For one Texas facility, the decision to convert to a rural emergency hospital came down to survivability.
Anson General Hospital, located in a city with about 2,200 residents, had experienced three years of financial losses. The hospital's patient volume had also declined to about 1.7 inpatients a week, on average, partially due to factors related to the COVID-19 pandemic.
"Our numbers drastically declined, and we knew that this was our only hope to stay open," Chief Nursing Officer Anna Doan, BSN, RN, told Becker's.
Last fall, CMS announced the final rule for the emergency rural hospital designation, which took effect Jan. 1, 2023.
The designation was intended to offer financial help to struggling rural hospitals and give these facilities an opportunity to close infrequently used inpatient beds and focus on providing outpatient and emergency department services.
Rural emergency hospitals may participate in the Medicare program and receive payment for items and services furnished on or after the Jan. 1 effective date, according to a CMS guidance. The agency defines "rural emergency hospitals" as facilities that convert from either a critical access hospital or a small rural hospital that had no more than 50 beds on Dec. 27, 2020, and "don't provide any acute care inpatient hospital services (other than post-hospital extended care services provided in a distinct part unit licensed as a skilled nursing facility)."
Anson General was not eligible to be a critical access hospital and began assessing the possibility of becoming a rural emergency hospital in summer 2022.
"We have two full-time physicians, and then we have about four [advanced practice] providers, and they were all on board knowing that this was probably our only hope," Ms. Doan said. "We knew that we would lose inpatient services and swing bed services if we were able to convert, but we knew that the hope for us was to be able to go to REH."
CEO Ted Matthews retired from the hospital more than a decade ago and returned to helm the facility in February. He said the hospital continued looking into the process of becoming a rural emergency facility and received help from a West Texas firm to submit paperwork to CMS.
"We filed our application in early January, and on March 30, we received notice that we were, effective March 27, a rural emergency hospital. So that happened quickly for us, and we were glad it did," Mr. Matthews told Becker's.
Under the rural emergency hospital designation, CMS pays hospitals an additional 5 percent over the payment rate of the Hospital Outpatient Prospective Payment System for rural emergency hospital services, according to an agency fact sheet. Mr. Matthews said Anson General received its first monthly payment in April, of about $273,000.
While there have been financial benefits to the new designation, there have also been challenges, Ms. Doan said. This included decreasing staff by about 17 percent. Anson General now has 55 full-time employees.
"That primarily did affect nursing services because we would not be having inpatients or swing beds anymore," Ms. Doan said.
She also said the new designation "will become personal to the community" during busier months in the fall and winter.
"Those are going to be times when it really becomes personal to them that their family members are not going to be able to be hospitalized here for over 24 hours," she said, adding that the nearest hospital to Anson General is more than 30 miles away. That's where patients will be transferred if they need higher-level care.
Anson General still has an emergency room and radiology lab, and offers outpatient therapy. The hospital also has a rural health clinic that sees about 800 patients a month.
"I feel like we are utilizing all the services that we are able to still continue with. We're trying to utilize those to the max," Ms. Doan said.
Mr. Matthews added: "We have embraced this new identity. What it allowed us to do is continue to provide access to care. We were the only hospital at one time. Jones County had three hospitals, and we are the lone surviving hospital. And if we had to close, there would have been no hospitals in the county."
He said Anson General is also looking toward the future, including the possibility of doing some surgeries.
"We're thinking about doing that. And so we have this new identity, but we're still very focused on expanding services and meeting the needs of our community," Mr. Matthews said.