SMH Officially Designated Critical Access
Story by Alex Kielar of the Breckenridge American
Stephens Memorial Hospital has officially been designated a critical access hospital (CAH) as it makes the conversion from a Prospective Payment System (PPS) facility. To fully complete the transition, SMH will have to redo some of its reimbursement rates. Once the hospital knows what their rates for CAH will be, it will prompt them to start looking towards negotiating, as they will know what numbers they will need to work towards.
CEO Gena Speer made the announcement of the hospital receiving that designation at the latest SMH board of directors meeting Thursday, June 28.
In receiving the critical access designation, the hospital board also voted to join the Texas Organization of Rural and Community Hospitals (TORCH) Clinically Integrated Network. Speer said that it is something that came up about two years ago, and there are about 37 hospitals and 70 clinics in it now.
“Basically, the point in it right now is to be able to negotiate, for us as a group, on some payer contracts, specifically the value-based purchasing side of that. So anything that would give us supplemental payment or incentive payment for quality metrics, that they set for our patient population in the clinic,” Speer said. “It is $100 a year to join. There is some work involved, but they do help with providing tools to meet those metrics and things like that. It’s just really a way to kind of bring this together for more power in those negotiations.”
Speer added that this program would be specific to the clinic more than anything, but that some programs might flow over with the hospital.
A program that the hospital also became eligible for as a critical access is the 340B Program, which, in simple terms, qualifies SMH to purchase medications at a very discounted rate. For the program, the hospital will partner with W5 Pharmacy to dispense those medications, based on prescriptions that come from their contractor or employee providers.
“So it helps the patients afford their medications. We take and dispense them through W5, we pay a company to manage it,” Speer said. “They provide software, inventory management, program management and all of that, based on the prescription. So it is per prescription and per transaction.”
The company that the hospital is paying to manage the prescription program is PharmaCare Services, which Speer said they feel very comfortable with.
“You have to be careful with these kinds of companies, because some of them get into it for the wrong reasons and don’t always follow the rules exactly, and then it comes back on us,” Speer said. “I have basically zero fear of that with this company.”
The board voted to move forward with discussions regarding this program and they will have a formal contract to review in July.