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Rural hospitals urge Congress to spare Medicare programs

by Brendon Nafziger , DOTmed News Associate Editor
A coalition of rural hospitals marched on Washington, D.C. this week to save two Medicare programs the group says are vital to keep hundreds of smaller hospitals going, but which are scheduled to disappear this fall.

Organized by the National Rural Health Association, the two-day lobbying effort, which went from Monday to Tuesday, was aimed at pressuring Congress to spare the Medicare Dependent Hospital designation and the Low-Volume Hospital Adjuster, both of which are set to expire October 1.

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The two programs, which date to the 1980s, help cover the costs for low-volume rural hospitals that primarily treat Medicare beneficiaries, and would have a hard time providing care or keeping their doors open without the payment adjustments, especially as hospitals face a slew of other reductions, according to the NRHA.

"Rural facilities do not have the financial background to weather all of these cuts," Lance Keilers, the president of the NRHA and the administrator of Ballinger Memorial Hospital in San Angelo, Texas, told DOTmed News by phone on Tuesday.

A little over 200 hospitals meet the Medicare Dependent Hospital designation nationwide. To qualify, a hospital must have fewer than 100 beds and Medicare patients must make up 60 percent of their inpatient days or discharges. Also, the hospital can't qualify as a sole community hospital, another Medicare designation, also developed in the 1980s for isolated rural hospitals.

Under the MDH program, hospitals get an enhanced payment rate and Medicare also compensates them for fixed costs if patient volume drops 5 percent for reasons outside of the facility's control, thereby helping to mitigate the financial risks of caring for the elderly in rural areas.

Keilers estimated nearly 600 hospitals qualify for low-volume hospital adjustments, thanks to changes brought about in fiscal 2011 and 2012 under the Affordable Care Act, but which are set to expire this fall.

Under the more generous, and expiring, changes, low-volume hospitals must be at least 15 miles from another hospital and provide care for fewer than 1,600 Medicare beneficiaries a year. In earlier versions of the rule, hospitals had to be 25 miles and treat fewer than 200 people a year. Keilers said only 19 or so hospitals qualified under these stricter terms.

Raising awareness

The purpose of this week's march on Capitol Hill was to help NRHA members raise awareness of their plight with senators and their local representatives. About 70 people came for the meet-up, representing more than 200 rural hospitals, Keilers said. He said they've been meeting with politicians from both sides of the aisle.
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