This letter responds to Ms. Michel’s article about Critical Access Hospitals. Before pushing the panic button, Ms. Michel should update her information. There is no proposal by Congress to change CAH requirements or status. A report was issued in August, NOT by Congress, noting that many CAHs do not meet current criteria for CAH status, and that money could be saved if those hospitals changed to prospective payment. Those statements are true.
It is not true that CAHs would necessarily close if they changed to the prospective payment system (PPS); indeed, they were paid under PPS before CAH status was invented. The fact is that many CAH are very close to another hospital, and it is these CAHs that could be reclassified IF a proposal is enacted.
It is not true that PPS does not consider rural location, salaries, and other costs of providing services. All those things are part of rate setting, and that is why it is important to submit an accurate cost report to CMS. Every hospital submits an annual cost report.
PPS requires effective, efficient management of every hospital. CAH permits many small hospitals that are poorly managed — NVH among them, according to many — to continue to operate. It is appropriate to look at the best, most cost-efficient ways to ensure health care in our communities, and I encourage the NVH Board and administrator to do that, instead of panicking at the mention of a single, reasonable report.