Critical Access Hospital Status and What it Means for Alice Hyde

Alice Hyde has submitted a Certificate of Need (CON) to New York State Department of Health (NYSDOH) and the Centers for Medicare and Medicaid Services (CMS) seeking approval to become a Critical Access Hospital (CAH). AHMC’s goal is to ‘go live’ as a CAH effective Oct. 1, 2023, coinciding with the start of the 2024 Fiscal Year (FY24).

 In this FAQ, we'll address the basics of what CAH status is and what this transition means for Alice Hyde and the communities we serve.

What is a Critical Access Hospital?

Critical Access Hospital (CAH) status is a designation given by the Centers for Medicare & Medicaid Services (CMS) to hospitals which meet certain eligibility requirements. Those requirements include:

• Being located in a rural area
• Being located more than 35 miles from the next nearest hospital
• Having a maximum of 25 inpatient beds
• Maintaining an average length of stay of 96 hours for acute inpatient care patients
• Providing 24-hour emergency care services seven days per week.

What are the benefits of becoming Critical Access Hospital?

Becoming a CAH will reduce Alice Hyde’s financial vulnerability by improving the way the federal government reimburses us. Through so-called “cost-based reimbursement,” CAHs receive 101 percent of “reasonable costs” of care they provide to Medicare patients, while non-CAH hospitals receive, on average, about 87 percent of what it costs to provide care.

CAH status will mean increased revenue and will give our organization the flexibility and resources we need to continue meeting the needs of our community.

Is becoming a CAH a downgrade for Alice Hyde?

No. Becoming a CAH changes how CMS reimburses Alice Hyde for the care we provide patients enrolled in Medicare insurance plans; it is not a downgrade and becoming a CAH does not mean losing services.

Alice Hyde will continue to provide the same continuum of care we do today, including our outpatient clinics and offices, outpatient and inpatient surgeries and acute care, dental care, 24/7 emergency department, and our Walk-in Clinic.

Becoming a CAH will not limit Alice Hyde’s ability to care for our patients. In some cases, hospitals that transitioned to CAH status actually expand services, after enrolling in the program improved their financial stability.

I saw that Alice Hyde is making changes to its Hospital Operating Certificate. What are those changes and how will they impact hospital operations?

As we make this transition, one step in the process will be to amend a legal document called a Hospital Operating Certificate. This document is a license issued by New York State Department of Health which contains information on the number of beds certified for the hospital and the specific services our hospital is licensed to provide.

Alice Hyde’s operating certificate lists some services that the hospital has not provided in many years, including dialysis and an Intensive Care Unit. Those listings will be removed as we update the operating certificate, but will have no impact on the continuum of care we provide today.

Will Alice Hyde still provide Intermediate Care through our IMCU?

As part of our transition to a CAH, Alice Hyde will combine our IMCU and Medical-Surgical inpatient care units – another technical change that will not impact the level of patient care we currently provide.

Our IMCU’s physical space will remain open and operational, and our IMCU and Med-Surg care teams will continue to work together providing the appropriate level of inpatient care based on each patient’s needs.

Is there a limit on the length of stay (LOS) for inpatients at CAHs?

CAHs must maintain an average acute care length of stay of 96 hours – or four days or less — for acute care patients. However, swing bed patients have no length of stay limit, and all of Alice Hyde’s 25 inpatient care beds will be designated as swing beds.

Is there a bed limit for CAHs?

CAHs may have a maximum of 25 acute care inpatient beds.

Certain beds do not count towards the 25-bed limit, including examination or procedure beds, stretchers, operating room tables, long-term care beds, and distinct observation beds.

How will the CAH bed limit impact Alice Hyde?

In order to become a CAH, Alice Hyde will reduce the number of beds on our hospital operating certificate to 25.

This will not impact our ability to care for those admitted to our inpatient care unit (Med-Surg). Over the past year, our Med-Surg Unit has averaged 17 patients per day, and the unit’s current maximum capacity is 22 beds.

What is a swing bed and why are they important?

A Swing Bed is a service that rural hospitals and CAHs with a Medicare provider agreement use to allow patients to transition from acute inpatient care to Skilled Nursing Facility (SNF) care without leaving the hospital. Swing beds allow patients to continue receiving hospital services even though acute care is no longer required.

Swing beds can be an especially important service in rural areas like ours, because they improve access to SNF care for Medicare patients.

What about emergency services?

CAHs are required to provide 24/7 emergency services. Alice Hyde’s Emergency Department will not experience any changes as a result of the hospital becoming a CAH.

Won’t our aging population lead to more inpatient admissions?

Having an aging population does not mean the hospital will see more patients in need of inpatient care. Prior to the pandemic, hospitalization rates for senior citizens across the country were steadily falling. In 1997, 18% of Americans ages 65 and older had at least one hospital stay. In 2019, that rate had fallen to 16.6% of older Americans, according to the Centers for Disease Control and Prevention (CDC).

One of the benefits of becoming a CAH is an increased focus on care coordination and meeting specific community needs. As we lean into this work, it will result in more patients receiving care in outpatient settings — reducing access issues and helping to decompress our hospital, and resulting in lower healthcare costs for our patients and community.

In addition to becoming a CAH, improving access to primary care is part of AHMC’s Path Forward work.

What is Alice Hyde’s financial position right now?

Like hospitals across our region and our Health Network, Alice Hyde has had financial losses since the beginning of the COVID-19 pandemic. In fiscal year 2022, Alice Hyde lost approximately $12 million as the result of a combination of factors, including the nationwide healthcare workforce shortage, the high cost of traveling staff, and unpredictable challenges around patient access in general and inpatient volumes at our hospital.

What is the estimated financial impact of CAH status on Alice Hyde?

Alice Hyde could potentially receive between $3 million and $4.5 million in additional reimbursement per year. Additional savings and revenue may be identified as we continue working through this transition.

What is our vision for the future at Alice Hyde?

Becoming a Critical Access Hospital is just one piece of the work we are doing to support our people and patients, ensure our organization’s future success, and redefine how we approach our mission to meet the changing needs of our community. This work includes but is not limited to:

• Recruiting additional physicians and providers for outpatient, inpatient and specialty care services, with the goal of addressing patient access issues in high-demand specialty services and connecting patients with the care they need, as close to home as possible.
• Reopening Skilled Nursing beds on The Alice Center’s third floor, increasing access to high-quality long-term care services in our community and helping to decompress our Emergency Department, where many patients in need of long-term care services ultimately end up.
• Improving the patient experience and timely throughput in the hospital’s Emergency Department.
• Building teams of shared providers to expand access to critical services like Women’s Health, Orthopedics, Cardiology and General Surgery at both Alice Hyde and our partners across UVM Health Network.
• Pursuing state grant funding for major capital investment projects to modernize existing facilities on our campus and in our hospital, including: our Emergency Department, Operating Rooms and perioperative suites, specialty care offices and clinics, our inpatient unit (Med-Surg), and our boiler plant.

Is Alice Hyde the only CAH in the North Country?

No. New York State has 18 Critical Access Hospitals overall, with a number of CAHs in our region. Those hospitals include: UVM Health Network – Elizabethtown Community Hospital. Gouverneur Hospital, Lewis County General Hospital, Carthage Area Hospital, River Hospital and Clifton-Fine Hospital.

In addition to these existing CAHs, multiple health care organizations in our region are also currently making the transition to critical access status.