A new report from the inspector general of the U.S. Department of Health and Human Services includes recommendations that — if acted upon — could undermine

hundreds of small, rural hospitals across the nation including scores in Kansas, including those in WaKeeney, Plainville, La Crosse, Hill City, Hoxie, Oakley, Ness City, Larned, and Russell, hospital officials and some rural health experts say.

“It would be a matter of time before many of them (the hospitals) would have to close,” predicted Brock Slabach, senior vice president for member services at the National Rural Health Association, which is encouraging its 20,000 members to voice alarm about the 34-page report to members of Congress.

“I don’t think any senator or congressman would want to preside over the closure of hundreds of hospitals in rural communities across the United States,” Slabach said, noting that even if the report’s recommendations were to go mostly unheeded by federal officials there are other proposals, including a budget plan from the White House, that could hurt the hospitals as the government looks for ways to brake Medicare spending.

Proliferation
According to the Office of Inspector General, there are more than 1,300 U.S. hospitals designated as “critical access” facilities.

Kansas has 83 critical access hospitals — more than any other state.

The designation, created by Congress with the Balanced Budget Act of 1997, was intended to assure reasonably close hospital access to rural residents across the country by guaranteeing that the qualifying hospitals would receive favorable Medicare payment rates.

Reimbursing these small hospitals at 101 percent of their costs for Medicare services helps them stay in business despite the relatively small number of patients they treat compared to their urban counterparts.

In Kansas, critical access hospitals are also reimbursed on a cost-plus basis for Medicaid services. Congress authorized the higher rates in response to hundreds of rural hospitals closing their doors in the 1980s and 1990s.

Sixteen years later, the facilities have proliferated. Now, only five smaller states on the east coast have no critical access hospitals. Kansas has 83. Iowa has the second most with 82. Texas has 80 and Minnesota, 79, according to a list kept by the Flex Monitoring Team.

Initially, the designation was allowed only for hospitals more than 35 miles apart with some exceptions for those in “mountainous terrain” or accessible only by secondary roads, meaning via state highways or local roads.

‘Necessary providers’
But until Jan. 1, 2006, states and their governors were allowed to also designate some hospitals that failed to meet the distance requirements but qualified as “necessary providers.” That state authority, which qualified the designated hospitals for the higher reimbursements, was widely used, Kansas being a prime example.

HHS Secretary Kathleen Sebelius, then Kansas governor, signed off on the certification of 31 Kansas hospitals between 2003 and 2006, according to Slabach, who said he hoped she would remember why she did that now that she is the top federal health official.

“So, now that she’s secretary we just hope she remembers her commitment to rural health and ensuring access to care in those 31 (Kansas) counties,” he said.

In any event, the HHS inspectors concluded in their report that 849 of the nation’s critical access hospitals — nearly two-thirds of them — would not meet the law’s distance benchmarks, if they were forced to reapply for the designation using the original standards. Of those, 751 had been designated by state leaders, such as Sebelius, as “necessary providers.”

Cutting costs
The inspectors are recommending that Congress change the law so that the federal Centers for Medicare and Medicaid Services could reassess the critical access hospitals.

If that were done according to the original distance requirements, they concluded, hundreds of the hospitals would fail to meet the standards and the government and Medicare patients would save billions of dollars thanks to halted preferred payments.

By their estimate, pushing those hospitals out of the designation would save taxpayers $268 million a year in 2011 dollars. Medicare patients would save another $181 million thanks to reduced co-insurance payments.

Those calculations are challenged by the National Rural Health Association. Officials there don’t even agree with the way the inspectors calculated the number of hospitals that would fail the distance standards, if forced to reapply.

“We happen to think that list is in error,” Slabach said. “They didn’t use very sophisticated mapping techniques. It could be over or under we don’t know. But I would say any hospital on the list that doesn’t meet the (original) criteria should consider themselves vulnerable.”

Critical Access Designation
To be certified for favorable Medicare rates, Critical Access Hospitals must meet location requirements and cannot have more than 25 beds for acute-care or “swing-bed” patients. They must offer 24-hour emergency services and the average annual length of patient stays cannot exceed 96 hours.

Quite a few Kansas and Missouri hospitals would be among the vulnerable.

