CMS Proposed Rule Attempts to Address Emergency Care in Rural Hospitals

Sarasota, FL (WorkersCompensation.com) – According to recent studies from the NC Rural Health Research Program some services in rural areas decreased while others increased. For instance, from 2011 to 2017, researchers noted a decrease in skilled nursing and obstetric services but orthopedic, emergency psychiatric, hospital-based outpatient, and oncology services increased. Additionally, outpatient services for rural hospitals increased from 66.5 percent to 74.2 percent, and the total outpatient revenue average increased by 56.4 percent from 2011 to 2019. In comparison, inpatient revenue for these same rural hospitals only increased 9.3 percent during the same period.

While certain services may have increased, rural areas could be in for a staff shortage especially when it comes to the emergency department. According a report from Healthleaders, from 2008 to 2020 the number of emergency physicians increased by more than 9,000 however only 6 percent of those were in rural areas, and 2 percent were in small rural areas. Part of the issue is that several mostly rural states have no emergency medicine residency programs. Those states include Alaska, Hawaii, Idaho, Montana, North and South Dakota, and Wyoming.

In addition to the emergency staff shortages, 19 rural hospitals closed in 2020 due to a myriad of issues including fraud, financial issues, and reduced reimbursement in addition to issues fueled by the pandemic. According to recent data from the Cecil G. Sheps Center for Health Services Research, Mercy One Medical Center in Nebraska and St. Mary’s Community Health in Kansas were the only rural hospitals to close in 2021. So far in 2022, Galesburg Cottage Hospital in Illinois, Callaway Community Hospital and Audrain Community Hospital in Missouri have closed.

In a press release last month, CMS announced a proposed rule to address emergency care at rural hospitals by allowing them to qualify for new health care provider designation. CMS is creating requirements or Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs), with proposed effective dates of service starting January 1, 2023. The rules align with requirements for critical access hospitals. CMS is seeking feedback on the new proposed rule until August 29, 2022.

Some of the issues that the CMS is seeking comment on includes whether or not it’s appropriate to have an emergency medicine trained clinician on call, and available on site during certain time frames. CMS is also proposing the term “primary roads” be included in the location and distance requirements. Additionally, the proposal allows critical access hospitals that are part of a health system to combine their policies and resources to improve infection control and patient care.  

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