More rural hospitals go emergency only

The ideas and innovators shaping health care

Oct 24, 2023 View in browser   By Daniel Payne, Evan Peng and Erin Schumaker OPERATING ROOM Some hospitals are scaling back services to take advantage of a new federal program. | AP Photo/Chris O'Meara Only 16 rural hospitals have taken Congress up on its offer to reduce their inpatient services and focus on emergency care in exchange for cash. Congress created the rural emergency hospital designation in 2020 to help struggling rural hospitals avoid closure by boosting federal payments if they go emergency-only. The program took effect this year, and 16 have signed up, according to a tracker from the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. They include Harper County Community Hospital in Buffalo, Okla., and Crosbyton Clinic Hospital in Crosbyton, Texas. Most are in the South and in states that haven’t expanded Medicaid coverage. State of play: The new designation was met with trepidation from some rural hospitals wary of such a large change to their services and business model, and relatively few have signed up. But those that have see it as a lifeline — perhaps the only way to stay open. Still other hospitals are on the fence, waiting to see whether their financial health forces a decision and how it works out for those making the change. Some hospital advocates are pressing legislators to tweak the program to make it more attractive to more hospitals. Future financials: The financial prospects for many hospitals have worsened in the past year as pandemic payments from the government dried up. Meanwhile, inflation, including rising labor costs, has affected facilities’ bottom lines, analysts have said. Those problems could be more severe for rural hospitals, which have often had more financial difficulty than their urban peers.   GO INSIDE THE CAPITOL DOME: From the outset, POLITICO has been your eyes and ears on Capitol Hill, providing the most thorough Congress coverage — from political characters and emerging leaders to leadership squabbles and policy nuggets during committee markups and hearings. We're stepping up our game to ensure you’re fully informed on every key detail inside the Capitol Dome, all day, every day. Start your day with Playbook AM, refuel at midday with our Playbook PM halftime report and enrich your evening discussions with Huddle. Plus, stay updated with real-time buzz all day through our brand new Inside Congress Live feature. Learn more and subscribe here.     WELCOME TO FUTURE PULSE Great Smoky Mountains National Park | Shawn Zeller This is where we explore the ideas and innovators shaping health care. Close to half of people with moderate-to-severe depression were in remission after an eight-week course in hot yoga, according to a study by researchers at Massachusetts General Hospital. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Evan Peng at epeng@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Ben Leonard talks with POLITICO health care reporter Robert King, who explains why some state insurance commissioners want Congress to restore their authority to regulate Medicare Advantage marketing. Listen to today’s Pulse Check podcast WORKFORCE A new doctors group aims to bolster independent practices. | AFP via Getty Images Doctors are banding together to protect independent physician-owned practices in the face of widespread consolidation. The American Independent Medical Practice Association is debuting with about 5,000 physician members from about 200 physician-owned practices. It will work to persuade policymakers — and patients — that independent practices can offer better care and more value than those bought by hospitals. “Big hospital chains have increasingly acquired physician practices over the past two decades — and contrary to hospital executives’ promises, that consolidation has not led to better care or lower costs for patients,” said Dr. Paul Berggreen, president of the new association. Battle joined: The new group comes as lawmakers consider legislation to crack down on some billing practices at hospital-owned practices. Representatives and senators have introduced bills that would bar hospital-owned practices from charging Medicare hospital prices for services provided outside of hospital buildings. The Federal Trade Commission is also probing the effects of consolidation — particularly how it might increase costs. In September, the agency sued U.S. Anesthesia Partners, the dominant provider of anesthesia services in Texas, and private equity firm Welsh, Carson, Anderson & Stowe and alleged they’d conspired to drive up costs in the Lone Star State.   DOWNLOAD THE POLITICO APP: Stay in the know with the POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need. DOWNLOAD FOR iOS – DOWNLOAD FOR ANDROID.     WORLD VIEW Mosquitoes carrying Cache Valley virus may pose a greater risk to people than previously known. | AFP via Getty Images A dangerous mosquito-borne disease called Cache Valley virus could be more prevalent in humans in the U.S. and Mexico than previously thought, new research from the CDC reveals. Cache Valley is chiefly a threat to livestock, not humans. But the CDC research, presented in Chicago at the annual meeting of the American Society of Tropical Medicine and Hygiene, suggests cases in people have been missed. Cache Valley was discovered in 1956 in mosquitoes in Utah and has been observed in mosquitoes and mammals throughout parts of the Americas since then. Only seven cases have been documented in humans, all in the U.S. The virus in humans causes flu-like symptoms, but also can progress to a severe neurological condition, including inflammation of the brain. Of the seven documented cases, two were fatal and two caused neurological problems, though three of the four patients had documented chronic conditions that may have contributed. What’s new? Scientists from the CDC recently developed a new test to detect antibodies associated with Cache Valley infection, providing a simpler alternative to diagnose the virus. Until now, diagnosis required working with a live virus in biosecure facilities. Researchers used the new antibody test on 27 patients from Mexico and nine patients from the U.S. with acute febrile illness, a condition characterized by fever and other nonspecific symptoms that have no apparent cause. Ten patients from Mexico and six from the U.S. returned test results indicating potential exposure to Cache Valley. The results indicated that Cache Valley might have caused the illness in at least six of them. What’s next? The new test will enable additional surveillance to determine the true extent of Cache Valley infection and whether the initial findings indicate a growing threat. Even so: The findings haven’t yet undergone the peer review process required to ensure their accuracy before publication.   Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Evan Peng @thepngfile   Follow us

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