|
|
|
Jackson General Hospital is once again endeavoring to achieve critical-access status in the state.
The hospital is in the application process, said CEO Stephanie McCoy. Jackson General currently has Medicare-dependant status, but attaining critical-access status would mean more reimbursement, about $1.2 million annually, for the hospital without a cut in services, she said.
“Angie Frame, our CFO, is doing a financial feasibility study, which looks back three years but projects the numbers as if you had been a critical-access hospital, what your revenues would have been versus what they actually were,” McCoy said.
“The difference in reimbursement between critical access and us is that that critical access pays 101 percent of cost, whereas Medicare dependant status pays a lump fee. It doesn’t matter how long you stay. You would still get that one lump payment. Typically for pneumonia, it would be $5,000. So if you stay 20 days and your bill is $40,000, we would still just get $5,000.”
The difference in reimbursement would be a great benefit to the hospital, McCoy said.
“You know, we struggle, like all hospitals now are struggling even the big hospitals. We actually look better than some of the hospitals that are larger than us,” she said.
In addition to Frame’s financial feasibility study, McCoy is working on a community needs assessment, which consists of a community survey seeking information on local healthcare and community issues. The information from the survey alone will benefit the community, McCoy said.
“We have a community advisory board that has different entities on it, different members of the community, a lot of them healthcare providers. We’ will be sharing the survey results with all of the healthcare providers. Also, not-for-profit organizations, for their IRS 990 forms are required to do a community needs assessment every three years. This will help them with that. We’re working with them on it. We’re also meeting with key community groups,” McCoy said.
“We’re hoping to have the surveys back and the report complied by mid-March and the whole application turned in by the end of March. That’s the goal.”
McCoy said officials are also attempting to determine whether they need a certificate of need from the Healthcare Authority.
Becoming a critical-access hospital should not mean JGH will have to cut services, McCoy said.
“We don’t have to cut services. Our average census now is around 17. Critical-access says you can have 25 beds for inpatients and swing beds, which are skilled nursing beds. Then you can have observation patients. They typically stay 24 to 48 hours, and you can have extra beds for observation,” McCoy said.
Hospital officials are monitoring census numbers to ensure that current patient flow levels are remaining at about the same number required for critical-access hospitals.
“We’re kind of playing what if we were critical-acces now. What would our transfers be, are our observation beds enough. So far it has not been a problem. We have had times this winter when our census was 26 or 27 but that counts the observation patients so, so far, we don’t’ think it will create a burden on our EMS,” McCoy said.
“We intend to keep all of our services that we currently have: Our critical care unit and, of course, our lab, radiology, physical therapy, respiratory therapy and emergency department. Really it’s anticipated to be just like it is right now. We really feel like we’ll be going at the same rate we are but will be billing and reimbursed differently.”
The hospital has attempted the conversion twice in the past. McCoy said the previous attempts at attaining critical-access status didn’t come at the right time.
“If you recall back in 2004, we were going to convert to a critical-access hospital. At pretty much the Eleventh Hour they decided not to do that, for a couple of reasons. They were having a couple years of profitability issues, our average census was higher and we felt like all the transfers would be a burden on our EMS system.
“It just looked like we were in a growth period, which we were. Of course no one could anticipate what was going to happen with the economy,” McCoy said.
McCoy said the issue was revisited again in 2008.
“At the time we were going to go critical access the first time, they allowed the states to make the decision through necessary provider status. If the state said you were a necessary provider, you didn’t have to meet all of the regulations. They did away with necessary provider in 2006. It looked like we would not qualify,” she said.
The reason JGH didn’t qualify was due to the route between it and Pleasant Valley Hospital, McCoy said. Critical-access status includes specific requirements regarding distances to other hospitals and the types of roads in between. Critical access hospitals must be 35 miles from another hospital or critical access hospital (or 15 miles in mountains or areas with secondary roads).
“We’re good between us and Charleston and Parkersburg because we’re more than 35 miles from another hospital. We’re good between here and Roane General because although it is a U.S. Highway but it’s on mountainous terrain. That’s part of the regulations.
“But between here and Pleasant Valley the state said it was a primary road but not mountainous terrain. We thought were not able to apply again because of that,” McCoy said.
In 2007, the Centers for Medicare and Medicaid Services issued a memorandum that defined a primary road, McCoy said. This new definition affected the route between JGH and Pleasant Valley Hospital.
“The CMS definition of a primary road for a state highway is two or more lanes each way. We’ve all been to Point Pleasant, it’s not two or more lanes.
“We checked with the state, the Division of Rural Health, and the Federal Division of Rural Health about that definition and they confirmed it would be considered a secondary road as far as Medicare is considered. That gave us an opportunity again,” McCoy said.
