Big-Time Experience at a Small-Town Hospital

Young cowboy with hat over face laying on bales of hay on the back of an old, red pickup at a ranch.

Dr. John Zelem, a former hospital surgeon-turned-consultant, is scheduled to begin a new a career assignment at a critical access hospital (CAH).

There was a time in my life when my mother and father bought 80 acres of “raw” land in Southern California, a small parcel in a tiny ranching community in the San Bernardino foothills. All of us in the Buck family were 100 percent “city slickers,” as the term implied, in those days.

But the allure of fresh air and wide-open spaces was too alluring for my parents to turn down. So, we moved up. Or rather, we moved down, from all the conveniences of a modern life in Los Angeles to the rustic setting that we called “the Ranch.” Nonetheless, medical care – a hospital with doctors and nurses – was miles away, and the fastest route was over a dirt road (40 miles over a dusty, cratered dirt road). Getting seriously sick or injured in those days was pretty much a life-or-death situation.

Today, healthcare in the United States is not too much better than it was back then.

So, when I learned that Dr. John Zelem, a member of the ICD10monitor editorial board and a panelist on Talk Ten Tuesdays, was accepting a new gig at a critical access hospital (CAH), I was intrigued.

“In my own consulting career, I have only been involved with medium to large hospitals and multi-hospital systems,” Zelem wrote to me in an email. “This new experience will be with a CAH, which is the Centers for Medicare & Medicaid Services (CMS) designation for hospitals with no more than a 25-patient census.”

Zelem explained that the CAH designation is given to eligible rural hospitals by CMS with the express purpose of reducing the financial vulnerability of these facilities, and improving access to healthcare by keeping essential services in these communities. 

“CAHs provide this essential access to high-quality healthcare in rural communities and represent more than two-thirds of all rural hospitals, (making them) vital for ensuring the health of communities that may not have access to larger facilities,” Zelem said.

The founder and president of Streamline Solutions Consulting, Zelem told me that one of the most exciting parts of this venture will be assisting in ensuring the continued success of such a hospital, as CAHs make up approximately 20 percent of all hospitals in the U.S.

When asked about the role he will assume at his new post, Zelem explained that he will be a physician advisor, something that aligns with his consulting business, which is focused on “streamlining” efficiencies and interaction among various departments (such as utilization management, compliance and revenue cycle).

“This will be a physician advisor role, which can involve administrative and clinical revenue cycle roles,” Zelem wrote in his email. “There will be interaction with elements of utilization review, case management, and CDI (clinical documentation integrity). I will also have a chance to work with various physician areas for improving documentation – which, as we know, is so well-needed – and appealing denials. It is important to do everything possible to ensure the survival of these rural healthcare facilities.”

As a news and information service, we have been reporting on the plight of rural hospitals consistently for years, so naturally, I was concerned about the constant rumor I hear that rural hospitals are on the “endangered species list” – so I asked Dr. Zelem for his take on the notion.

“Yes, and here are some of the concerning statistics,” Zelem wrote: “This designation of a critical access hospital, through the Balanced Budget Act of 1997, was in response to over 400 rural hospital closures during the 1980s and early 1990s. Even today, more than 180 rural hospitals have closed since 2005.”

Closures, according to Zelem, were already occurring at an accelerated rate over the last decade, noting that 21 more such facilities have shut down since the start of the COVID-19 pandemic. 

“Close to half of rural hospitals in the United States are now operating at a loss,” Zelem said. “One needs to keep in mind that we have an obligation to provide quality healthcare to all, regardless of location.”

Especially when that location is hard to reach.

Print Friendly, PDF & Email

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering the Two-Midnight Rule: Keys to Navigating Short-Stay Admissions with Confidence

Mastering the Two-Midnight Rule: Keys to Navigating Short-Stay Admissions with Confidence

The CMS Two-Midnight Rule and short-stay audits are here to stay, impacting inpatient and outpatient admissions, ASC procedures, and Medicare Parts C & D. New for 2024, the Two-Midnight Rule applies to Medicare Advantage patients, requiring differentiation between Medicare plans affecting Case Managers, Utilization Review, and operational processes and knowledge of a vital distinction between these patients that influences post-discharge medical reviews and compliance risk. Join Michael G. Calahan for a comprehensive webcast covering federal laws for all admission processes. Gain the knowledge needed to navigate audits effectively and optimize patient access points, personnel, and compliance strategies. Learn Two-Midnight Rule essentials, Medicare Advantage implications, and compliance best practices. Discover operational insights for short-stay admissions, outpatient observation, and the ever-changing Inpatient-Only Listing.

Print Friendly, PDF & Email
September 19, 2023
Secondary Diagnosis Coding: A Deep Dive into Guidelines and Best Practices

Secondary Diagnosis Coding: A Deep Dive into Guidelines and Best Practices

Explore comprehensive guidelines and best practices for secondary diagnosis coding in our illuminating webcast. Delve into the intricacies of accurately assigning secondary diagnosis codes to ensure precise medical documentation. Learn how to navigate complex scenarios and adhere to coding regulations while enhancing coding proficiency. Our expert-led webcast covers essential insights, including documentation requirements, sequencing strategies, and industry updates. Elevate your coding skills and stay current with the latest coding advancements so you can determine the correct DRG assignment to optimize reimbursement, support medical decision-making, and maintain compliance.

Print Friendly, PDF & Email
September 20, 2023
Principal Diagnosis Coding: Mastering Selection and Sequencing

Principal Diagnosis Coding: Mastering Selection and Sequencing

Enhance your inpatient coding precision and revenue with Principal Diagnosis Coding: Mastering Selection and Sequencing. Join our expert-led webcast to conquer the challenges of principal diagnosis selection and sequencing. We’ll decode the intricacies of ICD-10-CM guidelines, equipping you with a clear grasp of the rules and the official UHDDS principal diagnosis definition. Uncover the crucial role of coding conventions, master the sequencing of related conditions, and confidently tackle cases with equally valid principal diagnoses.

Print Friendly, PDF & Email
September 14, 2023
2024 IPPS Summit: Final Rule Update with Expert Insights and Analysis

2024 IPPS Summit: Final Rule Update with Expert Insights and Analysis

Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY24 Inpatient Prospective Payment System (IPPS) Final Rule, including new ICD-10-CM/PCS codes, plus insights, analysis and answers to questions from the country’s most respected subject matter experts.

Print Friendly, PDF & Email
2024 IPPS Summit Day 3: MS-DRG Shifts and NTAPs

2024 IPPS Summit Day 3: MS-DRG Shifts and NTAPs

This third session in our 2024 IPPS Summit will feature a review of FY24 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts

Print Friendly, PDF & Email
August 17, 2023

Trending News