Dickinson hospital funding comes through

DICKINSON - A door is now open for Dickinson's St. Joseph's Hospital and Health Center to seek additional revenue over the next two years.

Thanks to efforts by the state's congressional delegation and Gov. John Hoeven's office, the Center for Medicare and Medicaid Services reopened a demonstration project that allows hospitals to receive cost-based reimbursement for certain hospital inpatient services.

April Bishop, St. Joe's vice president for Patient Care Services, said Friday afternoon she was informed of the development Thursday at 4:30 p.m. She said the Rural Community Hospital Program reopened at midnight Thursday.

In a joint press release from Sen. Kent Conrad, D-N.D., Sen. Byron Dorgan, D-N.D., and Rep. Earl Pomeroy, D-N.D., CMS Administrator Keery Weems notified them of CMS' decision to resume the demonstration program on Wednesday.

Conrad organized a visit by Weems and the state congressional delegation to Dickinson this past Dec. 10 to visit with hospital officials and local community members about the financial challenges at the Dickinson hospital. St. Joe's continues to seek ways to recover from $13.2 million in operational losses from fiscal 2002 to the end of the past fiscal year this past June 30.

Bishop said Friday the reopened Rural Community Hospital Program is specifically for hospitals that do not qualify for a critical access designation from CMS. The critical access designation provides higher CMS reimbursements to rural health care facilities.

St. Joe's does not qualify for this designation, however, because it is located 25 miles from the Richardton hospital, which already has the critical access designation. CMS rules do not allow critical access facilities to be located within 35 miles of each other. Some estimates have the critical access designation providing an additional $3 million to $4 million a year to St. Joe's if it is able to get the designation.

One option immediately pursued after the December visit here was seeing if the governor's office could waive the moratorium on new long-term beds in the state. One idea is to convert the Richardton facility into a long-term care operation to provide it with an adequate revenue stream to continue.

It was discovered, however, that Hoeven does not have the authority to waive the existing state moratorium. The moratorium on adding new long-term beds in the state was created by the state Legislature, which also would have to act to lift the moratorium.

The idea of reopening the CMS demonstration project also was mentioned during the December visit here, as CMS officials stated having St. Joe's participate in that program could represent an additional $1.3 million in additional Medicare reimbursements over two years.

In reviewing some of the eligibility requirements for the program, Bishop said the facility has to be in a rural area, has to have fewer than 51 acute beds and has to have 24-hour emergency services. Nine hospitals across the country are currently participating in the program, including facilities in Havre, Mont., and Miles City, Mont., and Spearfish, S.D., Bishop said.

The program will provide payment for reasonable costs for inpatient services, with the exception of psychiatric or rehabilitation, she added.

"We have to download the application. It really looks like a narrative application," Bishop said, and then submit it for CMS approval.

Bishop understands the hospital has 45 days in which to submit the application to CMS.

"It is only open for a short period of time," she said. "It's a step in the right direction. It doesn't get us all the way there."

"This new designation is a critical first step toward repairing and securing the financial health of St. Joseph's Hospital," the delegation said in its joint press release Friday. "While our work is far from complete, this latest development is good news for the entire Dickinson community and will allow the caregivers at St. Joseph's to go about doing what they do best - providing quality health care at a reasonable cost."

Hospital board of directors President Nancy Johnson said the facility still needs to apply for the program, but the likelihood of getting approval is pretty strong.

"We've had a lot of people in our camp helping us out. Not only the congressional delegation, but also the governor's office and others," she said.

A press release from Hoeven's office Friday states he spoke last month with U.S. Health and Human Services Secretary Mike Leavitt and Weems to request a waiver allowing St. Joe's to obtain critical access designation, as well as requesting the reopening of the demonstration project.

"This is good news for St. Joseph's Hospital and the community of Dickinson in the short term, but we remain focused on the long-term solution that addresses the needs of both Dickinson and Richardton," Hoeven is quoted as saying in Friday's press release. "We will continue to work on securing a waiver for critical access status for St. Joseph's, which will increase its reimbursement rates and strengthen its financial situation over the long term."

Johnson acknowledged the St. Joe's board recently met with a portion of the Richardton hospital board to discuss options to help make both facilities financially stable in the long term.

"I know people would like to see both of the boards work together to resolve this. I'm hopeful we're moving down that path," Johnson said.