Enacted by Congress in 1987, MDH status requires that hospitals be in a rural area, have no more than 100 beds, and show that Medicare patients represent at least 60% of their inpatient days or discharges.
A study done for NRHA found that in 2009 MDHs operated at a negative 4% margin on average. Without hospital-specific and transitional outpatient payments, the study estimated that those MDH margins would have fallen to negative 12.6%.
Elehwany credits rural hospital advocates from across the nation with generating much of the support for SB2620 when they rallied at the Capitol in late July to push for the bill.
Unfortunately, with the fiscal pressures and partisanship facing Congress, Elehwany is not optimistic about a long-term fix for MDH. Like the sustainable growth rate formula, she believes that MDH status is something that rural providers may have to fight for every year.