Wilson TG, Hyde JC, Breaux DA; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.

Presented by: Thomas G. Wilson, M.S., Ph.D. Candidate, 62 Carrera Street, St. Augustine, FL 32084. Tel. 904-808-8785; FAX 904-823-1853; E-mail: tgw35@hotmail.com

Research objective: The Medicare Critical Access Hospital (CAH) program, part of the Balanced Budget Act of 1997, has received much national attention with the goal of limiting the range of services for small rural not-for-profit and governmental hospitals. The intent of the legislation was to push for the regionalization of health care, while controlling costs by reducing the scope of services. Using the federal criteria for conversion, this paper attempts to predict from a selection of six cases, which acute care facilities will in fact convert to CAH's.Study Design: The theoretical framework for analysis was based on systems theory and how rural acute care facilities choose to adapt to dramatic changes in their environment. In March 1998, Governor Kirk Fordice (R) signed legislation which adopted the federal Medical Rural Hospital Flexibility Program. Six sole provider county cases were selected for the analysis from three distinct geographical regions within the state of Mississippi: the southern piney-woods, the northern hills, and the delta. Quantitative indicators used include: a quota survey of 200 adult residents form each of the six selected counties, Medicare and Medicaid cost reports from the three most recent fiscal years, and county-level economic data. The qualitative components consisted of on-site interviews with the hospital administrators and telephone interviews with the trustees. Additional archival data consisted of board minutes from the selected facilities.Population Studied: Six rural sole provider government owned acute care hospitals in Mississippi.Principle Findings: Community attitudes were correlated with a number of indicators including usage, distance traveled to receive care, and perceptions related to quality of care provided by the local hospital. Respondents to the telephone survey wanted to retain the hospital as a full service facility. To strengthen the local hospital, respondents recommended that is should become affiliated with a larger hospital or health care system. The initial reaction of the local administrators were guardedly optimistic, however reservations were expressed that potential resistance would come from physicians. Several administrators conducted cursory financial analyses to determine if conversion would be possible. Three of the selected facilities currently receive cost-based reimbursement for geriatric and chemical dependency beds, and they saw no financial benefits. Other facilities were more receptive to the CAH programs, due to low patient volume and the possibility of cost-base reimbursement. The issue of network relationships was not mentioned as a significant impediment to conversions.Conclusions: Our findings related to CAH conversion are mixed, due to the various reimbursement plans that are utilized in the rural acute care facilities. Community attitudes were supportive in retaining the hospital as a full service acute care facility, however if access was limited (15 acute care beds) respondents were less willing to travel further distances to receive care. An unintended consequence may be a community less willing to use the local hospital since a patient could be transferred to a network affiliate and family members may not have transportation to visit relatives in distant hospitals. Local politics could play a pivotal role in conversion because elected officials must determine how the change would impact the community.Implications for Policy, Delivery or Practice: The findings suggest that CAH conversion may not be readily embraced in the selected rural communities studied since facilities will not receive cost based reimbursement for both acute care and geriatric/chemical dependency beds. The community may also not support conversion due to the perception that a CAH is less than a full-service facility.Primary Funding Source: The John C. Stennis Institute of Government, Mississippi State University.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Costs and Cost Analysis
• Data Collection
• Health Services Accessibility
• Hospital Administration
• Hospital Restructuring
• Hospitals
• Humans
• Interviews as Topic
• Medicare
• Mississippi
• economics
• therapy
• hsrmtgs

Other ID:

• GWHSR0000696

UI: 102272370

From Meeting Abstracts