Archive for the ‘Critical Access Hospitals’ Category

Medicare and Medicaid Funding for Hospitals Jeopardized in Federal Debt Ceiling Debate
—Posted Thursday, July 14th, 2011 at 8:09 pm— « »

Gina and Shelly

MCDH Nurses Jeanna and Shelley

You may be wondering if the struggle that is currently going on in Washington, D.C. over the decreasing the Nation’s debt will have an effect on health care in our local area.  We are all watching as both sides of Congress appear to agree that taking action to raise the Federal Debt Ceiling before the August 2 deadline is imperative.  We have been told that failure to raise the Debt Ceiling would push the U.S. into default on it’s existing financial obligations, which according to experts would have a catastrophic effect on our economy.  The answer to the question, “will the Debt Ceiling struggle affect us locally?”  is probably yes, given the fact that Medicare and Medicaid (known as Medi-Cal in California) comprise 20% of all Federal spending.

Earlier this week a list of 27 specific health care cuts were released by a “Deficit Reduction Group” led by Vice President Joe Biden.  On the list is $14 billion in savings (over 10 years) for “Reform Rural Hospital Programs (Medicare).”  Very few people outside of the Deficit Reduction Group know for sure what is included in that $14 billion cut.  (more…)

JAMA Article on Quality of Care in Critical Access Hospitals
—Posted Tuesday, July 5th, 2011 at 5:48 pm— « »

MCDH Front Entrance

Tomorrow a Nationally respected Medical Journal (the Journal of the American Medical Association) is issuing a report on “Quality of Care and Patient Outcomes in Critical Access Hospitals.”  The report uses a scientific approach to determining if there is a difference between critical access hospitals (CAHs, such as Mendocino Coast District Hospital) and non-Critical Access Hospitals when it comes to quality.  The report provides evidence that when looking at Nationally recognized hospital quality data, that critical access hospitals consistently come in with lower quality scores than non-critical access hospitals.   I have 2 reactions to the report.  First, I think that the report misses the boat by not recognizing that there are some fundamental differences between CAH hospitals and non-CAH hospitals.  The most major difference is that the CAHs exist in smaller rural markets with much less availability of physicians, specialist physicians and advanced clinical capabilities (such as cardiac catheterization labs).  Also, critical access hospitals are focused on keeping only those patients that can be treated safely in a smaller hospitals and transfering the more acutely ill patients to larger hospitals.  In the JAMA study, patients that were transfered to a larger hospital were excluded from some of the analysis.  So my first reaction is that quality in critical access hospitals needs to be measured differently than quality in urban hospitals.  My second reaction is that our hospital, Mendocino Coast District Hospital, compares very well to the National database that the JAMA article uses.   The data that they are using is available to anybody with a computer and internet access.  It’s available on a website called “Hospital Compare” on the Medicare site,   We have an ICU here, which is a big advantage for a critical access hospital (only 30% of them do, according to the report).  And in the areas of “processes of care” and “clinical outcomes” we compare pretty well.  In those 2 areas on the Medicare Hospital Compare website, we report and we consistently show as being comparable to larger hospitals.  The one caveat that I would point out is that, due to our low numbers, many of our scores have a footnote number 1.  Footnote number 1 says “the number of cases is too small to be sure how well a hospital is performing.”  So, in other words, even though the report says that our numbers are good, it is also saying that small numbers are unreliable.

My conclusions from reading the JAMA article are that (1) there needs to be more study on what constitutes high quality in critical access hospitals and (2) Mendocino Coast District Hospital is doing all of the right things to ensure that we are providing a high quality of care here on the Mendocino Coast.