Saving $449 Million dollars may sound like a good idea, but what if it were to close 800 hospitals and up to 400 rural EMS systems that rely on them?
The OIG has issued a report to Congress recommending that Congress allow CMS to stop paying an estimated 800 Critical Access Hospitals an enhanced Medicare rate that actually allows the hospital to break even on the costs of providing the care. The request does not specifically ask to close the hospitals, but in light of the fact that most of the country’s 1300 critical access hospitals operate at a loss, the proposal virtually assures bankruptcy for the rural healthcare system in the US.
Rural EMS systems typically are heavily supported by training, medical direction, and in some cases actual ownership by the local rural hospitals. Many systems operated by volunteers and paid-on-call personnel also depend on the shorter transport times to rural facilities to make their operations feasible. Loss of these resources would severely impact as many as half of the systems, with some forced to close.
The hospitals at issue are part of the “necessary provider” exception to a Medicare rule that requires critical access hospitals to be located at least 15 miles from the next nearest hospital. These hospitals have been certified by their states as being necessary for healthcare in the state. Each hospital gets an extra $1.3 million per year from Medicare, according to John Cummins of Healthleaders Media.
The OIG recommendation is based on pure finances, but would have the perverse effect of closing up to 20% or more of the nation’s hospitals at a time when Obamacare already threatens to overwhelm the system with new participants. Apparently the OIG plans to make room for new system enrollees by taking away emergency care, hospitals, and doctors from rural areas.
It appears the administration will adopt an old Alaskan saying as its new motto: “Live in the bush, die in the bush.”