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Rural hospital funding threatened
DARLINGTON - Memorial Hospital of Lafayette County in Darlington is among a handful of Critical Access Hospitals that have been removed from an earlier list of rural hospitals that could face decertification and a loss of Medicare funding.

The U. S. Department of Health and Human Services announced in a report earlier this month that nearly two-thirds of the more than 1,300 CAHs in the United States do not meet the distance requirements and the definition of a rural community. The report said that decertifying CAHs, those not considered to be in sufficiently remote areas, could save up to $1.1 billion per year, according to the Associated Press.

Darlington's hospital was on the list of 53 Wisconsin hospitals initially thought to be affected; that list now numbers 42 and does not include Darlington.

While that's good news for Lafayette County residents, there are numerous other hospitals in western Wisconsin on the list, making it a concern of Sen. Dale Schultz, who represents the 17th State Senate district.

"There are 11 Critical Access Hospitals in or near my district, and all 11 of them are threatened by this proposal," Schultz, R-Richland Center, said in a statement Monday, Aug. 26. "So naturally I'm deeply concerned by the signals coming from Washington, and the implications of downsizing this vitally important program."

Congress created the CAH certification in 1997, at a time when rural hospitals were closing to ensure that rural residents are able to access hospital services. Medicare reimburses these rural medical centers at 101 percent of their reasonable costs, rather than at the rates set by prospective payment systems or fee schedules.

Schultz said the federal government, hoping to cut spending, now proposes implementing new standards that likely would revoke the Critical Access status of many Wisconsin hospitals.

The 11 southwestern Wisconsin health care providers currently designated as CAHs are: Southwest Health Center in Platteville, Upland Hills Health in Dodgeville, Reedsburg Area Medical Center, Vernon Memorial Healthcare, Boscobel Area Healthcare, Prairie du Chien Memorial Hospital, Grant Regional Health Center in Lancaster, Tomah Memorial Hospital, Memorial Hospital in Darlington, and St. Joseph's Community Health Services in Hillsboro.

The distance requirement for a CAH is more than 35 miles from a hospital or another CAH. That distance is reduced to 15 miles in mountainous regions or where only secondary roads are available. Secondary roads are typically one-lane state highways and all other local roads.

The Wisconsin Hospital Association worked directly with state legislators on a letter to Wisconsin members of Congress in support of their local CAH. The bipartisan letter was released Thursday, Aug. 22. More than 40 state legislators have signed on.

"Critical access hospitals are foundational elements of Wisconsin's rural health care infrastructure, important economic drivers and provide family-sustaining jobs," according to the letter.

"Rural hospitals are often one of the largest local employers, providing family-supporting wages that ripple throughout rural communities and that generate tax revenue to support state and local services," the letter reads. "A 2009 study, updated in 2011, by the University of Wisconsin-Extension and the Wisconsin Hospital Association, revealed that hospitals across the state generate $28 billion in economic activity and employ more than 100,000 people. The study found that hospitals were one of the top 10 employers in 44 of Wisconsin's 72 counties and one of the top five employers in 20 counties."

But the Department of Health and Human Services reported Medicare could have potentially saved $373 million in 2011, if half the CAHs that did not meet the location requirements had been decertified, "because services provided at CAHs are typically reimbursed at rates that are higher than the base rates."

And, the report added, beneficiaries would have saved an estimated $200 million in coinsurance in 2011 "because coinsurance amounts for services provided at CAHs are calculated on the basis of charges rather than final costs, (so) beneficiaries pay more for services at these facilities than they likely would for the same services at acute-care hospitals." On average, beneficiaries who received outpatient services in 2011 could have saved about $400 each.