Big Changes with the New Rural Emergency Hospital Model

00;00;01;08 - 00;00;27;12
Tom Haederle
For critical access hospitals and rural hospitals with 50 beds or less, an attractive new option became available on January 1st of this year. And that was the opportunity to seek designation as a new rural emergency hospital, which expands the conditions under which hospitals can seek payment from Medicare. For interested candidates, it's a big change. But there's a lot of help out there to make it go smoothly.

00;00;30;20 - 00;01;07;21
Tom Haederle
Welcome to Community Cornerstones Conversations with Rural Hospitals in America, a new series from the American Hospital Association. I'm Tom Haederle with AHA Communications. We hope these 15 episodes will shed new light on the challenges, triumphs and issues facing rural health care providers who are a health lifeline for approximately 20% of Americans. Designation or reclassification as a rural emergency hospital means that REH's reaches can provide emergency department services and other outpatient services without having to provide inpatient care in order to receive Medicare payments.

00;01;08;06 - 00;01;25;29
Tom Haederle
The Rural Health Care Redesign center helps caregivers who want to make this administrative transition understand all that's involved. This podcast series was recorded at the AHA’s 2023 Rural Conference in San Antonio. And now let's go to our moderator, the AHA's Shannon Wu.

00;01;26;23 - 00;01;51;16
Shannon Wu
Welcome. I am Shannon Wu, senior associate director of policy at the American Hospital Association. I'm here with Janice Walters, the chief operating officer of the Rural Health Redesign Center to discuss the new Rural Emergency Hospital model, the role of the Rural Health Redesign Center and how they are providing support to eligible and interested facilities. And we're coming to you from the AHA Rural Conference here in San Antonio.

00;01;52;07 - 00;02;16;29
Shannon Wu
As our listeners may know, the Rural Emergency Hospital model is a new Medicare provider type that is available for critical access hospitals and rural hospitals with 50 beds or less to convert to. And this designation became effective as of January 1st of this year. So Janice, can you give us a brief overview of what type of services REH's can offer and how they will receive Medicare payments?

00;02;17;10 - 00;02;40;29
Janice Walters
Sure. Thank you. So, REH's are facilities that converted from the two eligible providers that you just described and they can provide emergency department and other outpatient services without the need to provide inpatient care and receive Medicare payments. Medicare payments will include a monthly facility payment equating to $3.3 million a year to our rural emergency hospital facility.

00;02;41;16 - 00;02;49;04
Janice Walters
And they will also receive a 5% add-on to their outpatient service payments per the outpatient perspective fee schedule.

00;02;49;11 - 00;02;54;04
Shannon Wu
Great. And can you give us a background of the technical assistance center and who you are?

00;02;54;14 - 00;03;30;07
Janice Walters
Sure. So the Rural Emergency Hospital Technical Assistance Center is an organization that was set up through HRSA dollars, so it's a federally funded program that provides technical assistance to hospitals that are interested in learning more about what an REH conversion could look like for their organization. So the organization itself, the Rural Emergency Hospital Technical Assistance Center, is a collaboration of three organizations with unique expertise formed to provide a comprehensive catalog of technical assistance services to support the REH consideration and transition process.

00;03;30;15 - 00;03;36;13
Shannon Wu
Oh, great. So what is the pathway that an interested hospital would go through once they contact your center?

00;03;36;22 - 00;04;02;13
Janice Walters
Yeah. So we have various ways to get in contact with us which I'll go into a little bit more detail later on in the podcast. But really we work cooperatively with HRSA and the state offices of our Health and Flex coordinators to really identify interested hospitals. So we certainly aren't looking to replace those organizations, but really work in collaboration with organizations that already have existing relationships with hospitals.

00;04;02;26 - 00;04;28;12
Janice Walters
Once we become aware of hospitals that are interested in this designation, we start with education. We certainly want to make sure that hospitals understand what the designation is and what it is not. And so we start with education in a conversation, and then typically we ask hospitals also to perform an initial intake assessment where we ask some very basic questions to just get an understanding of who they are as an organization.

00;04;28;12 - 00;04;51;22
Janice Walters
Are thet a critical access hospitals? A small PPS hospital, etc.? Also, you know, through that, in addition to that assessment process, we then also try to provide real relevant subject matter, expertise and coaching. And most of the staff at the Technical Assistance center have prior rural hospital leadership experience. And so they certainly understand the context of the decision that they're facing and we look to support that, that the best we can.

00;04;51;22 - 00;05;17;07
Janice Walters
Additionally, we then perform financial assessments where it makes sense to do so when we understand, you know, a little bit about the organization and know that it makes sense to to go to the next step, do that financial assessment. And then we also support strategic planning that might be needed in in consideration of that new rural emergency hospital designation.

00;05;17;15 - 00;05;30;11
Shannon Wu
Oh, great. You guys offer a lot of resources available to interested facilities then. So how can facilities and even other stakeholders who are interested in learning more about the model reach out to all of you?

00;05;30;20 - 00;05;57;26
Janice Walters
Yes, certainly. So we have tried to make that simple. You can go to our website and through the real emergency hospital webpage as part of their Rural Health Redesign Center organization's website, there's a link there to fill out an initial intake assessment. We'll review that intake assessment form, reach out within 24 hours to schedule a conversation. And phase two is where we really dig in to the financial assessment.

00;05;58;16 - 00;06;37;20
Janice Walters
We discuss delivery strategies and involve financial modeling. So we will capture your all historical claims revenue, run that through groupers for the critical access hospitals to really understand what that 5% fee schedule might look like for you. And then in addition to that, as we're discussing financial assessment, we also then start looking at what other types of activities might be needed from like a community engagement perspective, board discussions, all of that, because we certainly do understand the emotional decision that could be attached to the emergency hospital designation and what the community might have to work through together.

00;06;37;20 - 00;06;51;01
Janice Walters
So we really do try to provide that continuum of technical assistance from, you know, initial assessment, financial assessment, strategy conversations, and then even helping with community engagement strategies as well.

00;06;51;02 - 00;06;59;23
Shannon Wu
That's great. That's a wonderful resource that you all are providing to our rural communities and areas, then. So thank you very much, everyone, for listening to this podcast.

00;07;00;24 - 00;07;01;05
Janice Walters
Thank you, Shannon.