Critical Access Hospitals' Length of Stay Requirements Increase Hospitalist Admissions.

I practice hospitalist medicine in the leading regional referral center in my state. We are a full service hospital that is capable of providing just about all medically necessary (and unnecessary) health care your Medicare National Bank can afford to pay for. If you are a Medicare patient and you get admitted to any major hospital system in this country, your hospital will get paid based on a diagnosis related group (DRG).  Go here to learn more about how hospitals get paid by Medicare.  

However, if you are a Critical Access Hospital (CAH), many of the rules placed on major regional referral hospitals don't apply.   I always knew that critical access hospitals weren't paid based on the DRG rules of big hospital centers.  You might be interested to know that.
  • To gain CAH status, the hospital must be in a rural area and be at least 35 miles from another hospital or 15 miles from another hospital in a mountainous terrain or with secondary roads only.
  • As of March 31st, 2011, there were 1327 CAHs.  Here is a 2011  map of all Critical Access Hospitals in the country. 
  • CAHs receive cost-based payment from Medicare. (Cost + 1%).  DRGs do not apply.
  • CAH centers must have a maximum of 25 acute care inpatient beds.
  • CAH centers must maintain an average length of stay of 96 hours or less for their acute care patients.
  • Go here for more from CMS on Critical Access Hospitals.  
It never occurred to me before, but this length of stay requirement may be why hospitalists are often asked to accept patients from critical access hospitals who are in their acute care hospital day #2 or #3.  I rarely  see transfer patients from CAHs who have been admitted more than 96 hours.  That may have less to do with their severity of illness and more to do with the government mandated rules on Critical Access Hospital length of stay requirements.

That's OK though because they come to us with urosepsis sepsis with UTI and go home the next day.  My hospital gets paid a nice one day DRG for sepsis, my  length of stay and mortality data rocks the averages and the Critical Care Hospital gets their cost + 1%.  It's WIN-WIN.  I just wonder how long The Medicare National Bank will be able to continue paying for it all and what effect the bundled payment models being tossed around these days will have on how patient care is divided between CAHs and acute care regional referral centers.  

If CAH are excluded from the bundled care fixed pie model, there may be more incentive for big hospital systems to partner with CAHs  as a way to defer radiology and laboratory and labor expenses in the first 96 hours of illness while providing highly specialized care in the form of  TeliPad medicine.  Once that golden 96th hour is achieved, the patient can safely be transferred for a truncated and more lucrative DRG who's upfront costs have been diverted to the cost +1% model of CAH care.

That makes sense to me.  Go here for a CMS Fact Sheet on Critical Access Hospitals.

Some of this post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk. 

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