Jackson General Hospital is once again endeavoring to achieve critical-access status in the state.
The hospital is in the application process, said CEO Stephanie McCoy. Jackson General currently has Medicare-dependant status, but attaining critical-access status would mean more reimbursement, about $1.2 million annually, for the hospital without a cut in services, she said.
“Angie Frame, our CFO, is doing a financial feasibility study, which looks back three years but projects the numbers as if you had been a critical-access hospital, what your revenues would have been versus what they actually were,” McCoy said.
“The difference in reimbursement between critical access and us is that that critical access pays 101 percent of cost, whereas Medicare dependant status pays a lump fee. It doesn’t matter how long you stay. You would still get that one lump payment. Typically for pneumonia, it would be $5,000. So if you stay 20 days and your bill is $40,000, we would still just get $5,000.”
The difference in reimbursement would be a great benefit to the hospital, McCoy said.
“You know, we struggle, like all hospitals now are struggling even the big hospitals. We actually look better than some of the hospitals that are larger than us,” she said.
In addition to Frame’s financial feasibility study, McCoy is working on a community needs assessment, which consists of a community survey seeking information on local healthcare and community issues. The information from the survey alone will benefit the community, McCoy said.
“We have a community advisory board that has different entities on it, different members of the community, a lot of them healthcare providers. We’ will be sharing the survey results with all of the healthcare providers. Also, not-for-profit organizations, for their IRS 990 forms are required to do a community needs assessment every three years. This will help them with that. We’re working with them on it. We’re also meeting with key community groups,” McCoy said.
“We’re hoping to have the surveys back and the report complied by mid-March and the whole application turned in by the end of March. That’s the goal.”
McCoy said officials are also attempting to determine whether they need a certificate of need from the Healthcare Authority.
Becoming a critical-access hospital should not mean JGH will have to cut services, McCoy said.
“We don’t have to cut services. Our average census now is around 17. Critical-access says you can have 25 beds for inpatients and swing beds, which are skilled nursing beds. Then you can have observation patients. They typically stay 24 to 48 hours, and you can have extra beds for observation,” McCoy said.
Hospital officials are monitoring census numbers to ensure that current patient flow levels are remaining at about the same number required for critical-access hospitals.
“We’re kind of playing what if we were critical-acces now. What would our transfers be, are our observation beds enough. So far it has not been a problem. We have had times this winter when our census was 26 or 27 but that counts the observation patients so, so far, we don’t’ think it will create a burden on our EMS,” McCoy said.
“We intend to keep all of our services that we currently have: Our critical care unit and, of course, our lab, radiology, physical therapy, respiratory therapy and emergency department. Really it’s anticipated to be just like it is right now. We really feel like we’ll be going at the same rate we are but will be billing and reimbursed differently.”
The hospital has attempted the conversion twice in the past. McCoy said the previous attempts at attaining critical-access status didn’t come at the right time.
“If you recall back in 2004, we were going to convert to a critical-access hospital. At pretty much the Eleventh Hour they decided not to do that, for a couple of reasons. They were having a couple years of profitability issues, our average census was higher and we felt like all the transfers would be a burden on our EMS system.
“It just looked like we were in a growth period, which we were. Of course no one could anticipate what was going to happen with the economy,” McCoy said.
McCoy said the issue was revisited again in 2008.
“At the time we were going to go critical access the first time, they allowed the states to make the decision through necessary provider status. If the state said you were a necessary provider, you didn’t have to meet all of the regulations. They did away with necessary provider in 2006. It looked like we would not qualify,” she said.
The reason JGH didn’t qualify was due to the route between it and Pleasant Valley Hospital, McCoy said. Critical-access status includes specific requirements regarding distances to other hospitals and the types of roads in between. Critical access hospitals must be 35 miles from another hospital or critical access hospital (or 15 miles in mountains or areas with secondary roads).
“We’re good between us and Charleston and Parkersburg because we’re more than 35 miles from another hospital. We’re good between here and Roane General because although it is a U.S. Highway but it’s on mountainous terrain. That’s part of the regulations.
“But between here and Pleasant Valley the state said it was a primary road but not mountainous terrain. We thought were not able to apply again because of that,” McCoy said.
In 2007, the Centers for Medicare and Medicaid Services issued a memorandum that defined a primary road, McCoy said. This new definition affected the route between JGH and Pleasant Valley Hospital.
“The CMS definition of a primary road for a state highway is two or more lanes each way. We’ve all been to Point Pleasant, it’s not two or more lanes.
“We checked with the state, the Division of Rural Health, and the Federal Division of Rural Health about that definition and they confirmed it would be considered a secondary road as far as Medicare is considered. That gave us an opportunity again,” McCoy said.
