The rural emergency hospital is the first new federal billing program since the critical access hospital model was introduced in 1997.
Senator Chuck Grassley (R-Iowa), who co-sponsor the law that led to the creation of the new program, hopes it will prevent hospital closures from decimating the local economy and forcing patients to travel. further to be cared for. About 140 rural hospitals have closed or converted into outpatient-only facilities in the past 12 years, with more than 40 closed since 2019, according to data from the University of North Carolina.
Under the CMS 2023 Future Outpatient Billing System final rule issued in November outlining the specifics of the model, rural emergency hospitals will eliminate patient beds. inpatient in exchange for a 5% increase in Medicare outpatient reimbursement and an average base fee payment of $3.3 million a year.
Converted hospitals should always have their clinicians on duty, staff their emergency departments 24 hours a day, implement a quality assurance and performance improvement program, and have an average length of hospital stay per patient. patient for less than 24 hours and maintain an infection prevention program. States must also pass legislation to register and license converted facilities.
Kansas, Nebraska and South Dakota have passed such legislation allowing hospitals to convert. As of last week, several Texas hospitals hoping for transition are waiting for Governor Greg Abbott (R) to implement an emergency rule to speed up the process.
Rural hospitals with fewer than 50 beds enrolled in Medicare as of December 27, 2020, are eligible, totaling about 1,400 facilities nationwide. But a 2021 summary from the North Carolina Rural Health Research Program predicted about 68 conversions. Industry observers say that number may have dropped.
The program’s appeal has been limited by the potential loss of $340 billion in drug and swing bed discount sales, along with concerns about public perception of the removal of inpatient services.
“The final version of the law brought relief to a very large number of people,” said Travis Lloyd, healthcare attorney with the law firm Bass Berry & Sims who specializes in healthcare management issues. limited hospitals. “It’s not the broad-based antidote that rural hospitals need to change their closing trajectory.”
Before CMS issues a final rule, rural hospitals hope the agency will include provisions that would allow them to maintain revenue under the 340B program, which allows some hospitals to serve the community. Low-income co-workers buy outpatient drugs at a significant discount. The agency said in the final rule that it had no statutory authority to include those provisions, meaning Congress would have to pass another law. Transforming critical outreach hospitals will also have to sacrifice their cost-based reimbursement.
