Sen. Maria Cantwell Hears about ’96-Hour’ Rule for Critical-Access Hospitals as She Tours Port Townsend Hospital

By:  The Peninsula Daily News – Chris McDaniel
Source: The Peninsula Daily News

U.S. Sen. Maria Cantwell gathered information during a tour of Jefferson Healthcare hospital about a rule that a bill now in Congress aims to overturn.

Cantwell, D-Mountlake Terrace, toured the Port Townsend hospital, one of two critical-access hospitals on the North Olympic Peninsula, on Friday as part of a tour of such facilities across the state.

“Sen. Cantwell is a supporter of rural health care,” said Mike Glenn, Jefferson Healthcare CEO.

“We appreciate her taking the time to visit Jefferson Healthcare and learn about our new project and some of the issues we care about.”

During the tour, Marie Dressler, a Jefferson Healthcare Hospital commissioner, told Cantwell of staff frustrations with the “96-hour” rule for patient reimbursement at critical-access hospitals.

The critical-access designation allows rural hospitals with 25 beds or fewer, and which fulfill other criteria, to receive 100 percent Medicare reimbursement.

Both Jefferson Healthcare and Forks Community hospitals have the designation. The other hospital on the North Olympic Peninsula, Olympic Medical Center, is too large for the category.

OMC was designated a sole community hospital in legislation Gov. Jay Inslee signed into law in March 2014. That increases Medicaid payments for outpatient services from 55 percent of cost to 70 percent of cost.

Payment rule

The Centers for Medicare & Medicaid Services said in 2013 that physicians working at critical-access hospitals must certify that a patient will be discharged or transferred within 96 hours of admission — four days — or the hospital will not be paid for that patient.

A longer stay does not endanger the designation. Congress in 1999 modified the rule to make the 96-hour limit an annual average rather than a requirement for each patient.

But payment for an individual patient is contingent upon the rule.

Cantwell is one of 26 co-sponsors of the Senate version of the Critical Access Hospital Relief Act of 2015 introduced in January in both houses of Congress to remove the Medicare 96-hour physician certification requirement for inpatient critical-access hospital services.

Derek Kilmer, whose 6th Congressional District includes the North Olympic Peninsula, is one of 56 co-sponsors of the House version of the bill.

Both versions of the bill, which was also unsuccessfully introduced in 2014, are in committee. The bills are S 258 and HR 169.

Red tape, costs

The per-patient requirement has led to unnecessary bureaucracy and red tape for physicians and potentially higher costs for patients and their families, Dressler said.

Moving long-term patients can lead to higher costs for medical transport via ambulance or helicopter for the patients and their families, she said.

Costs can continue to rise for family members when their loved ones are admitted to hospitals in the Seattle area.

“It definitely would and could have a detrimental effect on the patients and the patients' families, especially with the elderly patients,” Dressler said.

And “even though it is similar care, it is much more expensive in the city than it is here,” she added.

One of the biggest challenges facing small rural hospitals such as Jefferson Healthcare is ensuring “they are able to keep their designation as a critical-access hospital and get a Medicare reimbursement rate,” Cantwell said.

While “our state does very well on making sure that we focus on delivering better health care outcomes for lower costs . . . you want to make sure that when you think about how to continue that, and do things in a new way, you don't leave out rural access hospitals,” she added.

Cantwell's tour included Jefferson Healthcare's $22 million Emergency and Specialty Services building now under construction.

Crews began working on the project May 18. The building is expected to be completed in July 2016, and the move-in date is the following October.

The facility will offer patients access to lab services next to the registration and lobby area, a new and expanded emergency department and orthopedic clinic, upgraded cardiology services and a heart health education program.

It also will include a cancer treatment center and infusion services area, and a women's imaging center equipped with mammography, ultrasound and bone density scanning equipment.

The building is on the south side of Jefferson Healthcare adjacent to Sheridan Street.

It was pleasing to witness “how much people are doing to try to make sure they have good access to health care,” Cantwell said.

Aging population

Cantwell also spoke about the need to address the aging population of local baby boomers, who will increasingly be reliant on the hospital in coming years.

“No matter what we do, that population is going to reach that age,” she said.

“So what we need to do is do all we can to focus on health and wellness and prevention and to get people to think about those practices that will help them stay healthier.”

Washington state is “pretty good at that as a state juxtaposed to the rest of the nation, but we want to take it to the next level,” Cantwell added.

“We want to continue to do pilots that will demonstrate to people in communities that there are some really basic things about exercise, diet, wellness and meditation and all those things that really help.”

Jefferson Healthcare is “trying to promote health and wellness,” Dresser said.

“It is for the betterment of the whole person because they will hopefully be healthier with education and food and those sorts of things that keeps the baby boomers going.”