[Editor’s Note: This article was researched and written at the request of a reader. If you, too, have questions about Gila Regional, please send them to editor@grantcountybeat.com, and the Beat will endeavor to get answers. Sometimes, privacy laws prevent detailed responses.]
By Mary Alice Murphy
Most of the time, one hears that critical access designation will bring higher reimbursement rates to Gila Regional Medical Center. Yes, instead of an about 65 percent reimbursement rate for eligible procedures paid for by Medicare, the reimbursement rate will rise to 101 percent of allowable expenses.
Gila Regional received its critical access designation this summer. So, it is officially a critical access hospital (CAH). Most CAHs are located in rural areas and have multiple requirements such as being at least 35 miles from the closest nearby hospital, we well as inpatient bed number limits and limits to how long an inpatient can stay on an annual average.
Those utilizing GRMC services as they have in the past, probably won’t notice any changes. Although the hospital under the critical access designation will allow only a total average of 25 beds to be occupied at any one time by inpatients, intensive care patients and mothers and their newborns, the reality is that over the past several years, Gila Regional has averaged well below that number at 18-19 inpatients per day.
If and when a behavioral health unit is restored at Gila Regional, those inpatient beds will not count against the 25-bed limit. At least that’s this author’s understanding.
The length of stay is another requirement of a CAH. It’s an average of no more than 96 hours per inpatient stay.
Most patient services nowadays are outpatient services, where the patient checks in for a procedure, such as a colonoscopy, and then goes home a few hours later. These cases do not count as part of the 25-bed limit.
You’ve maybe heard about swing beds and wondered what they are. According to CMS.org, “a CAH can use its beds, as needed, to provide either acute or skilled nursing facility (SNF) care. As defined in the regulations, a swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital SNF care and meets certain requirements. Medicare Part A (the hospital insurance program) covers post-hospital extended care services furnished in a swing bed hospital.”
Another point of confusion for some, including this writer, are the observation beds. Again, according to CMS.org, “a CAH may maintain beds used solely for outpatient observation services without counting these beds toward the statutory CAH maximum of 25 inpatient beds. However, State Survey Agencies (SAs) must examine CAH provision of outpatient observation services carefully to assure they are consistent with the statutory limit of 25 inpatient beds that have an annual average length of stay that does not exceed 96 hours per patient.”
The Beat regularly covers the GRMC Governing Board meetings, where the various interim administrators give their reports. You can read part 1 of the latest governing board meeting, where the preparation for a potential COVID-19 surge were presented, at https://www.grantcountybeat.com/news/news-articles/60958-grmc-governing-board-met-in-monthly-session-102920.
Most CAHs are exempted from the 25-bed rule and the 96-hour stay if the hospital has a major surge in COVID-19 cases.