Mississippi Today
Under a new program, rural hospitals could get more money — but they have to end inpatient care
Under a new program, rural hospitals could get more money — but they have to end inpatient care
Thanks to a new federal program, a few rural Mississippi hospitals at risk of closure might have been given a lifeline.
The Mississippi Department of Health finalized its rules for “rural emergency hospitals” last week, so Mississippi rural hospitals with less than 50 beds and critical access hospitals can now apply for the designation.
Critical access hospitals — another designation designed to reduce hospital financial strain — must have 25 or fewer inpatient beds, be located 35 miles from another hospital, maintain an annual hospital stay of less than 96 hours for patients and provide full-time emergency services.
The federal government created the rural emergency hospital program, which was finalized in November, to ease the financial strain of rural hospitals across the country at risk of closure.
To qualify, the hospitals must agree to have emergency care available all day, every day, and provide observation care and outpatient services.
But there’s one more catch: In exchange for monthly payments and higher Medicare reimbursements, rural emergency hospitals must end all inpatient care and discharge or transfer its patients to bigger hospitals within 24 hours of their arrival.
Ryan Kelly, executive director of the Mississippi Rural Health Association, said the program is ideal for hospitals that have low patient counts and are in deep financial distress.
“It’s a good opportunity,” Kelly said. “This is no silver bullet, but the more tools we can put in the tool belt to solve this issue, the better.”
The premise of the program is that so many rural hospitals already struggle with low census counts and inpatient care costs far higher than what they’re paid. In states that have not expanded Medicaid, the program could be a solution for small hospitals that only operate some of the health services in their communities and have shuttered other units in order to maintain operations.
Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, takes issue with several of the program’s requirements.
Seniors whose health conditions most often need more intensive care might have to be transferred to a larger facility if their local hospital is a rural emergency hospital, and transferring patients is no longer as easy as it used to be, he said. Bigger hospitals, already under strain, must be willing to accept them.
The University of Mississippi Medical Center, for example, was on diversion (or at capacity) for both critical care and medical-surgical beds consistently from Jan. 30 to Feb. 11 of this year, according to a website that tracks hospitals on diversion. The website is updated at least twice a day.
Richard Roberson, the vice president of state policy for the Mississippi Hospital Association, said UMMC is not alone.
“You always had hospitals go on diversion, even prior to COVID, so that’s not a new thing … but what we’re seeing now is more and more diversions becoming the norm in some places,” he said.
Hospitals – even larger ones – are making decisions based on limited budgets, inadequate nurse staffing and increased wages for employees.
“Unfortunately, what’s happening is it’s impacting patient care,” said Roberson.
Additionally, when a facility is converted into a rural emergency hospital, it can no longer provide swing bed services. In that case, when there’s no separate skilled nursing facility, the community loses its nursing home, too.
Rural emergency hospitals also can’t utilize the federal 340B drug pricing program, which allows hospitals that treat low-income populations to buy prescription drugs at a discount.
“For some very small hospitals, all of the changes in payments might mean that the hospital is more profitable than it was before,” Miller said. “But it also has to eliminate services for the community in order to do that. Why should a small rural hospital that is losing money be forced to eliminate important services in order to get higher payment?”
And still, there is no guarantee that the hospital will be paid enough to remain open, Miller said.
However, for some Mississippi communities in danger of losing their only hospital, the payoff might be worth the risk.
According to a report from the CHQPR, 19 out of the state’s 74 rural hospitals are at risk of closing within the next two to three years, putting Mississippi fourth in the country for percentage of rural hospitals at immediate risk of closure.
The University of North Carolina’s Sheps Center estimates that more than 1,700 hospitals might be eligible. Kelly said he estimates around five Mississippi hospitals will qualify for the program.
Though the federal program took effect Jan. 1, the state had to finalize its qualifications before hospitals could begin applying for the designation.
Mississippi will be one of the first states to roll out the program, Kelly said.
“We’ve been waiting on the Department of Health to finalize their rules,” he said. “Now, they have the guidelines that they need to follow through and begin work.”
To become rural emergency hospitals, officials must first notify the MDSH Office of Licensure of their intent to convert, provide required documents and complete the Centers for Medicare and Medicaid Services’ application. Then, they must complete an initial survey, and apply for an MSDH rural emergency hospital license.
Community Health Editor Kate Royals contributed reporting to this story.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1997
Dec. 22, 1997
The Mississippi Supreme Court upheld the conviction of white supremacist Byron De La Beckwith for the 1963 murder of Medgar Evers.
In the court’s 4–2 decision, Justice Mike Mills praised efforts “to squeeze justice out of the harm caused by a furtive explosion which erupted from dark bushes on a June night in Jackson, Mississippi.”
He wrote that Beckwith’s constitutional right to a speedy trial had not been denied. His “complicity with the Sovereignty Commission’s involvement in the prior trials contributed to the delay.”
