Rural health care centers may take a hit with the passing of site-neutral payments for post acute care. And with rural residents and veterans already struggling with access to the care they need, post-acute care has been a point of contention to people on both sides of the issue.
So what’s happening with bundled post acute care at the moment? Let’s take a look.
What are Critical Access Hospitals?
First, it’s important to understand what qualifies as a CAH.
CAHs serve as healthcare centers for large geographic areas (often being the sole provider for a wide range of essential services such
as inpatient, ambulatory care, labor and delivery, emergency room, general surgery, home care, hospice, ambulance, and post acute care) by utilizing the Medicare “swing bed” program.
CAH physicians and providers also staff clinics that provide primary care in their rural communities and deliver a local continuum of care with a personal connection that is sometimes hard to find in urban settings.
What’s the issue?
Threat of bundling post acute care reimbursements has been looming for the past 6 years, as congress has placed post-acute care bundling in budget requests. According to some numbers, funding cuts have threatened 40 percent of all home health agencies across the country, especially in those rural areas. Nearly every time the bundling issue has been raised, the American Health Care Association has publicly opposed it.
Under the proposal, risk-based, per beneficiary bundled payments would be delivered to an acute care coordinator. The bundled payments wouldn’t include physician services, outpatient therapies, outpatient ambulance, hospice and outpatient hospital services.
So, what do we do?
According to some sources, CAHs are still the top option for providing rural residents with local access to cost-effective, high-quality care across the healthcare continuum. They claim that the facilities and staff already exist to promote establishment of new Transitional Care programs to address the quality and patient safety gaps in post-acute care.
One organization claimed, “Policies and funding that significantly alter the present CAH infrastructure in favor of shifting care to urban areas and skilled nursing facilities with the present quality and patient safety gaps, at best, will create problems and, at worst, could prove devastating.” Which means more strain on those living in rural areas–another hit for a demographic already limited in healthcare resources.
Look to the Numbers
For many rural healthcare providers, post acute care is a numbers game. If they can’t find a way to make bundled payments work with their revenue cycles, the threat of closure becomes very real.
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