HLM: Will the feds attempt to strip some rural hospitals of their critical access status?
Elehwany: Maybe. That is a big concern we have. The reason we say 'maybe' is this very large proposal for fixing the SGR that sounds good on paper, but they don't have a pay source for it yet. That is where the sticking point is going to be – a lot of the 'pay fors.' President Obama has proposed cuts to critical access hospitals in three or so of the last administration budgets. We are worried that that could be on the chopping block— that it could be viewed as a piece of low-hanging fruit.
Our strong message to Capitol Hill is that first of all, these payments to rural hospitals are not bonus payments that you get simply because you are rural. Members of Congress need to look back in their history and see why these payments were established. They were not to give hospitals bonuses but to keep services going and keep doors open. That is part of the big education battle we are dealing with in Congress, specifically on the House side.
Congress arbitrarily came up with the 35-mile outline of where critical access hospitals should be at a distance from each other, but they knew that rural Iowa, rural Texas, rural Montana, and rural Alaska are very different animals.
So they said they would leave it up to the states' discretion to deem certain facilities within the states as critical access points. So states developed their criteria and it was the federal government that approved that designation. We're frustrated that the federal government said 'OK we agree with you that they are necessary providers,' but now they could rescind on that in an arbitrary manner.