Becker's Hospital Review

94 Executive Briefing: Critical Access Hospitals Sponsored by B y definition, critical access hospitals are often their com- munities' sole healthcare provider, as they must be locat- ed more than a 35-mile drive from any hospital (a 15-mile drive in mountainous terrain). For that reason, it is especially im- portant that these hospitals remain in their communities, ensuring patients have easy access to healthcare services. However, that may be easier said than done. As hospitals in mostly rural areas and with no more than 25 beds, critical ac- cess hospitals often face financial and operational obstacles that their larger or urban counterparts never encounter. While they do have some advantages when compared with the typical acute- care hospital that help them stay afloat, like receiving cost-based reimbursement instead of reimbursement based on DRGs, often these hospitals are still at a disadvantage because of their size. "By nature, they're small, and their margin for error is much small- er than larger hospitals we work with," says Wilson Weber, the executive vice president and COO of Community Hospital Corp., which owns, manages and consults with mostly small and rural hospitals. Additionally, there have been recent discussions of pulling the critical access hospital designation all together, taking away the cost-based reimbursement advantage critical access hospitals enjoy currently. While they do face obstacles to success, there are certain steps this special breed of hospital can take that will put them in a strong position to succeed in healthcare today. Below are five examples. Use swing beds advantageously Critical access hospitals must have an average annual length of stay of 96 hours or less per patient for their acute care beds, which is why swing beds should be part of every critical access hospital's strategy, according to Mr. Weber. "A critical access hospital should have a swing bed program," he says. "If a patient needs more extended care [beyond the 96-hour window], a swing bed allows [the hospital] to swing the patient and keep them there to provide needed services," he explains. Gunnison Valley Health, the sole comprehensive health system for Gunnison Valley in Colorado that includes a 24-bed critical ac- cess hospital, has benefitted firsthand from swing bed use. "For a critical access hospital, swing beds are key for revenue," says Robert Santilli, the CEO of GVH. Prior to Mr. Santilli joining the hospital, GVH sent many of its potential swing bed patients to a nursing home. With the help of CHC, GVH improved its swing bed utilization and gained $301,000. In addition to boosting a critical access hospital's bottom line, swing beds can also improve the care provided to patients. For example, a swing bed patient can continue seeing the physician they started with in the hospital as well as receive care from the same nurses on the unit, thus improving the continuity of care, as opposed to discharging the patient to a new facility with new providers. Streamline the revenue cycle Many times, small hospitals like critical access hospitals just don't have the bandwidth to fully optimize certain operations, like the revenue cycle, Mr. Weber says, making it an area where these hospitals can gain some ground. "We see a lot of opportunity there for critical access hospitals," he says. For instance, before partnering with CHC, GVH was in technical default for failing to satisfy bond covenants, including cash-on- hand requirements. Days in accounts receivable were over 100, and the hospital was struggling to stay afloat. After looking into the revenue cycle and making certain improve- ments, like collecting appropriate patient information up front and sending out bills in days (as opposed to months), days in accounts receivable dropped to 35, and days cash on hand now hovers around 180. These revenue cycle improvements helped the hospital move from financially struggling to financially stable, with net revenue up 16.6 percent. How to Put Critical Access Hospitals in Positions of Strength By Heather Punke ® Though critical access hospitals do face some unique hurdles that can make running them a challenge, they also play a unique role in their communities and are an indispensible resource for their patients.

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