While Tavenner's rebuff of OIG was heartening for rural providers, she no longer runs CMS. Regardless, the Obama budget proposal puts CAHs in the crosshairs, and it's not clear if Tavenner's replacement, Acting Administrator Andy Slavitt, understands the special challenges posed by rural healthcare.
President and CEO,
Margaret Mary Community Hospital
Tim Putnam, president and CEO of Margaret Mary Community Hospital in Batesville, IN, expresses the concerns of many rural providers who feel that there is a disconnection in the federal government when it comes to rural healthcare.
"If you grew up in an urban area or trained in an urban area or work in an urban area, it takes effort to understand the specific challenges that exist in a rural community," Putnam says. "That is one thing where you see a lot of organizations trying to educate legislators and policy makers and groups like HHS about the specific challenges for rural areas."
The OIG call to re-examine the CAH swing bed program is a great example of that disconnect, Putnam says. It makes sense from a bottom line perspective, but the bottom line doesn't tell the whole story.
"You can pick one program and say 'Aha! It' seems like they are paid more than they should be,'" he says. "But there are also 99 programs that aren't paid at all or paid very poorly that critical access hospitals have to run 24/7 that are not reimbursed anywhere near what it costs to provide those services."
"Having a swing bed program allows for staffing to exist in these low-volume facilities 24/7," Putnam says. "The swing bed volume is not very heavy in some communities, but you have [to have the] staff for it because you have to be ready for patients all the time. It helps to have staff available for acute care. A lot of times the hospitals will cross-train staff to work in swing beds and acute care. It really helps form the foundation of having an availability to serve a community need any time day or night."
Putnam says the proposed cuts to CAH funding and a reappraisal of their special status in the Obama budget also send a troubling message at a time when rural hospitals are trying to make the transition from volume to value.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.