By Dr. Seleem R. Choudhury

Originally published by the Caledonian Record, May 9, 2019

Almost one fifth of the US population live in a rural area. In Vermont, one of the most rural states in the country, rural hospitals act as a health anchor for our communities. These hospitals, known as Critical Access Hospitals (CAH), also are major contributors to the local economy and are the largest employers in their regions.

“Critical Access is a federal designation providing rural hospitals with a reimbursement structure protecting local access to emergency care,” said Brian Nall, FACHE, President & CEO of North Country Hospital. North Country Hospital and Northeastern Vermont Regional Hospital are two of Vermont’s eight CAH’s, and Littleton Regional Healthcare is one of New Hampshire’s 13 CAH’s.

Before a hospital can be designated as a CAH they must meet certain requirements, including providing emergency care 24 hours a day, seven days a week; having 25 or fewer acute care (short-stay) inpatient beds; and maintaining an average acute care inpatient length of stay of four days or less. Another requirement for a hospital to become CAH-designated is to be geographically located a certain number of driving miles from another hospital, so it’s essential that a CAH can handle life‐threatening conditions and stabilize a patient before the patient can be transferred.

CAH’s strive to provide as many services as possible to their communities based on community need and safety. Having to travel 60 minutes or more to a bigger hospital to get a necessary service could be a barrier to accessing care. Receiving a CAH designation is designed to reduce the financial vulnerability of rural hospitals through increased Medicare reimbursement services and improve access to healthcare by keeping essential services in rural communities. However, this does not always ensure that CAH’s face fewer financial difficulties.

In December, it was reported that Springfield Hospital was struggling financially, losing $14 million in just two years. Since that announcement, Springfield Hospital has started restructuring its services, trying to maintain a balance between financial needs and community needs.

Financial worries are not unique to Springfield. In Vermont eight of the 14 hospitals failed to make money on operations in fiscal year 2018 and today struggle financially. The concern is that this trend will continue or maybe even worsen and, if that happens, what that might mean for local care and the communities.

The real issue is keeping essential care accessible where it is needed. In the 2019 County Health Rankings, Caledonia and Essex counties were among the lowest ranked for how long people live and how healthy people feel. There is a connection between how rural an area is and how healthy the area’s population is, so it is vital to make sure that CAH’s stay viable, vibrant and financially strong to support their communities. Critical Access Hospitals are a crucial part of improving the health of our community and reducing healthcare costs, and is an economic engine through its employment and hiring.