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CAH Status Challenge Must Consider Access

John Commins, for HealthLeaders Media, August 21, 2013

However, rural healthcare advocates such as Putnam are correct when they protest any review that is based on cost alone. There has to be equal consideration for the role of critical access hospitals in the rural healthcare safety net. And because job growth is a critical issue in this country right now, the role of the hospital as a local economic driver should also merit some consideration.

Let's remember that critical access hospital designation was created by Congress in 1997 after a wave of rural hospital closings. With the designation 16 years ago federal policymakers demonstrated that they understood the importance of access and that what works in an urban hospital might not work in a rural hospital.

Now that OIG has called for a review of critical access hospitals, it is up to rural providers to make their care and ensure that the lessons learned in the 1980s and 1990s aren't lost.

"People say small rural hospitals need to be part of a larger system, but when you cut the reimbursement so much that they can't operate on the volumes without losing money, my question is how many systems will want to expand into rural healthcare? "Putnam says.

"That is the mindset when I talked to people in Washington. 'If it gets bad you'll have to join a system.'I tell them' that is not going to be the option you think it is.'"

John Commins is a senior editor with HealthLeaders Media.

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