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It’s staggering to think of the challenges that CAHs face. Now OIG is calling for a re-examination of a program that it says has overpaid CAHs billions of dollars to provide skilled nursing services using hospital swing beds.

They’re called “Critical Access Hospitals” for a reason. These tiny healthcare outposts provide “critical access” to people who live in remote areas.

That was the intent of the legislation that created CAHs in 1997 at a time when rural hospitals were shuttering at an alarming rate. Congress understood that rural America needed extra Medicare dollars to keep the doors open at hospitals that serve an older, sicker and poorer patient mix.

It’s staggering to think of the challenges that CAHs face:

  • Because of their location and size, CAHs have few economies of scale, little leverage with vendors or payers, or a sufficiently large patient mix or volume of commercial payers to help cover costs.
  • CAHs are often limited in their ability to provide some of the more lucrative services that are cash cows for larger hospitals in urban areas.
  • Recruiting clinicians to rural areas is a slog.
  • And because of all those challenges, it’s also more difficult to merge or collaborate with other healthcare providers from such an isolated perch. It’s surprising to learn that only 40% of CAHs operate in the red.

Unfortunately, some people in Washington, DC have short institutional memories.

For the past couple of years, reports from the Office of the Inspector General at the Department of Health and Human Services have made it clear that they believe the CAH designation and funding scheme should be overhauled.

In its latest shot across the bow, OIG this week called for a re-examination of the swing bed program that allows CAHs to provide long-term care. The OIG audit claimed that the federal government has overpaid CAHs $4.1 billion over the past six years for services that could have cost less in relatively nearby skilled nursing and long-term care facilities.

Tavenner Pushes Back
Rural healthcare advocates rallied around the reply to the OIG recommendations from former Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner, who challenged the OIG findings and recommendations in her formal response, and suggested that auditors don’t understand healthcare delivery in rural areas.

In that same response to OIG, however, Tavenner said the Obama 2016 budget has called for reducing the Medicare reimbursement that CAHs receive from 101% to 100% of allowable costs, and reassessing and eliminating CAH status for hospitals that are within 10 miles each other.



IBM Watson Health ranks top 15 hospitals

Truven Health Analytics research initiative found that the highest performers achieved better care consistency and alignment across facilities.

BM Watson Health has revealed its 15 Top Health Systems based on overall organizational performance. Formerly known as the Truven Health Analytics 15 Top Health Systems, the rankings have been conducted annually since 2008 and reflect operational and clinical excellence, IBM Watson Health said.

Top systems earned the ranking at least in part through more consistent care across member hospitals, finding a “small but discernable difference” in the level of individual hospital alignment within the top-performing health systems as well as 1.9 percent lower volatility, the group said.

Demonstrating what separates the best from the rest, top hospitals achieved several benchmarks over their peers including: 14.6 percent fewer in-hospital deaths, 17.3 percent fewer complications and 16.2 percent fewer healthcare-associated infections. They also had a median severity-adjusted length of stay roughly one half-day shorter than peers and median ED wait times 40 minutes shorter per patient as well as 5.6 percent lower per episode combined in-hospital and post-discharge costs. HCAHPS scores for overall hospital experience were also 2.3 percent higher.

Using the study’s findings, IBM Watson health said that if all Medicare inpatients received the same level of care as delivered by the top 15 systems, more than 60,000 lives could have been saved, more than 31,000 more patients could have a complication-free care episode, HAI’s would drop 16 percent and ER wait times would be reduced to 40 minutes or less.

Researchers evaluated 338 health systems and 2,422 member hospitals on nine clinical and operational performance benchmarks to formulate the rankings. Those benchmarks included risk-adjusted inpatient mortality index, risk-adjusted complications index, mean healthcare-associated infection index, mean 30-day risk-adjusted mortality rate, mean 30-day risk-adjusted readmission rate, severity-adjusted length of stay, mean emergency department throughput, Medicare spend per beneficiary index and HCAHPS score.

The research was based on public data including Medicare cost reports, Medicare Provider Analysis and Review data, Healthcare Associated Infections and patient satisfaction data from the CMS Hospital Compare website.

Mayo Foundation Rochester Minnesota
Mercy Chesterfield Missouri
Sentara Healthcare Norfolk Virginia
St. Luke’s Health System Boise Idaho
UCHealth Aurora Colorado
Aspirus Network Wausau Wisconsin
HealthPartners Bloomington Minnesota
Mercy Health, Cincinnati Cincinnati Ohio
Mission Health Ashville North Carolina
TriHealth Cincinnati Ohio
Asante Medford Oregon
CHI St. Joseph Health Bryan Texas
Maury Regional Health Columbia Tennessee
Roper St. Francis Healthcare Charleston South Carolina
UPMC Susquehanna Health System Williamsport Pennsylvania