by
Lisa Chamoff, Contributing Reporter | December 21, 2016
From the December 2016 issue of HealthCare Business News magazine
“It involves a closer critical connection between hospitals and nursing homes,” says David Nerenz, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System. “We may have a hospital-based physician make rounds in the nursing home and look for signs of trouble. It means working with the nursing staff to go over what to do if a patient develops a fever or an infection and what to do to prevent falls.” There continues to be concern about new rules on hospital outpatient providers, which can only be on a hospital campus. In urban areas where a hospital may not have a self-contained campus, the rules are particularly harsh, Kugler says.
“Many urban hospitals are very narrow,” Kugler says. “Their outpatient sites may be a block or two away because that’s the way it is in a city. If it’s not on campus, it is freestanding and not provider-based. That changes the reimbursement significantly. They are billed as a community provider, not as the hospital.”
Government efforts
While there have been efforts over the years to address challenges facing rural and urban hospitals with legislation, success has been elusive. Last year, U.S. Rep. Sam Graves, RMissouri, introduced the Save Rural Hospitals Act, which would, among other things, eliminate Medicare sequestration cuts for rural hospitals, eliminate reductions to rural Medicare and Medicaid Disproportionate Share Hospital (DSH) payments, which cover the cost of providing care to uninsured patients, reduce and delay the application of penalties for failure to achieve meaningful use with electronic health records, and eliminate the requirement for doctors to certify that a Medicare patient will be discharged or transferred to another hospital within 96 hours, which is a condition of payment.
On the urban side, earlier this year, the U.S. House of Representatives Ways and Means Committee advanced legislation that would compare similar hospitals for the purposes of determining readmission penalties, but, like the Save Rural Hospitals Act, it has encountered legislative stagnation. Hospital advocates are hopeful that a change in government via the recent election can help bring new eyes to the issues facing hospitals. “I think that with a new Congress and new president it could refresh the screen in terms of the dynamics we’re talking about,” says Brock Slabach, senior vice president for member services at the National Rural Health Association. “This is something that can’t be delayed much longer because the more we wait, the more hospitals that close. Once they go away, they’re not coming back.”
