk
On Aug. 15, the Office of the Inspector General of the U.S. Department of Health and Human Services proposed changes that threaten the participation by many of New England’s rural hospitals in the Critical Access Hospital program. This program, in place for nearly two decades, is designed to stabilize small rural hospitals and reduce their risk of closure.
“Critical Access Hospital” designation provides qualifying rural hospitals with volume-appropriate Medicare reimbursement along with other regulatory provisions and technical assistance to help maintain access to care in rural areas by improving the financial viability and quality of key services in these small but necessary hospitals. The proposed changes would replace the statutorily granted authority that states now have to determine which of their rural hospitals are “necessary providers” with a simple drive-time distance test between hospitals which does not even take into account the types of services available at each hospital if the other were to fail.
These changes, if adopted, could remove the majority of current critical access hospitals across New England from this vital program and could potentially affect the lives of those who live in these communities.
Critical access hospitals are safety net providers for rural communities and the hubs around which local systems of care are organized. The loss of a hospital in a rural area, therefore, will extend further than just the walls of that facility, hurting the economic well-being of the community and access to care at all levels. Without them, many rural residents would experience reduced access to primary, emergency and acute care services. Critical access hospitals serve a disproportionate share of elderly and low-income individuals, populations more heavily affected by travel barriers. Reduced access due to hospital closures would unduly burden these vulnerable populations.
The proposed changes coincide with rising concerns about recent growth in rural hospital closures. Many critical access hospitals already face financial and operational challenges due to their rural location, workforce shortages, struggling economies and constrained resources. Critical access hospital designation supports them in meeting these challenges while serving their communities. The proposed changes threaten their participation in this important program.
The New England Rural Health Round Table works closely with critical access hospitals by supporting training initiatives, quality and performance improvement programs, and networking opportunities. We know their commitment to patients and providing high-quality, cost-effective care. They care for our families and vulnerable populations, employ our neighbors, and provide essential services.
Faced with the need to prepare for health reform implementation and the challenges posed by slow recovery of rural economies and a new round of rural hospital closures, we question the wisdom of overriding state determination of Necessary Provider status for purposes of Critical Access Hospital program participation.
The Critical Access Hospital program, while modest compared to other federal programs, is crucial to rural communities as it successfully fulfills its mission of ensuring access to care and protecting the health of rural residents.
(Julie Arel is executive director of the New England Rural Health Round Table in Starksboro, Vt.)