washington state hospital association critical access hospitals: protecting an essential community...
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Washington State Hospital Association
Critical Access Hospitals: Protecting an Essential Community Resource
Washington State Hospital Association
Critical Access Hospital Overview
Washington State Hospital Association
Legislative History• Federal law: 1997• State law: 2001• Goal: Assure essential health care services
in rural areas• Must meet certain criteria, including:
– No more than 25 inpatient beds– 24 hour emergency services– Defined distance from other hospitals
(10-25+ miles)– Short stays (4 days or less)
Washington State Hospital Association
Washington State Locations
Washington State Hospital Association
• 38 Critical Access Hospitals• 40% of hospitals in state• Serve over 60% of state area• The only health resource for miles• Often center of care network with primary
care, long term care, emergency medicine
Washington Characteristics
Washington State Hospital Association
Medicaid is a Significant Payer
Medicare; 37.0%
Medicaid; 17.5%
Other; 45.5%
Note: Wide range of Medicaid, from 2% – 43%“Other”’ includes uninsured, underinsured, and people who do not pay for care
Washington State Hospital Association
State CAH Spending as a Percent of State Medicaid Budget
Very Little of Total Medicaid Budget Spent on CAH
Washington State Hospital Association
Proposed CAH Reductions Cut Amount of
ReductionMedicaid Fee-for-Service $27 million
Medicaid managed care $15.5 million
Federal match $42.5 million
TOTAL $85 million
Washington State Hospital Association
Total CAH Medicaid Payments Proposed Cut is Almost 50% of Payments
Dollars in millions
Washington State Hospital Association
Impact of the Reductions
Washington State Hospital Association
Individual Hospital Margins Before the Cut
Each bar represents an individual hospital
Washington State Hospital Association
Individual Hospital Margins After the Cut
Each bar represents an individual hospital
Washington State Hospital Association
8th Legislative District ImpactHospital
Total Operating Revenue
CAH Total Cut
Medicaid Payment
Reduction Percentage
Current Operating
Margin
Operating Margin after
CAH Cut
Change to Operating
Margin
PMH Medical Center 28,502,890 2,304,465 43.90% -9.1% -16.5% -7.3%
Washington State Hospital Association
•Loss of local services•Increased travel time to care•Inability to travel for care increases risk of prolonged illness, disability, even death
Impact on Patients
Washington State Hospital Association
• Some CAHs will close—in a few cases, fast• Others will eliminate important services• Adversely impact access to care• In some communities, lives will be lost
Loss of Services
Washington State Hospital Association
• Compromises entire health care system• Increases costs by…
– Delaying/avoiding care– Requiring long distance transports– Contributing to fragmentation of services
• Not simply a “rural” problem
Effect on System
Washington State Hospital Association
Economic Impact
• Largest/one of the largest employers in town;• Significant payroll; excellent family wage jobs• Vital for attracting and keeping businesses in
the rural community• Layoffs and service closures will happen if the
cut is enacted• Significant ripple effect
Washington State Hospital Association
What We Need
• Legislators to stand strongly against this cut• Oppose any budget that includes it
Washington State Hospital Association
Questions and Comments