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 1917
May 5, 1917
Eugene Jacques Bullard became the first Black American combat pilot.
After the near lynching of his father and hearing that Great Britain lacked such racism, the 12-year-old Georgia native stowed away on a ship headed for Scotland. From there, he moved to Liverpool, England, where he handled odd jobs before becoming a boxer, traveling across Europe before he settled in Paris.
“It seems to me that the French democracy influenced the minds of both White and Black Americans there and helped us all to act like brothers as near as possible,” he said. “It convinced me, too, that God really did create all men equal, and it was easy to live that way.”
When World War I began, he was too young to fight for his adopted country, so he and other American expatriates joined the French Foreign Legion. Through a series of battles, he was wounded, and doctors believed he would never walk again.
No longer able to serve in the infantry, an American friend bet him $2,000 that he could not get into aviation. Taking on the challenge, he earned his “wings” and began fighting for the French Aéronautique Militaire.
He addressed racism with words on his plane, “All Blood Runs Red,” and he nicknamed himself, “The Black Swallow of Death.”
On his flights, he reportedly took along a Rhesus monkey named “Jimmy.” He tried to join the U.S. Air Service, only to be turned away because he was Black. He became one of France's most decorated war heroes, earning the French Legion of Honor.
After the war he bought a Paris nightclub, where Josephine Baker and Louis Armstrong performed and eventually helped French officials ferret out Nazi sympathizers. After World War II ended, he moved to Harlem, but his widespread fame never followed him back to the U.S.
In 1960, when French President Charles de Gaulle visited, he told government officials that he wanted to see his old friend, Bullard. No one in the government knew where Bullard was, and the FBI finally found him in an unexpected place — working as an elevator operator at the Rockefeller Center in New York City.
After de Gaulle's visit, he appeared on “The Today Show,” which was shot in the same building where he worked.
Upon his death from cancer in 1961, he was buried with honors in the French War Veterans' section of the Flushing Cemetery in Queens, New York.
A sculpture of Bullard can be viewed in the Smithsonian National Space and Air Museum in Washington, D.C., a statue of him can be found outside the Museum of Aviation, and an exhibit on him can be seen inside the National Museum of the U.S. Air Force, which posthumously gave him the rank of a second lieutenant. He is loosely portrayed in the 2006 film, “Flyboys.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
A seat at table for Democrats might have gotten Medicaid expansion across the finish line
The Mississippi Capitol is 171,000 square feet, granted a massive structure, but when it comes to communication between the two legislative chambers that occupy the building, it might as well be as big as the cosmos.
Such was the case in recent days during the intense and often combustible process that eventually led to the death of Medicaid expansion and with that the loss of the opportunity to provide health care for 200,000 working poor Mississippians with the federal government paying the bulk of the cost.
Democrats in the state House came under intense pressure and criticism for blocking a Medicaid expansion compromise reached by Republican House and Senate negotiators.
First of all, it would be disingenuous to argue that Democrats, who compose less than one-third of the membership of either chamber, blocked any proposal. Truth be known, Republicans should be able to pass anything they want without a solitary Democratic vote.
But on this particular issue, the Republican legislative leadership who finally decided that Medicaid expansion would be good for the state needed the votes of the minority party, which incidentally had been working for 10 years to pass Medicaid expansion. The reason their votes were needed is that many Republicans, despite the wishes of their leaders, still oppose Medicaid expansion.
The breakdown in the process could be attributed to the decision of the two presiding officers, House Speaker Jason White and Lt. Gov. Delbert Hosemann in the Senate, not to appoint a single Democrat to the all-important conference committee.
Conference committees are formed of three senators and three House members who work out the differences between the two chambers on a bill. Considering that Democratic votes were needed in both chambers to pass Medicaid expansion, and considering Democrats had been working on the issue for a decade while Republicans blocked it, it would have made sense that they had a seat at the table in the final negotiations process.
One Democrat from each chamber on the conference committee could not have altered the outcome of the negotiations. But the two Democrats could have provided input on what their fellow legislative Democrats would accept and vote for.
In the eyes of the Democrats, the compromise reached without their voice being heard was unworkable and would not have resulted in Medicaid expansion.
The Republican compromise said Medicaid would not be expanded until the federal government provided a waiver mandating those on Medicaid expansion were working. Similar work requirement requests by other states have been denied. Under the compromise, if the work requirement was rejected by federal officials, Medicaid expansion would not occur in Mississippi.
After voicing strong objections to the work requirement, House Minority Leader Rep. Robert Johnson, recognizing the Senate would not budge from the work requirement, offered a compromise. The Johnson compromise to the compromise was to remove a provision mandating the state apply annually with federal officials for the work requirement.
Instead, under Johnson's proposal, state Medicaid officials would be mandated to apply just once for the work requirement. If it was rejected, Medicaid expansion would not occur, but hopefully that would compel the Legislature to take up the issue of the work requirement and perhaps remove it.
“We just want the Legislature to come back and have a conversation next year if the federal government doesn't approve the work requirement. It's as simple as that,” Johnson said.
Senate leaders agreed that Johnson's proposal was a simple ask and something they might consider.
But Lt. Gov. Delbert Hosemann, who presides over the Senate, said he never heard Johnson's proposal until late in the process — too late in the process, as it turned out.
Speaker Jason White, R-West, also said he never heard the proposal, though Johnson said he repeatedly discussed it with House leaders. He certainly was relaying the information to the media during the final hectic days before Medicaid expansion died.
And perhaps if Johnson or one of his Democratic colleagues had been on the conference committee, that information would have been heard by the right legislative people and perhaps Medicaid expansion would not have died.
After all, a conference room or an office where negotiators are meeting to hammer out a compromise is much smaller than the massive state Capitol, where communications often get lost in the cosmos.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1884
May 4, 1884
Crusading journalist Ida B. Wells, an African-American native of Holly Springs, Mississippi, was riding a train from Memphis to Woodstock, Tennessee, where she worked as a teacher, when a white railroad conductor ordered her to move to another car. She refused.
When the conductor grabbed her by the arm, “I fastened my teeth in the back of his hand,” she wrote.
The conductor got help from others, who dragged her off the train.
In response, she sued the railroad, saying the company forced Black Americans to ride in “separate but unequal” coaches. A local judge agreed, awarding her $500 in damages.
But the Tennessee Supreme Court reversed that ruling three years later. The decision upended her belief in the court system.
“I have firmly believed all along that the law was on our side and would, when we appealed it, give us justice,” she said. “I feel shorn of that belief and utterly discouraged, and just now, if it were possible, would gather my race in my arms and fly away with them.”
Wells knew about caring for others. At age 16, she raised her younger siblings after her parents and a brother died in a yellow fever epidemic. She became a teacher to support her family.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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