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CAH Status Challenge Must Consider Access

John Commins, for HealthLeaders Media, August 21, 2013

A recommendation to strip critical access designation from any hospital that was given that status under a state "necessary provider" designation lacks consideration for the role of critical access hospitals in the rural healthcare safety net.

As alarming as it may have been, the federal government's call last week to review the special funding status of hundreds of critical access hospitals across the nation should not have surprised anyone paying attention.

Last year, for example, at the 25th Annual Rural Health Care Leadership Conference, James E. Orlikoff with the Center for Healthcare Governance told a hotel ballroom packed with hospitals leaders that payment cuts to critical access hospitals were "inevitable."

The outsized payments for critical access hospitals, he said, were low-hanging fruit in a cash-strapped healthcare delivery system. "Anytime you face an economic crunch when you have carved-out artificial protections, they can't last," he said then.

"Is it evitable? Yes. 'When' and 'how' are the questions… I think things are going to happen much more quickly. I tell my critical access hospitals to strategically plan on three years to be off the cost-plus model."

A year-and-a-half later, the Department of Health and Human Services' Office of the Inspector General has recommended that Congress allow the Centers for Medicare & Medicaid Services to strip critical access designation from any hospital that was given that status under a state "necessary provider" designation.

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