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CMS revokes Ohio hospital's Medicare funding over low patient volume


A small Ohio hospital is pushing the CMS to resurrect its ability to care for Medicare and Medicaid patients after the agency revoked its funding because the facility doesn’t serve enough patients.

The Medical Center at Elizabeth Place, a 12-bed hospital in Dayton, asked the CMS to resume Medicare and Medicaid payments that were terminated on Jan. 18. Federal lawmakers from Ohio are also pushing the agency to resume payments and give the facility an extension to meet agency requirements. It’s the latest facility to face termination due to regulatory guidance the CMS released in fall 2017.

Hospital officials said during a news conference Monday that the facility was no longer be covered by Medicare and Medicaid as of Jan. 18.

The termination notice had “nothing to do with quality or the care that we render or the community for that matter,” CEO Stephanie Johnson said during a news conference Monday. “We are still open for business, but Medicare and Medicaid comprises about 60% of our patient volume.”

If Elizabeth Place doesn’t receive an extension from the CMS, the small hospital could have to close, Johnson said. The hospital serves inner-city Dayton residents and employs nearly 100 healthcare workers.

The hospital said the termination is based on a change the CMS made in 2017 that alters the definition of hospital. The CMS said in a September 2017 guidance that a hospital must have a minimum number of patients in the facility each day for a certain duration. An average length of an inpatient stay is at least two midnights, and a hospital must have an average volume of two patients, according to the guidance.

Elizabeth Place said that the termination notice originally received last November was “surprising and completely unexpected.”

“This interpretation appears to contradict what CMS otherwise asks facilities to do with regard to improving outcomes and lowering the cost of care,” said Dr. John Fleishman, a member of the hospital’s board, in a statement.

Johnson added that Medicare terminated participation because “we were unable to demonstrate that we could meet the average daily census and average length of stay guidelines.”

The CMS initially planned on terminating the hospital’s funding on Dec. 18, but that was delayed until Jan. 18.

The CMS considers other factors when determining the patient volume, including that patients would lose access to hospital care.

Johnson is asking the CMS for a four- to six-month to meet the requirements.

The hospital will continue to be reimbursed by Medicare and Medicaid for services rendered to patients prior to Jan. 18.

Ohio congressional members are calling for an extension.

“This medical center would have an ability, if they had sufficient notice, to change the manner in which they deliver care,” said Rep. Mike Turner (R-Ohio), whose district includes Dayton, during the news conference.

Sens. Sherrod Brown (D-Ohio) and Rob Portman (R-Ohio) joined Turner to write to CMS calling for an extension.

The CMS told Modern Healthcare that the hospital can reapply for Medicare coverage after the termination or request an appeal. Another option is to become an ambulatory surgical center, but Johnson said that Elizabeth Place should remain a hospital.

Elizabeth Place is one of two hospitals to face Medicare termination for low inpatient admissions.

The other hospital is Blue Valley Hospital in Overland Park, Kan., which received a termination notice in June 2018.

The hospital sued the Trump administration over the termination. The hospital wanted to continue to receive Medicare payments while the lawsuit made its way through the federal courts but a federal judge rejected the request in June.

The case is now before the 10th U.S. Circuit Court of Appeals.

Johnson told Modern Healthcare that the hospital is not looking to sue over the issue.

“We hope to be able to work with CMS and have requested that they provide us with a four- to six-month extension so that we can continue to care for that patient population and make minor operational changes allowing us to comply with the census guidelines,” she said.