Helping critical access hospitals reach rural communities

17 years ago

As a native of Aroostook County, I know how important health care is to the vitality of rural communities. A strong rural health care system allows our citizens to live wherever they want in our state.
    Of Maine’s 39 hospitals, 15 are designated as Critical Access Hospitals. Congress established the CAH program in 1997 to ensure that people living in isolated, rural areas can receive essential health-care services and to strengthen the hospitals that provide those services. A central provision of this program was cost-based reimbursement for Medicaid inpatient and outpatient services, regardless of whether those services were provided in the hospital, a long-term care facility, a community clinic or physician’s office, or even the patient’s home.
Unfortunately, in 2003, the Center for Medicare & Medicaid Services imposed a regulation that prohibits Critical Access Hospitals from being reimbursed at-cost for laboratory services unless the patients are physically present in the hospital when laboratory specimens, such as blood samples, are collected. The Maine Hospital Association estimates that this reduction in reimbursement shortchanges our state’s rural hospitals by as much as $500,000 per year.
In addition to jeopardizing the financial health of these crucial health-care centers, this regulation may jeopardize the health of our most vulnerable citizens. If Critical Access Hospitals are forced to scale back their off-premises services, elderly, frail, and immobile patients will face the additional burden of having to travel, often great distances, to get simple tests done. For too many, this means the tests will not be done at all.
Critical Access Hospitals like Mayo Regional in Dover-Foxcroft and Houlton Regional point out that their ability to bring lab services to their patients is critical to serve people who live in rural areas or who are too frail or elderly to travel to the hospital itself. This ethics of putting the patient first is evident in all of Maine’s Critical Access Hospitals, from Calais to Rumford, and from Blue Hill to Houlton. It is an ethic that must be encouraged, not hampered by an illogical and arbitrary regulation.
I have worked hard to overturn this regulation. In November of 2003, I joined 28 Senators in a bipartisan letter to the Administrator of CMS asking for his assistance in constructing a rule which does not penalize Critical Access Hospitals for offering off-site laboratory services. Unfortunately, CMS was unwilling to reconsider their policy.
That is why I have joined Sen. Ben Nelson of Nebraska in introducing the Critical Access to Clinical Lab Services Act of 2007. This bipartisan legislation, which has the support of the Maine Hospital Association, would restore full reimbursement for lab services offered by our rural hospitals, whether they are performed in the hospital or in the patient’s home. It simply makes no sense that current reimbursement rules discriminate against lab services provided off hospital grounds when they are the exact same services that are provided to patients in the hospital. The additional Medicare spending necessary to ensure that Critical Access Hospitals receive full reimbursement for all clinical laboratory services is minimal, yet the dollars are incredibly important to the individual hospitals and to patients in need of care.
Critical Access Hospitals, such as Mayo Regional and Houlton Regional, often are the main source of health care in their communities. They are indispensable for our rural communities to survive and to thrive, and they help make these communities attractive places for physicians, nurses, and other medical professionals to live and to work. This legislation will encourage the innovative and compassionate care these hospitals provide, and help keep our rural communities strong.