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Area hospitals could lose Medicare funds
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DARLINGTON — The mission of the Memorial Hospital of Lafayette County is “To provide patient-centered quality health care to Lafayette County and the surrounding area.”

The hospital has been striving to carry out that mission while serving as a Critical Access Hospital for the residents of Lafayette County since its construction in 1952.

However, recent recommendations by the U.S. Department of Health and Human Services may make that mission as well as the very survival of the establishment difficult to maintain.

In a study report recently released, the Office of Inspector General-Department of Health and Human Services recommended taking action that would inevitably strip approximately two-thirds of the state’s current CAHs — including all of them in Grant, Lafayette and Iowa counties — of their critical access designation.

A CAH is a hospital certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures and ensure that rural residents have nearby access to hospital healthcare.

Besides MHLC, area CAHs include Southwest Health Center in Platteville, Grant Regional Health Center in Lancaster, Boscobel Area Health Care and Upland Hills Health in Dodgeville.

If the state’s CAHs were to lose that designation it would mean that they would no longer be eligible for Medicare reimbursements at 101 percent of their reasonable costs.

Hospitals can currently be certified as CAHs if they meet a variety of regulatory requirements, such as being located at least a certain driving distance from other hospitals and being located in rural areas.

However, states could exempt CAHs from the distance requirement if they were designated as being a necessary provider  CAH in the area. NP CAHs are permanently exempt from meeting the distance requirement.

The study from the Department of Health and Human Services points out that “the Critical Access Hospital certification was created to ensure that rural beneficiaries are able to access hospital services.”

But now, after plotting the locations of the 58 CAHs in the state on a map, the Department of Health and Human Services has discovered that almost two-thirds of the CAHs would not meet the distance requirement from other hospitals if they were taken out of exemption status and required to re-enroll,

The Department of Health and Human Services has determined that Medicare and beneficiaries would have saved $449 million in 2011 if all CAHs within 15 or fewer miles of their nearest hospital were decertified.

The Department of Health and Human Services is recommending that the Centers for Medicare & Medicaid Services seek legislative authority to do two things: remove NP CAHs’ permanent exemption from the distance requirement so the hospitals could be reassessed, and to revise the CAH conditions of participation to include alternative location-related requirements.

The study also recommended that CMS ensure that it periodically reassesses CAHs for compliance with location-related requirements and applies its uniform definition of “mountainous terrain” to all CAHs.

According to the study report, CMS concurred with all of the recommendations excluding the one regarding revising the CAH conditions of participation.

“Because the CAH certification results in increased spending for both Medicare and beneficiaries, CMS should ensure that the only CAHs to remain certified would be those that serve beneficiaries who would otherwise be unable to reasonably access hospital services,” concluded the study.

“If the Washington bureaucrats behind this had to drive a loved one to an emergency room during a January snowstorm in southwestern Wisconsin, they would realize this is just bad policy,” said state Sen. Dale Schultz (R–Richland Center) in a press release Aug. 26.

“This proposal betrays a fundamental lack of understanding of how and where healthcare is delivered in places like southwestern Wisconsin,” he said in the press release. “My genuine fear is, should these recommendations become law, hospitals will struggle to stay open, meaning people will have to drive 20 or 30 miles further for care.”

Schultz said the 17th Senate District has 11 CAHs in or near his district, “and all 11 of them are threatened by this proposal. So naturally I’m deeply concerned by the signals coming from Washington, and the implications of downsizing this vitally important program.”  

“The idea is ridiculous,” said MHLC’s administrator Julie Chikowski, who pointed out that if this goes through there will be a huge decrease not only in rural health, but also in employment for small, rural Lafayette County where the hospital is one of the biggest employers in the area.

“We would totally have to revamp the way we do business,” said Chikowski. “And it would put us in great jeopardy of surviving.”

Chikowski urged citizens who make use of MHLC to contact their congressmen if they do not want to see these proposed changes take place.