Hospital proactive in funding


Critical access designation comes under fire by OIG

by: HOLLY M. GILL - Critical Access Hospitals, such as St. Charles Madras, that are less than 35 miles from the nearest hospital, could have funding cut under a proposal by the Office of Inspector General. However, hospital CEO Jeanie Gentry said there are no proposals on the table now to make such changes.So far, a federal office's proposal to reduce Medicare spending that could have a serious impact on funding for St. Charles Madras has not gained any traction.

That's the good news. But the state is also reviewing the way Critical Access Hospitals — such as St. Charles Madras — are reimbursed for Medicaid patients.

"There are really no proposals on the table right now to take critical access away from hospitals — at least at the federal level," said Jeanie Gentry, CEO of St. Charles Madras. "At the state level, as part of all the reform that's going on in Oregon, (the question) is whether they should keep paying Critical Access Hospitals on a cost-based reimbursement."

by: HOLLY M. GILL - Jeanie GentryWhile Medicare and Medicaid are both government-sponsored health care programs, they serve different populations. Medicare payments are disbursed by the federal government for senior citizens and people with certain disabilities, while Medicaid payments are paid out by both the state and federal governments to low-income families and individuals.

The proposal by the U.S. Department of Health and Human Services Office of Inspector General suggested decertifying Critical Access Hospitals, such as St. Charles Madras and Pioneer Memorial Hospital in Prineville, that don't meet location requirements.

The federal Critical Access Hospital designation, created in 1997 to ensure access to hospital care in rural areas, specifies, among other criteria, that a hospital should be located more than 35 miles from another hospital, and have no more than 25 beds used for acute care.

Generally, Medicare pays out a lump sum to hospitals based on a certain diagnosis, Gentry explained. The problem was that small, rural hospitals didn't have enough volume to make it on those payments.

As a Critical Access Hospital, the small, rural hospitals receive 101 percent of allowable costs — but not payment for televisions in rooms or "a whole laundry list of things they don't include," she said.

"Usually, it ends up that they're paying about 95-some percent of our true costs for those patients on Medicare," said Gentry. "Medicaid would pay us the same money in Oregon."

The payments have helped the small hospitals survive and in many cases, provide the same services as larger hospitals, even though they have fewer patients.

The August report from the Office of Inspector General came as a surprise to Gentry. "Most Critical Access Hospitals are barely making it," she said, adding that the reimbursement is what allows the hospitals to remain open.

If the U.S. Congress agreed to decertify hospitals that don't meet the location criteria, it would have a major impact locally. "Even though our hospital is only 26 miles from Redmond, it's a lot further away from people we serve," she said. "We get people from all over the Warm Springs Reservation, Shaniko, Fossil, Antelope."

"To the north of us, there's 90 miles to get to The Dalles," she continued. "There are no interstates to get there; that's why it's important for us to keep open."

The transfer of assets from Mountain View Hospital to St. Charles Health System, which took place Jan. 1, has helped the hospital remain financially strong, she pointed out.

"If we hadn't merged with St. Charles, we'd be having a very difficult time keeping open," said Gentry, noting that St. Charles Madras employs about 200 people.

Hospital officials are also meeting with their U.S. senators and representative, who have been following the issue.

On the state level, the Oregon Association of Hospital and Healthcare Systems and the chief executive officers of the Critical Access Hospitals have been working with Gov. John Kitzhaber and his staff to determine how such hospitals would be paid, said Gentry.

"I think that the governor is really trying to think outside the box," she said. "I appreciate that he's working with us."

ER nursing staff change

Recently, members of the public and staff have questioned the safety of the hospital's plans to reduce dedicated emergency room nursing staff from two to one in the early morning hours.

Responding to that question, Gentry said that the plan is to have more nurses — not fewer — available when the change takes effect Jan. 1.

Beginning in December or January, the hospital will go from seven nurses to eight nurses on duty in those early hours, but, she said, the nurses "won't have to be tethered to the ER; they can float around."

"Some of the ER nurses are scared that if they can go someplace else, there won't be enough resources," she said, adding that nurses would like to see "a nurse in the ER who never leaves the ER."

With the increase in core staffing level, she said, there will always be at least two experienced ER nurses on duty in the hospital.

The busiest time in the ER is from about 3 p.m. until midnight, when there are eight nurses on duty, with two in the ER, and the others shifting around where they're needed. But that number could increase to nine.

"The intent is to have the most nurses of the whole day during that period from 3 p.m. until midnight — basically when we need them the most," said Gentry.

After midnight, when the ER might see only one or two patients, there would be more flexibility that would allow nurses to cover other areas.

"Now, they're starting to see that there will actually be more nurses," she said.

Oregon law requires a staffing committee to set up the plan for nursing staff. That committee met a couple weeks ago, and unanimously supported and approved the plan, Gentry said.