From the Arkansas Advocate:
Two years ago, Brian Miller said he was still unsure whether to sign up the rural Arkansas hospital he runs for a federal program that promised more financial stability.
DeWitt Hospital and Nursing Home is now a rural emergency hospital, which draws more federal funds to rural hospitals if they reduce or eliminate inpatient services and focus on emergency and outpatient treatment. Five Arkansas hospitals have made this trade since September 2023.
The DeWitt hospital has had “nothing but success” since receiving rural emergency designation from the federal Centers for Medicare and Medicaid Services (CMS) in May 2024, Miller told the Advocate in August. The extra funding from Medicare, which insures the elderly, has been particularly helpful for the facility’s nursing home, he said.
The facility has also added cardiology, wound care and “some things like that that have generated a little more cash,” Miller said.
While rural emergency status has benefited the DeWitt hospital and its patients, it’s not necessarily the right fit for all rural Arkansas hospitals. The Southwest Arkansas Regional Medical Center in Hope will not be applying for rural emergency status, Chief Administrative Officer Shelby Brown told lawmakers in September.
Rural hospitals with no more than 50 beds are eligible to apply for rural emergency hospital (REH) status. If accepted, they are subsequently licensed for zero inpatient beds.
Brown said in an interview that giving up the Hope hospital’s inpatient beds would not serve the health needs of Hempstead, Lafayette, Miller and Nevada county residents.
“We want to be able to, if we need to admit someone, to put them in our hospital so they can stay home locally,” Brown said, adding that rural emergency hospitals’ primary goals are to “treat, stabilize and transfer” to a larger facility.
Brown also said the number of patients at Southwest Arkansas Regional’s emergency room can range from 30 to over 50, which exceeds rural emergency hospitals’ typical patient volume.
Southwest Arkansas Regional instead received approval Sept. 19 to become a critical access hospital, a federal designation for facilities located no fewer than 35 miles from other hospitals and maintaining no more than 25 beds.
CMS subsidizes critical access hospitals for inpatient treatment of Medicare recipients. The DeWitt hospital was a critical access facility before it converted to REH status.
Southwest Arkansas Regional reduced its beds from 48 to 25, and two of the eliminated beds were in its geriatric psychiatric unit, Brown said.
She petitioned the Legislature’s Joint Public Health, Welfare and Labor Committee on Sept. 11 for more state funds for rural health care.
“The big scheme of rural health in the state of Arkansas is in a crisis mode,” Brown said in an interview. “I would always think it’s better to have a rural emergency hospital versus no hospital.”
Other considerations
Two counties and 50 miles east of Hope, Ouachita County Medical Center reduced its beds from 65 to 49 in preparation to apply for rural emergency hospital status.
The hospital in Camden is under three miles too close to the hospital in Fordyce to be eligible for critical access status, said Glenda Harper, who took over OCMC as CEO in August.
OCMC is a prospective payment system (PPS) hospital, meaning it receives Medicare reimbursements based on predetermined amounts. If it becomes a rural emergency hospital, it will receive an additional 5% reimbursement rate for outpatient services. Harper said this extra money will be crucial to financial stability.
There’s a catch: the Camden hospital would have to scale back its labor and delivery services.
Patients’ average stay at a rural emergency hospital over the course of a year must be no more than 24 hours, according to federal eligibility requirements. Delivering a baby via Cesarean section requires two or three days in a hospital for post-birth observation, so OCMC would have to limit its obstetric services to low-risk patients only, Harper said.
Aside from Camden, Southwest Arkansas has only four delivery hospitals: two in Hot Springs, one in Arkadelphia and one in Mena. Texarkana, Arkansas, no longer has a hospital, and the facility on the Texas side of the state line does not accept Arkansas Medicaid.
Ouachita County’s labor and delivery unit “does not make money at this point.” Administrators have considered closing it, but decided to keep it open “because our community needs it so badly,” Harper said.
“Our fear was that if we closed it, we’d have women presenting in labor who had had little or no prenatal care, and we’d have people delivering in ambulances on the way to a place that did have OB services,” Harper said.
The extra money brought in via rural emergency status should make it possible for OCMC to keep both its labor and delivery unit and wound care unit open, she said.
Arkansas’ five existing rural emergency hospitals did not have labor and delivery services before receiving the designation. In addition to DeWitt, the other REH hospitals are in Pocahontas, Eureka Springs, Osceola and Helena-West Helena.
Thirty-three hospitals in 22 of Arkansas’ 75 counties have labor and delivery units, and six maternity wards have closed since 2020, including the one in Helena-West Helena.
The former Helena Regional Medical Center had 127 beds before Mississippi-based Progressive Health Group purchased the hospital last year, renamed it Progressive Health of Helena and converted it to a rural emergency hospital.