“Seventy-two of our 83 (critical access) hospitals would be affected. That’s a lot,” said Cindy Samuelson, vice president of member services and public relations at the Kansas Hospital Association, commenting on the HHS OIG report.

The OIG report included a map reference to Missouri that showed about 70 percent of that state’s critical hospitals would no longer be eligible, if the recommendations were followed. But the report did not reach that level of detail with other states. That has prompted state associations around the country to start their own tallies.

Slabach and KHA officials said their respective groups were rallying members of Congress in an effort to ward off any of the payment cuts proposed in the inspector’s report and likewise to stave off a budget proposal from the Obama administration that also would pare the nation’s list of critical access hospitals, though less dramatically.

The Obama plan would bump from the list about 70 hospitals nationwide that are within 10 miles of one another, trimming Medicare spending by about $40 million a year.

Congressional opposition
Slabach said Kansas U.S. Sens. Jerry Moran and Pat Roberts, both Republicans, have signaled they would oppose the proposed changes to the critical access system and a bi-partisan letter penned by two other farm state senators to HHS has picked up more than 20 signatures. Nose counting in the U.S. House also is underway.

“The fact this (OIG) report exists and is out there I don’t think is imminently troubling to us because of the support in Congress that we’re pleased about,” Slabach said. “But you remember how they did the 2013 budget reconciliation. It was 11:55 on New Year’s Eve. We’re fearful of those last-minute conference committees behind closed doors where they throw everything but the kitchen sink in to boil and you wake up the next morning to find something horrific has been done. So that’s what we’re trying to prevent.”

There are other ways that small hospitals are being squeezed financially, regardless what Congress does with the budget or the OIG report.

HHS officials in March began a new policy of requiring periodic reassessments of some critical access hospitals, opening the door on the possibility some will be decertified.

“This just reiterates the status quo we’ve seen from the regulatory agencies,” said Chad Austin, senior vice president of government relations at the Kansas Hospital Association. “They’re just really making it difficult on critical access hospitals.”

Slabach said his group didn’t agree with the OIG’s apparent premise that there are too many rural hospitals.

“Nobody seems to question whether there are too many hospitals in an urban environment when there’s a hospital on each of four corners,” Slabach said. “Each state was asked to commit their assessment of what they felt the necessary providers should be. Why would the federal government, some bureaucrat at CMS sitting in Baltimore, know better than the governor and health department in each state?”

By Mike Shields, KHI News

11:00 a.m. Monday  The Smith County undersheriff James Dean told Hays Post that their office did locate the stolen Hummer H3. However, no suspects in the case are in custody.

9:30  a.m. Monday     Kearney police told Hays Post that the stolen Hummer has been located near Kensington, in Smith County. The Chevy 2500 truck was possibly located near Colby. Police would not confirm that.  It is still listed as missing.

The suspects in the case are also still missing. However, authorities had a report that John Kinzie was hospitalized in Colby.  Wendi Kinzie is described as a 34 year old, 260 pound white female.  She has brown hair and blue eyes. No other details or photos are available.

The attempt to locate alert for Kinzie said he was on his way to Hays.

 

Sunday 4 p.m. The search continues for a suspect wanted in connection with a truck stolen from Midway Motors in Kearney who was reportedly coming to Hays.

Police in Kearney told Hays Post a second vehicle and suspect are also the subject of their search. In addition to a suspect who claimed to be John Kinzie, authorities are looking for a woman who identified herself as Wendi Kinzie and a 2007 Black Hummer H3.  The pair were reportedly married and had connections to Smith Center, Kensington, and Hays.

 

7 p.m. Saturday Law enforcement authorities in the region have been alerted to a man driving a truck that was reportedly stolen in Nebraska and headed to Hays.

Authorities say 41-year-old John Sheridan Kinzie, a 5’ 10” white male, who weighs 175 pounds was last seen on Friday.

He is driving a tan Chevy 2500 pickup taken from Midway Motors in Kearney, Nebraska. Kinzie was reportedly using a fake Kansas driver’s license and is also wanted on a felony warrant in Nebraska.

Kinzie has served time  for  convictions on first degree sexual assault and theft.

Stay tuned to Eagle Radio and Check Hays Post for more information on this story as it becomes available.

