"There are also the rigors of complying with the ACA and (disproportionate share) payment reductions. Critical access hospitals have their own threats. The president is probably going to propose in his budget again to reduce cost-based reimbursement for those hospitals, and maybe the elimination of some of them within a certain mileage of another facility."
Elehwany says she is fearful that the budget cuts combined with the mandates will recreate the environment in the late 1980s and early 1990s when federal government shifted to the Prospective Payment System and scores of rural hospitals across the nation shuttered.
"That is when Congress intervened and said ‘these are critical points of care for rural patients. We need to make sure that they keep their doors open,'" Elehwany says. "That is when they intervened and created unique payments for rural providers. We are trying to gently remind Congress why these payments were needed in the first place."
Of course, there is still time. Elehwany insists she isn't surrendering on sequestration and she is urging every rural hospital executive and to contact their senators and congressmen and speak with their local news media make sure they understand the affect that the sequestration cuts would have on providing care for their communities, constituents and neighbors.
"We also remind Congress that the rural population is vulnerable," she says. "They are proportionately older, poorer and sicker and less likely to be insured—just about every negative. We are doing everything we can to see if we can protect them. We know it's a long shot but we have to try."