A change in federal regulations has put Pearl River County Hospital and Nursing Home in danger of losing its Critical Access Hospital designation, a title that allows rural hospitals to keep the doors open.
Stacey Wilkes, who serves on the legislative committee of the Mississippi Rural Health Association and is the public relations consultant for Pearl River County Hospital and Nursing Home, recently took a trip to the District of Columbia to speak with lawmakers about the importance of rural healthcare.
The Centers for Medicare and Medicaid Services has the authority to designate rural hospitals as Critical Access Hospitals, making them eligible for 99 percent reimbursement of Medicare allowable costs, Wilkes said.
CAH hospitals are required to be “more than a 35-mile drive (or, in the case of mountainous terrain or in areas with only secondary roads available, a 15-mile drive) from a hospital or another CAH,” Public Health Code §485.610 (c) states.
Prior to 2014, Wilkes said a secondary road was defined as roadways with only one lane of traffic in each direction, such as Highway 11.
An example of a primary road is Interstate 59, where there are two lanes traveling in each direction.
In 2014, CMS altered that interpretation to include all U.S. highways, like Highway 11, as primary highways, regardless of the number of lanes traveling in either direction, Wilkes said.
Because Highway 11 serves as a direct route between Pearl River County Hospital and Highland Community Hospital, the change makes an impact on PRCH’s critical access designation.
The distance between the two hospitals is about 23 miles. As a secondary highway, it meets the federal requirements; as a primary highway, it does not, Wilkes said.
The distance to Bogalusa Medical Center via MS Highway 26 is about 20 miles.
If Bogalusa decides to improve a stretch of the road, it could become an improved or primary highway and also pose the same risk, Wilkes said.
These changes put Pearl River County Hospital in danger of losing its critical access designation pending its next inspection, Wilkes said. Five more rural hospitals are next on the list.
The hospital’s inspection was pushed back to September 2018 because CMS recently changed surveys from every three years to every four, Wilkes said.
Other rural hospitals across the state have been forced to close after losing their CAH designation, including Pioneer Community Hospital of Newton, she said.
Wilkes said she met with Senator Roger Wicker to discuss the issue earlier this month.
She said Wicker was responsive to the issue, sending a letter to the new Health and Human Services Secretary Tom Price in support of rural healthcare as an important investment.
“We request that you work with us to ensure that the federal government does not act as an impediment to providing health care in rural communities,” the letter states. “Overreaching and onerous regulations from Washington disproportionally harm rural America.”
Also in the letter, Wicker said that almost 90 percent of the U.S. is geographically rural and 20 percent of the population lives those areas.
Wilkes also noted that the most hospital with a CAH designation are in the South, showing a correlation with states who did not expand Medicaid.
With the help of Wicker, Sen. Thad Cochran and other legislators, Wilkes said they are hoping for one of two solutions; either grandfather in all accredited CAH’s to prevent a massive shutdown, or put a freeze on the inspection process until a permanent solution is found.
Wicker’s letter to Price did not specify a solution to this issue.
Wilkes said she also spoke with Kellyanne Conway, counselor to President Donald Trump, about the issue. Wilkes said Conway was supportive of rural health and optimistic about future growth.
If nothing is done, “it would probably close the hospital, we cannot survive under the methods of an acute care hospital,” Wilkes said.
Closing the hospital would create a massive economic ripple effect throughout the county, she said.
“When the hospital closes in a town, families, friends, students, employees are forced to seek care outside the local community, sometimes travelling long distances in emergencies,” Pearl River County Hospital and Nursing Home Administrator Steve Vaughan said in a written statement provided by Wilkes. “One only has to look at Lumberton to see how the impact of losing the local hospital hinders economic development. If our rural hospitals close, patients will suffer and so will the local economy.”
Wilkes said she personally funded her trip to the District of Columbia.
“As a lifelong resident of Pearl River County, my heart is here and I like to give back to my community and this, to me, is a very worthy cause,” she said in an emailed statement.