Critical Access Hospitals

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

Skilled Nursing facility(SNFs) serve patients requiring preventive, therapeutic, and rehabilitative nursing care services for non-acute, long-term conditions. Specialized clinical and diagnostic services are obtained outside the nursing home. Most residents are frail and aged and often use canes, walkers, or wheelchairs. Nursing homes also care for a smaller percentage of restorative patients of all ages like a rehabilitation and other residents are in long-term recovery from acute illnesses, but no longer require hospitalization.

One area where access to care is a problem is in the rural communities. Healthcare professionals including physicians, nurse practitioners, and nurses all affect the quality and cost of care (Derksen, & Whelan, 2009). Going forward importance needs to be placed on using recourses more efficiently and effectively; these resources include but are not limited to tests, prescriptions,

Transportation is one of the largest barriers to health care access in rural communities. Fortunately, many interventions

Such data suggests that rural areas were actually better off in terms of medical care prior to the enactment of the Affordable Care Act than they are now. Before ACA implementation, the rural population was significantly more likely to be covered by Medicaid (21%) or other public insurance (4%) than the metropolitan population (16% and 3%, respectively). Therefore, while urban individuals on average had more healthcare benefits due to the nature of their insurance provider, since Medicaid made up some of the gap in employer-sponsored coverage in rural areas, the uninsured rate was similar in rural and urbans populations prior to the ACA (Figure 2).

Another threat is the current state of rural hospitals nationwide. According to the case study, about 25% of Americans live in rural areas and only about 10% of physicians actually practice in rural areas. There is a 15% gap in the ratio of rural citizens to available practicing physicians. This is a threat to ELH’s need to attract and hire more physicians. In relation to rural hospitals, citizens have longer drive times to their medical facilities. This causes them to delay routine visits which subsequently exacerbates

Within the United States, there are substantial inequalities between the places and people. The rural community is one of such significant inequalities and health care disparities. With approximately one-sixth of the population in the United States of America living in rural areas, it is necessary to address the social and economic conditions accountable for the health disparities and inequalities among this vulnerable population.

Quality healthcare in the more rural areas of the United States is not only getting more difficult to obtain, but difficult to afford. American citizens living in rural areas have the highest rates of chronic disease, higher poverty populations, less health insurance, and there is less access to primary care physicians. When the economy is at its lowest point it causes an increase in a number of access and health issues that have already had prior problems in communities and in rural areas, therefore the main goal of the national health care tax of 2010 was to allow coverage to all residents of the United States, and also by transferring necessary health care to places that were farther away, such as the

Rural and Urban Health Care The term “rural” encompasses all populations, housing, and territory not included within an urban area. To qualify as an urban area, the territory identified must encompass at least 2,500 people, at least 1,500 of which reside outside institutional group quarters (Branch, 2016). Practice areas for Kentucky

Rural Americans face an exclusive combination of issues that create disparities in health care that are not found in urban areas. Many complications met by healthcare providers and patients in rural arears are massively different than those located in urban areas. Financial factors, cultural and social variances, educational deficiencies, lack of acknowledgement by delegates and the absolute isolation of living in remote rural areas all combined to hinder rural Americans in their struggle to lead a normal, healthy life. Rural hospitals located in rural areas faces many disadvantages, such as; minimum resources, shortcoming or unprepared professionals, and financial disparities. Although many of these challenges could be solved

There are two principal conditions leading to physician shortages in rural communities according to Wright and colleagues. They are “demand-deficient”, meaning they have insufficient populations and resources to support a physician practice, they are “ambiance-challenged,” meaning they are isolated, lack quality services and amenities, and/or are in geographically unattractive settings, or a combination of the two sets of conditions. Inner-city physician shortages are a more recently recognized issue. They are affected by the same conditions, though the specifics are different (Wright, Andrilla, and Hart 2001).

In terms of the individualized market, DMC’s core market consists of one-hundred and forty thousand people that live within thirty-nine square miles of the hospital and within this core market, the population is twenty-six percent under 18 years old, sixty-three percent are between 18-¬64 years old, and ten percent are over 65 years old (Oxendine et. al. 2017). Based on the community’s demographics, it is clear that DMC’s core market will include a high level of Medicaid recipients since around half of the core market population is under two-hundred percent of the Federal Poverty Level (Oxendine et. al. 2017). This means that DMC’s core market features a populace that county hospitals usually provide services: “lower income, indigent populations”

Geographic maldistribution has creates barriers of care to people living in rural areas. Although there is an oversupply of physician specialists in many of the urban healthcare areas around the world, while the inner cities and rural community are struggling to attract healthcare physician professional to provide high quality care to the local population. “The supply of specialties has increased more than 100% over the last 20 years, while supply of generalists has increased only 18%” (Niles,2014). Any shortage of health workers can prevent good access to health services and is a barrier to universal coverage. The issue of the matter is that maldistribution of health workers between urban and rural is consider to be virtual concern around

A challenge that many rural communities are dealing with is the lack of primary care physicians, specialist, understaffed hospitals, and transportation. “Only about ten percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas” (National Rural Health Association [NHRA], n.d., para. 2). Although, there are programs designed to improve patients access to hospitals and physicians in rural areas, provider access for these patients remains a barrier. Technology can bridge some of the gaps of care for these patients and it can be beneficial in many ways. With enhanced technology, primary care physicians and patients will be able to have support, access to quality care, improvement in self-management skills, which ultimately, will improve a patient’s health. To assist physicians with delivery of optimal care and for patients to be able to go to scheduled wellness visits with physicians, a new approach to solving rural health barriers are needed.

Critical Access Hospitals are considered as rural hospitals and they have no more than 25 beds within the hospital and are located within 35 miles from any other hospital. Critical Access Hospitals are reimbursed differently by the CMA compared to traditional acute care hospitals, their compensations reveal their operating expenses instead of their volumes. Even through there are large amount of rural hospitals, a lot of them are at jeopardy with being shut down. The United States healthcare expenditures have escalated to 5.3 percent in 2014 to an overall amount of $ 3 trillion, as stated by the CMS Office to the Actuary. The recompenses a hospital gets for the services that were rendered differs and it’s established on the payer. Government payers which entail Medicare and Medicaid, set their rates, and almost all hospitals agree to accept them so they can have access and provide services to these individuals. The commercial payers allow the hospitals to negotiate the rates that are centered around the expected volume and additional factors; but a lot of commercial rates are determined based on the percentage of Medicare and certain formulas that utilizes Medicare rates in the role of baseline figures. For those reasons, reductions in Medicare rates could possibly have a greater effect on hospital funds compared to the Medicare patients (Marshall, 2016).