As I understand it, HRH is now a "critical access" hospital. They made this change to get bigger reimbursements for Medicare and Medicade. What it seems to mean is they are even more dedicated to funneling folks to Billings.

They are only permitted to keep a patient 72 hours. Even if the patient only needs to stay an extra day and could be cared for here, they have to sent away. No matter what. Three days and you are off to Billings.

Will this improve their bottom line? Maybe. Will this improve medical care in Miles City? I can't see how.

Anyone understand this better and can explain how it will be good for Miles Citians to be forced to travel hundreds of miles round trip when they could be treated at home under the old system?

I'm not sure whether it's 72 hours or not, but I think that's supposed to be an average, not a cutoff.

I'm pretty sure they can keep people longer than that, so long as the average length of stay is less.

From what I remember the big limitation of a CAH is in the census. 25 beds or less I think for direct inpatient care. I doubt they hit that number very often nowadays.

Where did you hear about the 72 hours thing? Not saying it's wrong, but I've been googling about Critical Access Hospitals and I can't find any mention of such a limitation.

Never mind I found it:

http://www.raconline.org/...cahfaq.php

Question: Is there a limit on the length of stay for patients at CAHs?

Answer: CAHs must maintain an annual average length of stay of 96 hours or less for their acute care patients. There is no length of stay limit for swing bed patients.

Question: How many beds are allowed?

Answer: CAHs may have a maximum of 25 acute care inpatient beds. For CAHs with swing bed agreements, any of its beds may be used for either inpatient acute care or swing bed services. Any hospital-type bed located in or adjacent to any location where the bed could be used for inpatient care counts toward the 25 bed limit.

Certain beds do not count toward the 25 bed limit, including examination or procedure beds, stretchers, operating room tables, and others. For a complete list of beds that do not count toward the 25 bed limit, please see Section C-0211, §485.620(a) Standard: Number of Beds: Interpretive Guidelines of the CMS State Operations Manual: Appendix W.

[This message has been edited by Levi Forman (7/21/2010)]

Don't worry folks Ron Webb will save us all.

To say the least HRHC has a tough road ahead if it plans to survive.

They have lost many good employees in the past 6 months or so & I would bet they are going to loose more in the next 6 months.

I was told 72 hours by an HRH employee but that may be a simplification.

Yes, more patient caregivers are going soon but I'm sure another administrator or two will solve the problem.

Maybe people should get ahold of someone that has all the insight on critical access in the hospital instead of hear say and I think so's. I work at the hospital and we have been explained to many times what it means to us. Please talk to someone knowledgable on the subject before shooting off about people having to go to
Billings. It just confuses people. Thanks.

Well said Dixie. People in our community need to quit bad mouthing our hospital and be more supportive. They are only doing what they need to do to survive in this time of Obama health care. A lot of hospitals are having to make major changes in order to continue good health care in their community. Come on Miles City lets be pround of our hospital and be glad we have it. People just love to look at the negative and blow up the story rather than getting the facts and looking for the positive. I guess that is small town mentality.

junebug wrote:

They are only doing what they need to do to survive in this time of Obama health care.

I keep thinking the last thread, or post or comment was the most stupid of all, however, I continue to be proven wrong.

So, changing the system to provide health care to the uninsured is the cause of the financial problems that have been plaguing HRH for the last several years. Who'd a thunk?

When you click on Junebug's profile thingy (name) it takes me to posts under the name Dan Benoit. I wonder if this is a system glitch, or if at one point people were able to change their profile names??

I'd rather not go to the hospital here (unless it's a need thing obviously). I was visiting here when I found out I was pregnant, and I went in at about 5 weeks gestational age. I had an doctor verify, and then she wanted to do some ultrasounds. At 5 weeks 3 days, she determined that my baby didn't have a heartbeat, and was an non-viable pregnancy. She scheduled me for a D&C (basically, it's an abortion... but not really because the baby isn't alive.) I was only 16 at the time and agreed. We set up the appointment for 3 days later. I would have been 5weeks 6 days at that appointment.

I didn't go to that appointment because I had a plane ticket back for the next day anyway. I went home and saw my gynecologist, who told me that their isn't a way to detect a heartbeat on an external ultrasound till around 8-12 weeks. We scheduled an appointment, and at 8wks 3 days I heard my daughter's heartbeat. She is 2 and a half today.

