Last week’s article on St. Vincent’s Blount focused on providing a profile description of the hospital, and questioning management on issues related to personnel and St. Vincent’s long-term commitment to the Blount County hospital. Questions remain on personnel matters. The corporation’s commitment to the Blount County facility appears by all reasonable standards to be strong.
This article focuses on two new programs, more appropriately thought of perhaps as “designations,” that strengthen the facility’s financial position as a rural health provider, and align it to better meet the community’s needs as well. Those two designations are “Critical Access Hospital” and “Swing Bed” facility. They’re explained in summary terms below. In the final section of this report, three separate indicators of hospital quality, all impressive, are covered briefly. Critical Access Hospital
A critical access hospital (CAH) is a small, generally remote facility that provides outpatient and inpatient services to people in rural areas. The designation as a CAH qualifies the hospital for special payments under the Medicare program.
To be designated a CAH, a hospital must be located in a rural area, provide 24-hour emergency services, have an average length-of-stay for its patients of 96 hours or less, be located more than 15 miles (in mountainous terrain) from the nearest hospital, and have no more than 25 beds. Allowances on number of beds are made for beds designated for certain specialized services. This description oversimplifies the criteria, but is all space allows for this article.
Each CAH receives 101 percent of its costs for outpatient, inpatient, laboratory, and therapy services, as well as post-acute care in the hospital’s swing beds.
The designation was created to allow small rural hospitals to:
•provide quality access to primary and emergency health care,
•meet community health care needs such as radiology, laboratory services, outpatient rehabilitation and surgery, and,
•assure their financial viability through enhanced reimbursements.
The CAH program has not been as widely implemented in Alabama as in other states because of the difficulty hospitals here have in meeting some of the criteria. “This designation will allow us to submit our total operating costs as a basis for reimbursement,” said Evan Ray, President – Rural Hospitals for St. Vincent’s Health System and local director of St.Vincent’s Blount. “By going through the Swing Bed and Critical Access processes, it will enable us to improve our financial performance.” Swing Bed concept
Medicare permits certain small rural hospitals, once approved, to use its beds as needed, either for acute care (“regular” hospital care) or for sub-acute skilled care (the kind of care that might be required for extended recovery from a number of conditions); the hospital is allowed to “swing” patients from one status or level of care to another while the patient stays in the same facility. It is for patients who have been discharged from acute care, but still need follow-up medical care before returning home. It may be used in patient need situations like the following:
•to heal or regain strength through physical, occupational, or speech therapy before returning home or to other living arrangements such as a nursing home,
•for specialized wound care,
•for IV therapy,
•for orthopedic rehabilitation following surgery,
•for stroke rehabilitation.
“This basically allows the hospital to treat more patients,” Ray said. “With the critical access and swing bed designations, St. Vincent’s Blount will be in the strongest position we’ve ever been as an organization. We’ve always been strong from a quality perspective. This will make us stronger from a financial, operating standpoint.” Quality indicators
In a March 19 interview with The Blount Countian, Ray elaborated on his statement concerning the quality of care at St. Vincent’s Blount. He said that an accreditation audit conducted by the Joint Commission in September 2012 rated St. Vincent’s Blount “best in class” out of a total of 1500 hospitals nationally. The Joint Commission, formerly known as The Joint Commission on Accreditation of Hospitals is the nonprofit accrediting agency for health care organizations in the United States. A majority of state governments recognize the accreditation as a condition of licensure and receipt of Medicaid reimbursement.
He said that more recently the hospital was awarded the “Zero Award” and designated No. 1 out of 67 state hospitals on nine medical and patient care categories. Examples of the categories are incidence of medical mistakes, incidence of infections, incidence of respiratory failure, incidence of postoperative blood clots, and incidence of post-operative bleeding.
In addition, Ray said the hospital has consistently performed near the top of the scale and ahead of neighboring hospitals on its in-house surveys of patient satisfaction.