The Ellis County Public Building Commission will meet Monday night September 9th at 6:40pm, and the Ellis County Commission will meet at 6:45pm.  Both agendas can be found below.

Below are some of the agenda items for Mondays’ meeting.  All items have been taken from the posted agenda:

-Consideration to join the Kansas Natural Resource Coalition.

• Based on interest shown on the part of Commissioners in joining this coalition that seeks to form a government to government partnership with the federal government for the purposes of addressing regarding the Endangered Species Act proposals on the table. As was reported on September 3, 2013, the Kansas Natural Resources Coalition is currently comprised of 29 counties in western Kansas. They are encouraging Ellis County to join them.
• The initial cost to the County would be $2,687 to help cover the cost of developing a plan to address the lesser prairie chicken.

-County Counselor attendance at Commission Meetings

• Commissioner Wasinger raised this issue earlier this year. She said she thought it was important to have the County’s Counselor attend Commission Meetings.
• At the time it was not approved, but County Attorney Drees is recommending reconsideration of this proposal. He said with the size of the County budget and the complexity of issues addressed having an attorney on hand to offer input will help in decision making.
• The problem with doing this is Mr. Jeter has a conflict on most Monday evenings as he attends the Hays School Board meetings as their attorney. For this reason, if the Commission wishes to reconsider having Mr. Jeter attend the meetings, it will have to come with a change in meeting time and/or day.

-Caterer License

• The Rose Garden Steak Haus and Catering currently operate the Rose Garden in the Hadley Center and are expanding to the former Franchon building on 8th Street east of Hays.
• Suggested Motion is to approve a caterer license for the Rose Garden Steak Haus and Catering to operate out of 2350 E. 8th Street, Hays.

Monday, September 9, 2013 6:45 PM Ellis County Courthouse
Order of Business
A. Call to Order
B. Pledge of Allegiance
C. Clerk Calls the Roll
D. Approval of Agenda
II. Approval of Prior Minutes
III. Consent Agenda
A. Approval of Employee Status Changes as presented
B. Approval of Refunding Warrants as presented
C. Approval of Tax Roll Adjustments as presented
D. Approval of Escape Tax Orders as presented
E. Approval of Accounts Payable and Payroll as presented
IV. Regular Agenda
A. Extension Service Monthly Report – Stacy Campbell
Report
B. County Administrator
1. Doonan Truck Development
Discussion/Update Enclosure
2. Resolution No. 2013-22 – Kansas Natural Resource
Coalition
Discussion/Consideration of Resolution Enclosure
3. Oil & Gas Lease
Consideration of Oil & Gas Lease Under a County Right of Way
Enclosure
4. KAC NACo Board Election
Consideration of Ellis County’s Preferred Representative Enclosure
5. KAC Public Health Workshop
Discussion about upcoming workshop in Russell Enclosure
6. Administrative Center Project Update
Report
7. County Counselor Attendance at Commission Meetings
Discussion
8. Executive Session
Possible Litigation Not Involving an Elected Official
9. Executive Session
For Non-Elected Employee Issue – Greg Sund performance evaluation
C. Other
1. Caterer License
Consideration of Application from Rose Garden Steak Haus & Catering, LLC for the 2350 E 8th, Hays, KS (former Franchon Building) Enclosure
D. County Commission
1. Commissioner Reports

 

Honoring educators while bringing the business and education communities together is the focus of the annual Teacher Reception hosted by the Hays Area Chamber of Commerce.  Scheduled for Tuesday, September 10th at the Sternberg Museum, this annual event is a way to welcome new educators to our community and introduce them to the business leaders of Hays.

New teachers and faculty from across Ellis County will be recognized at the event, including representatives from Hays USD 489, Victoria USD 432, Ellis USD 388, Fort Hays State University, North Central Kansas Technical College, Holy Family Elementary and Thomas More Prep-Marian schools.

The Chamber would like to thank the following supporters for their efforts in making this event a success: Auto World, Commerce Bank, Dean Ellner Realtors, Eagle Communications, EnerSys, Great Lakes Airlines, Nex-Tech, FHSU Sternberg Museum, Wal-Mart Supercenter and Western Beverage.