Hospital bankruptcies are on the rise, and rural hospitals are no exception. About 20% of rural hospitals are considered to be at risk of closure nationwide, and the majority of these hospitals are considered essential to their communities.
In light of these trends, this webinar will provide ABI members an overview of the unique issues faced by small rural hospital designated as “critical access hospitals” (“CAHs”) by the Centers for Medicare and Medicaid Services. Established by the Balanced Budget Act of 1997, the CAH designation allows eligible rural hospitals to receive reimbursement from Medicare (and state Medicaid programs) based on 101% of allowable costs rather than the traditional fee-for-service model. In order to receive the CAH designation, a hospital must be at least 35 miles from another hospital and meet at least the following criteria: (1) have 25 or fewer inpatient acute beds; (2) maintain an average length of stay of less than 96 hours for acute beds and (3) provide 24/7 emergency services.
Despite what should be a favorable reimbursement model, the nation’s approximately 1,350 CAHs are plagued with a variety of regulatory and socioeconomic hurdles hampering their profitability. These include shrinking federal and state budgets, physician shortages, the high cost of providing care to under- and uninsured patients, certain physician costs that are not reimbursed on a cost-plus basis, and difficulty repaying overpayments by the Medicare and Medicaid programs.
In a lively forum, this panel will focus on:
1. Debt restructuring challenges faced by CAHs due to their narrow margins and cost-based reimbursement model;
2. Alternative solutions to cash flow for CAHs through expansion of medical services, large group physician employment agreements, telemedicine and operational efficiencies;
3. Legal expansion programs in a CAH environment and illegal schemes perpetrated by bad actors who take expansion too far;
4. The roadmap to reorganization for CAHs who find themselves amid allegations of violations of the False Claims Act, Stark Law and Anti-Kickback federal and state laws and in the snarls of a healthcare fraud investigation with either CMS, Medicaid, OIG or commercial payers’ SIU departments; and
5. How to overcome the overpayment liability dilemma.
Speakers
Carol L. Fox
GlassRatner Advisory & Capital Group LLC
Elizabeth A. Green
BakerHostetler
Andrew Helman
Murray Plumb & Murray
Frank P. Terzo
Nelson Mullins Riley & Scarborough LLP
View Materials
1 hour
20 minutes
34 seconds