Money or patients?

In a move that could generate $1.4 million in new money while limiting the number of patients, officials at Whidbey General Hospital are again considering obtaining a critical access hospital designation.

At their Jan. 13 board meeting, the hospital’s board of directors requested updated information on the designation, which would increase the amount of reimbursements the hospital receives for Medicare and Medicaid patients.

The critical access designation is a federal program designed to help rural hospitals overcome declining reimbursement rates. In order to qualify, a hospital must show that it meets a set of criteria. According to the Washington State Department of Health’s Web site, those criteria include:

l No more than 25 acute care patients at any one time.

l At least 35 miles from the another hospital, or be classified as a “necessary provider.”

l Maintain an average length of stay below 96 hours (four days).

l Can staff with physician’s assistants or an advanced registered nurse practitioner, instead of a physician.

l Must maintain a 24-hour nursing staff.

Hospital CEO Scott Rhine said that the hospital easily meets the requirements, but administrators previously worried about maintaining only 25 beds.

Hospital officials abandoned seeking the critical access designation last June after it was thought that the hospital’s admissions rate was too high.

“At the time we were seriously looking at it, we were running at quite a high census level,” said Doug Bishop, the hospital’s chief financial officer. “If that continued, it would cause a lot of diverts.” Diverts occur when patients are sent to other hospitals.

According to hospital census information, it admitted 2,279 inpatients last year. Those patients stayed for approximately 3.13 days each, which works out to an average of 19.5 patients per day. In 2003, the number was approximately the same. The hospital admitted 2,268 inpatients that year. In 2002, the number was slightly higher at 2,307.

Chief Information Officer Tom Tomasino said that the critical access designation would help the hospital recoup a growing amount of bad debt.

According to its 2005 budget, the hospital is budgeting for a 25 percent increase in charity care, meaning that it will provide approximately $950,000 in charity care next year. In addition, the amount of bad debt is expected to increase 10.5 percent to $3.3 million in 2005.

“Based upon our 2003 patient mix, (critical access designation) could mean an additional $1.7 million in new money and that will grow for 2004,” Tomasino said.

A change of course

Judy Moore, chief nurse executive for the hospital, said that the main reason the hospital stalled at enrolling for the program in June was the fear of having to divert patients to other facilities.

The hospital administrators were using a census trend from a short, limited time frame. During the last quarter of 2003 and the first quarter of 2004, the hospital saw a spike in admissions.

“We looked at more data to ease our concerns over diversion,” Moore said. “One of the things we learned is that those diversion numbers last year were the worst-case scenario.”

The hospital is licensed to maintain 51 beds, but usually only has 46 available, Bishop said. And not all of those are filled with inpatients. Under critical access, a maximum of 25 inpatients are allowed at any one time. This does not mean that the extra 19 beds will go to waste, Moore said.

The hospital can still admit any number of patients for observation, which is different than inpatient admission. Moore said that a higher number of patients are coming in for outpatient services, instead of the extended hospital stays that were common in the past.

“In the worst-case scenarios, up to 20 patients per month would be diverted,” Moore said. “That is the most sobering part for us — being honest about the number of people we would be sending away.”

But Rhine said that the hospital’s inpatient growth has been flat over the last decade. The hospital’s outpatient services, however, have been rapidly growing.

“Technology, from a provider and pharmaceutical standpoint, continues to emphasize what can we do to get patients well without having them stay in the hospital,” Rhine said.

Rhine said that a reevaluation of the hospital’s admissions revealed that Whidbey’s demographics support the growth of the outpatient services.

“Those statistics show a relatively flat inpatient growth,” Rhine said. “Outpatient will grow, but inpatient will remain stable.”

Rhine has set a preliminary deadline for a final recommendation to be in place by the end of March. The hospital must then be evaluated by the state for admission into the program. Admission into the program ends on Dec. 31 of this year.

You can reach News-Times reporter Eric Berto at

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