Findings Brief: Communities Served by Rural Medicare Dependent Hospitals.

摘要

The Medicare Dependent Hospital (MDH) program provides enhanced reimbursement to support rural health infrastructure and to support small rural hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges. This greater dependence on Medicare may make these hospitals more financially vulnerable to prospective payment, and the MDH designation is designed to reduce this risk. A hospital qualifies for the MDH program if it is located in a rural area, has no more than 100 beds, is not classified as a Sole Community Hospital, and has at least 60 percent of inpatient days or discharges covered by Medicare. Hospitals meeting these criteria may benefit from two provisions. First, they are eligible to receive half or 75% (depending on the year) of the amount by which the highest of hospital-specific base year costs per discharge for Medicare patients (updated to the current year) exceeds the PPS rate in addition to the PPS payment rate. Second, an MDH with a caseload that falls by more than 5 percent (due to circumstances beyond its control) may receive payments necessary to fully compensate it for fixed costs. These provisions aim to reduce the risk of financial distress to the hospital, and improve financial health and sustainability of the facility. As an element in the Affordable Care Act, the MDH program will be terminated on October 1, 2012. When this happens, MDHs will revert to being reimbursed under the prospective payment system, which has potentially important implications for the communities served by MDHs.