Big-Time Experience at a Small-Town Hospital

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.