The Stevens County Hospital is a Critical Access Hospital (CAH). But what does that mean? In 1997, Congress created the Critical Access program to benefit hospitals like ours. Because we are a small hospital, we can focus only on providing the most essential medical services. Compared to larger, higher-volume hospitals that have more resources and greater flexibility to offer a wider range of services, we provide services that are considered essential to achieve and maintain our patient’s general good health. Larger hospitals have greater budgets and economic flexibility that allow them to provide less crucial, more optional health care services.
Because of geography and distance to larger hospitals, it is critical that patients have access to our services. We are a rural hospital, and we strive to provide health care that takes care of the resident’s immediate needs. We are critical to the health of this area.
Critical Access Hospitals (CAHs) survive largely due to a federal reimbursement structure from Medicare that provides funding of 1% above the cost of providing care. The Medicare Payment Advisory Commission (MedPAC) estimates that in past years, Medicare paid CAHs an average of $850,000 per year more than they otherwise would have without the CAH designation. Medicare recognizes that small hospitals like ours fill an urgent need to meet the essential healthcare needs of area residents, and without them, many people would find themselves in a crisis situation without local medical care.
The Critical Access program was created by Congress in 1997, after a wave of rural hospital closures. The program was aimed at keeping health care available to Americans in rural and isolated areas. In order to qualify to receive these benefits from Medicare, there are several criteria that must be met before a hospital can be defined as a Critical Access Hospital:
- Located in a state that established a State rural health plan for the State Flex Program. Only Connecticut, Delaware, Maryland, New Jersey and Rhode Island did not have a State Flex Program.
- Located more than a 35 mile drive from any other hospital—CAH or otherwise, OR, Located more than a 15 mile drive from any other hospital or CAH in an area with mountainous terrain or only secondary roads.
- Located in a rural area or be treated as rural under a special provision that allows qualified hospital providers in urban areas to be treated as rural for the purposes of becoming a CAH.
- Furnish 24-hour emergency care services 7 days a week, using either on-site or on-call staff. For on-call staff, there are specific response time frames that must be met.
- Maintain no more than 25 inpatient beds that may also be used for swing bed services. It may also operate a distinct rehabilitation or psychiatric unit, each with up to 10 beds.
- Have an average annual length of stay of 96 hours or less per patient for acute care (excluding swing bed services and beds that are within distinct units as mentioned above.
Notes: Payment rules require a physician to certify that an individual may be reasonably expected to be discharged or transferred within 96 hours after admission to the CAH. A swing bed is defined as a hospital bed that can be used for acute care for a stay expected to be under 96 hours, or it can be used for long-term care, similar to care received in a nursing home.
There are many other important facts regarding CAHs:
- There are 1,330 Critical Access Hospitals in 45 states in the United States.
- There are 83 Critical Access Hospitals in Kansas.
- The typical CAH provides an average of 204 jobs to the local economy.
- Seven million patients are treated annually in the emergency rooms of CAHs nationwide.
- There are 38 million outpatient visits annually to CAHs.
- 900,000 patients are admitted to CAHs each year.
- 86,000 babies are born in CAHs across the Unites States every year.
- 19.3% of the American population resides in rural areas that are served by CAHs.
The Office of Rural Health Policy (ORHP) is a subdivision of the United States Department of Health and Human Services (HHS). It was created in 1987 and is the lead federal agency responsible for monitoring and improving health care services for the 60 million Americans who live in rural areas. Historically, such services have been scarce and limited. In order to maintain, preserve and attempt to improve rural health care, the ORHP assists states in collecting and disseminating health-related information regarding rural health care, provides technical assistance to rural hospitals and providers, and works with communities to recruit and retain health care providers. Specific functions include:
- provides funding and technical assistance in partnership with the National Rural Health Association
- provides rural grant programs to benefit CAHs with acquisition of telemedicine and computer file-sharing equipment
- supports rural health research centers to conduct short and long-term studies on rural health issues
- offers technical assistance to more than 4,000 rural health clinics through quarterly conference calls
- supports the Rural Recruitment and Retention network to locate and retain health professionals
- oversees services provided by the University of North Dakota’s Rural Assistance Center, which serves as an information portal to help rural communities access the full range of available health care programs, funding and research.
Each of the 83 Critical Access Hospitals in Kansas belongs to a rural healthcare network, as required by the Kansas Department of Health and Environment (KDHE). In applying for certification as a CAH, each hospital must submit a plan to the secretary of the KDHE, specifying a Supporting Hospital that will be the primary recipient of patients who are transferred in need of more intensive medical care and the provision of emergency and non-emergency transportation among members. The Supporting Hospital also provides medical staff credentialing, risk management, quality assurance and peer review.
There are 19 networks in Kansas. The Stevens County Hospital belongs to the Southwest Kansas Regional Health Network, with St. Catherine Hospital in Garden City as the Supporting Hospital. Nine other southwest Kansas hospitals belong to this network, as well as one hospital in northwest Kansas. Six Kansas Critical Access Hospitals belong to networks with the Supporting Hospital in a bordering state due to their proximity to that hospital. The largest network in Kansas is the Northwest Kansas Health Alliance, with 24 CAHs in northwest Kansas that are supported by Hays Medical Center in Hays.
The history of rural healthcare has followed a pattern of economic struggle, with the future predicted to continue as such. However, Medicare provides incentives for hospitals and health care providers to provide essential services through CAHs, and offers reimbursement that is 1% above the cost of providing care. The dire need for rural health care through CAHs is recognized by Medicare, and their payments must continue in order for CAHs to continue to provide care.
47.3% of total reimbursement to CAHs nationally is through Medicare, with over 60% of the total revenue coming from Medicare and Medicaid (15.5%) combined. 35.9% of reimbursement comes from private insurance, with the remaining 1.3% coming from other sources. Because of the concentration of older, Medicare-funded patients in rural areas, the percentage of revenue from private insurance is considerably less than in urban areas.
It is frequently said that if a town loses its schools, then the town will not live on much longer. Some health care analysts feel that the same can be said for hospitals. Businesses typically don’t consider relocating or developing in a town that does not have a school, nor will they consider a town without a hospital. Thanks in part to our Critical Access Hospital Designation, our hospital is alive and well, as are our schools, and our community in general.