In the video below, HRSA's Tom Morris and I briefly discuss the findings from a series of reports that paint a pretty stark picture of the financial situation facing rural hospitals.

Produced by the North Carolina Rural Health Research Program, one report pointed out that rural hospitals paid under PPS and critical access hospitals have lower profitability when compared with hospitals with other payment classifications. Another report found that there's huge variation in profitability and margin among critical access hospitals. And a third report suggested that critical access hospitals could see Medicare revenue drop by 20 to 30 percent if they lose cost-plus reimbursement, and that's the "best case," NCRHRP's George Pink said during a sunrise session yesterday. He presented on the panel with Morris as attendees spilled out in the hallways, if only to hear data about the shared pain they are all feeling.

That session set the stage for later in the morning as AHA officials, including President and CEO Rich Umbdenstock, tried to rally attendees here, as well as those watching a special webcast, to make their voices heard on Capitol Hill. Umbdenstock pointed out that lawmakers are taking up bills over the next few weeks that will profoundly impact rural hospitals and their communities.

"If your legislators don't hear from you, they'll assume that you are OK with those decisions," Umbdenstock said. "We need you to stave off possible cuts and send Washington a strong message: Protect rural health care."

The AHA's Lisa Kidder Hrobsky and Priya Bathija joined Umbdenstock and laid out a slew of policies that are on the forefront of the rural agenda, including:

  • The 96-hour rule: Although on the books since 1997, CMS only recently announced that it was going to begin enforcing this rule that requires a physician at a critical access hospital to certify at the time of admission that a Medicare beneficiary will be discharged or transferred within 96 hours. If the patient stays past that time, the hospital won't get reimbursed. Adrian Smith (R-Neb.) has introduced legislation that seeks to address the situation.
  • Continued attention to the critical access hospital program: President Obama's 2014 budget again calls for shifting CAH payment to 100 percent of Medicare costs, rather than cost-plus. There are also assessments relating to the distance requirement for retaining a CAH designation.
  • Direct supervision: This rule requires direct supervision by a physician or nonphysician provider, such as a nurse practitioner, for outpatient physical therapy services.

While concerned about the advocacy challenges ahead, several of the attendees I talked with at lunch and during coffee breaks seemed energized about the need to rally support for their cause with lawmakers.

We'll have a final report from the meeting in tomorrow's H&HN Daily, including a look at the key IT issues facing rural hospitals.