Tester, Hoeven team up to extend rural health care program

Last week, U.S. Senators Jon Tester (D-Mont.) and John Hoeven (R-N.D.) introduced legislation to extend the Frontier Community Health Integration Project (FCHIP) until August 2024, a program in ten facilities across Montana, Nevada and North Dakota that develops and tests health care delivery and reimbursement models for Critical Access Hospitals in hyper-rural counties. The project began in August 2016, and expired in July 2019.

Dahl Memorial Healthcare Association in Ekalaka, McCone County Health Center in Circle and Roosevelt Medical Center in Culbertson are all FCHIP participants.

“In a medical emergency, having a health care facility in your community can be the difference between life and death for folks in rural America,” said Tester. “Montana’s Critical Access Hospitals are vital to making sure folks in frontier towns get the care they need, and we’ve got to extend this project so these facilities have every tool in the toolbox to get the job done.”

“Critical Access Hospitals play a key role in preserving and enhancing the quality of life in our rural communities,” said Hoeven. “By extending this demonstration project, we can enable rural health care providers, including the three North Dakota CAHs that participated in the program, to continue strengthening the care available to Medicare beneficiaries in their regions while also providing cost savings to the federal government.”

Critical Access Hospitals are hubs for health in the most sparsely populated areas in the country, and because of low patient volumes and geographic isolation, these health centers struggle to maintain services under traditional Medicare payment rules. A report last month showed that one in four rural hospitals are vulnerable to closure. In response to these challenges, FCHIP aims to test new models of health care delivery in frontier areas and to support Critical Access Hospitals that often experience provider and staff shortages, low patient volumes and tight operating budgets that jeopardize their fiscal sustainability.

Specifically, FCHIP provides a waiver to Medicare payment rules that allows hospitals to increase the number of available Skilled Nursing Facility or Nursing Facility beds, cover the costs required to facilitate and grow telehealth programs, and pay the expenses of providing ambulance services at each participating Critical Access Hospital.

Based on an interim report to Congress in 2018, FCHIP interventions demonstrated improved access and enhanced capability to provide services to the communities. However, given the low patient volume of these rural health care facilities, the project needs more data. Tester and Hoeven’s FCHIP Extension Act would allow the program to collect more information in order to accurately and fully evaluate budget neutrality, effects on care delivery and improvement of access to services in frontier communities.

“The Frontier Community Health Integration Project (FCHIP) tests a new reimbursement model for critical access hospitals serving our nation’s smallest communities and builds on the nationally recognized critical access hospital program that was pioneered in Montana,” said Rich Rasmussen, President of the Montana Hospital Association. “When programs like EMS are crumbling in frontier communities, the FCHIP program has strengthened hospital based ambulance services, while demonstrating savings to CMS. We applaud Senators Tester and Hoeven for their leadership in advocating for our country’s frontier communities.”

Additionally, the CEOs of the participating Montana Critical Access Hospitals sent letters to CMS last year strongly supporting the extension of FCHIP.

“Without the enhanced reimbursement associated with the FCHIP telehealth wavier for the originating site fee, continuation and growth of our telehealth program will not be financially sustainable,” wrote Ryan Tooke, CEO of Dahl Memorial Healthcare Association. “…This valuable service significantly improves our patient population’s access to care. This population, often very elderly in nature and frequently lacking in social or family support, would otherwise be required to travel, at times, over 200 miles to access their specialty provider.”

“MCHC’s goal is to help shape the delivery of healthcare services in frontier communities, demonstrate the importance of frontier facilities in serving remote communities, and show that at the same time we can generate cost savings for the Medicare program,” wrote Nancy Hansen Rosaaen, CEO of McCone County Health Center.

“Please give serious consideration to making these program changes for very low volume, frontier [community access hospitals] permanent,” wrote Audrey Stromberg, Administrator of Roosevelt Medical Clinic. “We walk a very fine line every year to keep our doors open.”