Valdosta Daily Times

August 22, 2013

Future of rural hospitals in question

Kay Harris
The Valdosta Daily Times

VALDOSTA — Recently recommended changes to the rural healthcare delivery system by the federal government may threaten hospitals across the nation, including dozens in the state and several in south Georgia.

On Wednesday, at the Hospital Authority of Valdosta-Lowndes County meeting at South Georgia Medical Center, the issue was brought forward to inform the members of the potential impact of the changes.

Neil Ginty, campus administrator for Louis Smith Hospital in Lakeland and Berrien County hospital in Nashville, said a study by the Department of Health and Human Services Office of the Inspector General states that most rural hospitals designated as critical care access facilities, would not meet the requirements if they had to re-enroll in Medicaid today.

“Under the Affordable Care Act, hospitals would have to reapply and most of them would not meet the 35 mile minimum from another hospital. This would impact the Medicare reimbursements under the rural hospitals designation and would effectively close Louis Smith and others,” Ginty said.

According to Sauls, there are 1,300 critical care access facilities in the country and if the recent recommendations are adopted, around 800 of them would close due to lack of funding.

There are 34 facilities in the state of Georgia under the rural designation, including Brooks County Hospital, Clinch Memorial Hospital, and Louis Smith. SGMC operates Clinch and Louis Smith, while Brooks County is operated by Archbold in Thomasville.

The study, “Most Critical Access Hospitals Would Not Meet the Location Requirements if Required to Re-Enroll in Medicare,” produced by the HHS Office of Inspector General (OIG), was released on Aug. 15. Its purpose was to determine if there were cost savings in closing rural

hospitals, with the results showing there would be significant savings.

The OIG study states that the critical care access designation began in 1997 to “ensure that hospital care is accessible to beneficiaries in rural communities.” These facilities would be reimbursed at a higher rate by Medicare as a means of preventing the hospitals from closing. The designation is based on location requirements for distance as well as the distance traveled on secondary roads or in mountainous terrain.

“Sixty-four precent of CAH’s would not meet the location requirements if required to re-enroll in Medicare, “ states the study’s conclusion. “... we calculated that Medicare and beneficiaries could have saved more than $1.3 million per decertified CAH (critical care hospital) in 2011.”

Ginty stated Wednesday that closing Louis Smith would have a devastating effect on Lanier County as the hospital is the largest area employer. Longer driving distances can severely impact patient care.

According to the Rural Hospital Association (RHA), rural Americans face “a unique combination of factors that create disparities in health care not found in urban areas. Economic factors, cultural and social differences, educational shortcomings, lack of recognition by legislators and the isolation of living in remote rural areas all conspire to impede rural Americans in their struggle to lead a normal, healthy life.”

The RHA states the issues faced in rural communities include:

• Rural residents are twice as likely to die in a motor vehicle accident, even though only one third of accidents occur in rural areas.

• Only about 10 percent of physicians practice in rural America although nearly one-fourth of the population lives in these areas.

• Rural residents are also twice as likely to die in non-vehicle accidents.

• Anywhere from 57 to 90 percent of first responders in rural areas are volunteers.

• The rates of heart disease, suicide, hypertension, alcohol and drug issues are much higher in rural areas.

The OIG has recommended that the cricitical access designation be removed by legislative authority and all the facilities be reassessed as part of the country’s FY 2014 budget process.