The decision did more than ensure that Beckwith would stay behind bars. The conviction helped clear the way for other prosecutions of unpunished killings from the Civil Rights Era.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Medicaid expansion tracker approaches $1 billion loss for Mississippi
About the time people ring in the new year next week, the digital tracker on Mississippi Today’s homepage tabulating the amount of money the state is losing by not expanding Medicaid will hit $1 billion.
The state has lost $1 billion not since the start of the quickly departing 2024 but since the beginning of the state’s fiscal year on July 1.
Some who oppose Medicaid expansion say the digital tracker is flawed.
During an October news conference, when state Auditor Shad White unveiled details of his $2 million study seeking ways to cut state government spending, he said he did not look at Medicaid expansion as a method to save money or grow state revenue.
“I think that (Mississippi Today) calculator is wrong,” White said. “… I don’t think that takes into account how many people are going to be moved off the federal health care exchange where their health care is paid for fully by the federal government and moved onto Medicaid.”
White is not the only Mississippi politician who has expressed concern that if Medicaid expansion were enacted, thousands of people would lose their insurance on the exchange and be forced to enroll in Medicaid for health care coverage.
Mississippi Today’s projections used for the tracker are based on studies conducted by the Institutions of Higher Learning University Research Center. Granted, there are a lot of variables in the study that are inexact. It is impossible to say, for example, how many people will get sick and need health care, thus increasing the cost of Medicaid expansion. But is reasonable that the projections of the University Research Center are in the ballpark of being accurate and close to other studies conducted by health care experts.
White and others are correct that Mississippi Today’s calculator does not take into account money flowing into the state for people covered on the health care exchange. But that money does not go to the state; it goes to insurance companies that, granted, use that money to reimburse Mississippians for providing health care. But at least a portion of the money goes to out-of-state insurance companies as profits.
Both Medicaid expansion and the health care exchange are part of the Affordable Care Act. Under Medicaid expansion people earning up to $20,120 annually can sign up for Medicaid and the federal government will pay the bulk of the cost. Mississippi is one of 10 states that have not opted into Medicaid expansion.
People making more than $14,580 annually can garner private insurance through the health insurance exchanges, and people below certain income levels can receive help from the federal government in paying for that coverage.
During the COVID-19 pandemic, legislation championed and signed into law by President Joe Biden significantly increased the federal subsidies provided to people receiving insurance on the exchange. Those increased subsidies led to many Mississippians — desperate for health care — turning to the exchange for help.
White, state Insurance Commissioner Mike Chaney, Gov. Tate Reeves and others have expressed concern that those people would lose their private health insurance and be forced to sign up for Medicaid if lawmakers vote to expand Medicaid.
They are correct.
But they do not mention that the enhanced benefits authored by the Biden administration are scheduled to expire in December 2025 unless they are reenacted by Congress. The incoming Donald Trump administration has given no indication it will continue the enhanced subsidies.
As a matter of fact, the Trump administration, led by billionaire Elon Musk, is looking for ways to cut federal spending.
Some have speculated that Medicaid expansion also could be on Musk’s chopping block.
That is possible. But remember congressional action is required to continue the enhanced subsidies. On the flip side, congressional action would most likely be required to end or cut Medicaid expansion.
Would the multiple U.S. senators and House members in the red states that have expanded Medicaid vote to end a program that is providing health care to thousands of their constituents?
If Congress does not continue Biden’s enhanced subsidies, the rates for Mississippians on the exchange will increase on average about $500 per year, according to a study by KFF, a national health advocacy nonprofit. If that occurs, it is likely that many of the 280,000 Mississippians on the exchange will drop their coverage.
The result will be that Mississippi’s rate of uninsured — already one of the highest in the nation – will rise further, putting additional pressure on hospitals and other providers who will be treating patients who have no ability to pay.
In the meantime, the Mississippi Today counter that tracks the amount of money Mississippi is losing by not expanding Medicaid keeps ticking up.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1911
Dec. 21, 1911
Josh Gibson, the Negro League’s “Home Run King,” was born in Buena Vista, Georgia.
When the family’s farm suffered, they moved to Pittsburgh, and Gibson tried baseball at age 16. He eventually played for a semi-pro team in Pittsburgh and became known for his towering home runs.
He was watching the Homestead Grays play on July 25, 1930, when the catcher injured his hand. Team members called for Gibson, sitting in the stands, to join them. He was such a talented catcher that base runners were more reluctant to steal. He hit the baseball so hard and so far (580 feet once at Yankee Stadium) that he became the second-highest paid player in the Negro Leagues behind Satchel Paige, with both of them entering the National Baseball Hame of Fame.
The Hall estimated that Gibson hit nearly 800 homers in his 17-year career and had a lifetime batting average of .359. Gibson was portrayed in the 1996 TV movie, “Soul of the Game,” by Mykelti Williamson. Blair Underwood played Jackie Robinson, Delroy Lindo portrayed Satchel Paige, and Harvey Williams played “Cat” Mays, the father of the legendary Willie Mays.
Gibson has now been honored with a statue outside the Washington Nationals’ ballpark.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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