On August 3, 2023, RMCHCS achieved certification as a Critical Access Hospital (CAH), a designation awarded to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS). The CAH program is designed to reduce the financial vulnerability of small rural hospitals while enhancing access to healthcare by maintaining essential services in rural communities. CAHs benefit from cost-based reimbursement for Medicare services.

RMCHCS could not be billed as a CAH facility until January 2024 due to delays in obtaining a PTAN number from CMS. Now that we have the required billing number, we are actively working to update our CAH billing.

Another benefit of our recent CAH designation is the ability to offer “Swing Bed” services. What is a Swing Bed? A Swing Bed in our inpatient unit can be used for acute or post-acute care equivalent to skilled nursing facility (SNF) level care. This flexibility enables RMCHCS to better meet our patients’ acute or SNF-level needs.

To optimize services under the new CAH care delivery model, RMCHCS restructured and relocated the Critical Care Services-Intensive Care Unit (CCS/ICU) in March 2024. The unit was renamed the Advanced Care Unit (ACU) and combined with the Medical-Surgical Unit (MSU). Some have expressed concerns about the impact of closing the CCS/ICU. However, while the name and location have changed, the ACU retains the same number of beds—four—as were previously staffed. Furthermore, this conversion minimally affects the types of patients we can treat or the services we provide. The ACU is consistent with services typically offered in a “step-down unit,” which closely aligns with the functionality of our previous ICU. We will continue to care for patients requiring close monitoring and will have greater flexibility in assigning patients to either a medical-surgical bed or an ACU bed.

Our physicians and nurses continue to possess ICU specialties, certifications, and skill sets to care for severe but specific medical conditions. They will utilize critical care equipment such as monitors and ventilators and arrange transfers to higher levels of care when necessary. In a CAH, the defining characteristic of an ACU is the nurse-to-patient ratio, not the technology, equipment, or training of ICU nurses. These services are vital to the hospital and the community. Over the past few months, we have observed a decline in CCS/ICU census and acuity since the COVID-19 pandemic. As a result, transitioning the CCS/ICU to the ACU was a logical step. Understanding this change will help you navigate the best possible care for yourself or your loved ones.