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Critical Access Hospital

On August 3rd, 2023, RMCHCS became certified as a Critical Access Hospital (CAH). This is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid (CMS). The CAH program is designed to reduce the financial vulnerability of small rural hospitals while improving access to healthcare by keeping essential services in rural communities. CAHs receive cost-based reimbursement for Medicare services.

RMCHCS was unable to bill as a CAH facility until January 2024 due to the delay in obtaining a PTAN number from CMS. Now that we have the required billing number, we are actively working to get the CAH billing caught up.

Another change related to our recent CAH designation is the ability to offer “Swing Bed” services. What is a Swing Bed? A swing bed is a bed in our inpatient unit that can be used for either acute care or post-acute care that is equivalent to skilled nursing facility (SNF) level care. This gives RMCHCS flexibility to better meet the needs of our patients, whether for acute care and SNF level care.

As part of optimizing it services under the new CAH care delivery model, in March 2024, RMCHCS restructured and relocated the previous Critical Care Service-Intensive Care Unit (CCS/ICU) changing the name to the Advanced Care Unit and collocating the unit with the Medical Surgical Unit (MSU). Some have expressed concern regarding the impact of closing the CCS/ICU. While we have changed the name and location, the number of beds in the Advanced Care Unit (ACU) is the same as we had been previously staffing, 4 beds. In addition, this conversion will have a minimal impact on the types of patients we can treat and the services that we provide. Our ACU is consistent with the services commonly provided in a “step down unit” which is essentially what our ICU had been. We will continue to care for patients that need to be closely monitored and we will have added flexibility in assigning patients to a medical-surgical or ACU bed.

Our physicians and nurses will continue to have the ICU specialty, certifications, and skills set to care for severe but defined medical conditions utilizing critical care equipment such as monitors, ventilators, and will also arrange for transfers to a higher level of care when that is what the patient needs. Nurse to patient ratio, not technology, equipment, or lack of ICU nurse training is the defining characteristic of an ACU in a CAH. These services are believed to be important to the well-being of the hospital and of the community. Over the past few months, we have experienced a decrease in CCS/ICU census and acuity since the COVID pandemic, therefore a transition of our CCS/ICU to the ACU made sense. Understanding this change can help you navigate the best possible care for yourself and your loved one.