I don't know why that "doctor" was so quick to assume my daughter was dead. I'm so glad I went home and had great medical care through my pregnancy. Loma Linda University Medical Clinic FTW!

Seriously, the critical access plan was discussed on Milescity.com some time ago and has been in the works since l o n g before any effort at healthcare reform. Blaming people who weren't involved doesn't solve any problems.

I'm still not sure I grasp WHAT this status change means? How will this effect our healthcare? Will it change anything? Improve anything? Make anything worse?

I know that health care providers are leaving HRH for various reasons and that disturbs me. I know they are having financial problems and I gather this change in status should improve that but I don't understand why.

Twenty-five years ago, the VA hospital here underwent a "change of mission." We were assured up one side and down the other that the hospital would stay. We all know how that turned out. Mind you, that was the bastion of socialized medicine in this country and HRH is private but if HRH goes under, then what?

I've had very good care the last times I have been there but I know my mother was unimpressed with her last stay and I've heard other people complain that where the patients are concerned, the care is not what it could be because of a shortage of CNAs and nurses. Will this status change improve that problem by putting more caregivers on the floor or will it simply lead to more administrators.

Smiley--I am stunned to hear someone wanted to do a D&C at HRH and could even get approval for it. They are so careful to avoid any hint of abortion that I had to have a pregnancy test before my gall bladder surgery and, if anyone had read my medical records, they would have known they were wasting their time. I told them to notify the Pope if it came back positive because it would take and act of God to get me in that condition.

Smiley wrote:

When you click on Junebug's profile thingy (name) it takes me to posts under the name Dan Benoit. I wonder if this is a system glitch, or if at one point people were able to change their profile names??

People can request their username to be changed, and most likely I'll update it, however it doesn't change any already existing posts.

A D & C is standard procedure in a case such as Smiley's although most physicians will suggest that the patient wait to see if her body rids itself of the non-viable tissue naturally. Sometimes it happens, sometimes not and a D & C is necessary to prevent infection. I'm glad she had the chance to get a second opinion. Could this be a case of a physician with an "agenda" given Smiley's youth at the time or just incompetence?

I will no longer be using miles city.com I would rather not be associated with people such as you who like to be so judgemental. A person has a right to state their opinion as long as it matches yours, otherwise look out you will get bashed. You people know nothing about what you are talking about. Get your facts straight. If you have questions, as a board member or better yet call the hospital and ask questions. I feel so sorry for all of you. You must have too much time on your hands to spend it looking up a persons name. I have learned my lesson from all of you. Remember what goes around comes around. What a waste of my time. So long

[This message has been edited by junebug (7/21/2010)]

[This message has been edited by junebug (7/21/2010)]

Actually Junebug, no one has a right to their opinion on this forum... Unless The Webmaster agrees with it or doesn't care. If he doesn't agree, you find yourself in the purgatory quickly.

Why doesn't the hospital be proactive in this and actually put out a news story with all the correct info? Stop the speculation and the rumor and give us the facts. What a concept!

You are correct, CAHs are limited to only 25 inpatient beds. They may have observation beds (not a part of the 25) that are limited to patients being there less than 24 hours. If anyone requests further information on CAHs please contact DPHHS Cerification Bureau - 406-444-2099. They will have answers to your questions.

http://www.milescitystar....php#story3

Sorry you feel so slighted Junebug. But you did claim that problems of today are the result of Obama's healthcare. To my knowledge, one very small part of Obama's healthcare plan has taken effect as of now. And that took place just last week. There is not a single hospital in this country suffering in any way because of Obama's healthcare plan. Things do happen quickly these days, but your comment was an epic stretch of reality.

Well, people, I hope you are pleased with yourselves for running poor junebug off.

WHERE IS THE CIVILITY ON THE INTERNETS THESE DAYS?????

REFUDIATE!!!

What is the internet coming to when a anonymous poster can make a ridiculous claim and get called on it! Why, I never.

Well, Ammorette since you're the one that started this thread, I hope you read Monday night's article in the Star. Next time get ALL the information before you start being so overly critical

Well said bh!!!

I did. And I got the answers I was seeking. I'm still nervous but I'm more hopeful that this won't lead to a decline in services.