The Role of CAHs in Rural Trauma Care

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The Role of CAHs in Rural Trauma Care Tami
Lichtenberg Rural Health Resource CenterDuluth,
Minnesota
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What is a CAH?

• 25 Acute/Swing Beds
• Observation Beds Count
• 96 hour Average Length of Stay
• Receive 101 of Reasonable Cost for Medicare
• Can have 10 bed Distinct Part Unit (Rehab or
  Pysch)
• Must make ER services available 24/7

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In the Beginning

• Medical Assistance Facility (MAF)
• Demonstration Project in Montana 1987
• Rural Primary Care Hospital (RPCH) Project
• Essential Access Community Hospital (EACH)

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Locations of Critical Access Hospitals
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Trauma System Agenda for the Future

• Rural Hospitals are the port of entry for many
  patients and they should have consistent high
  standards
• This is an area that needs considerable
  attention, resources and support in order to
  reduce the disproportionately high rural death
  rate.

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Visions from the Trauma System Agenda for Future

• Most facilities, whether small community
  hospitals or large tertiary care centers will
  have a designated role to play in the trauma
  system.
• Each participating facilitys available resources
  will be catalogued and capabilities defined to
  facilitate management/movement decisions.
• Innovative treatment methods will be explored,
  including utilization of mobile units for rural
  areas.
• Critical Access Hospitals will be better
  integrated with EMS systems.

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CAHs can Help Strengthen Emergency Medical
Services (EMS)

• Training initiatives
• - Clinical training
• Management
• Equipment
• Planning and Trauma Protocols
• Encouraging local collaboration
• Enhancing data collection and reporting
• Workforce
• Medical Direction
• Reporting to the State Trauma Database
• CALS

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CAHs As Safety Net Providers

• Three quarters of hospitals report difficulty
  finding specialists to take emergency and trauma
  calls.
• CAHs are called upon to provide life
  saving\sustaining emergency care when transfer is
  not an option or delayed
• Much more than a band-aid station (story)
• Fact sheet The Future of Emergency Care Key
  Findings and Recommendations

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Trauma Prevention

• CAHs as a hub provider in the continuum of care
  are uniquely positioned to play a major role in
  trauma prevention in rural communities.
• Saving the teenagers of Baudette, MN

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The Medicare Rural Hospital Flexibility (Flex)
Program

• Established by the Balanced Budget Act (BBA)
• - 1997
• Balanced Budget Refinement Act (BBRA)
• - 1999
• Benefits Improvement and Protection Act (BIPA)
• - 2000

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Key Components of the Flex Program

• CAH Designation/Program Development
• Network Development
• EMS Integration
• Quality/Performance Improvement

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How are Flex Program Dollars Providing Linkages

• Over 2 million targeted for EMS in 2004
• Activities include
• Rural trauma system development
• Eight states worked to link aspects of their
  statewide trauma activities.
• Activity focused on linking rural communities
  with existing state-wide systems
• Linking medical direction with pre-hospital
  providers

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Flex Program Linkages Contd

• 3.66 million for EMS integration in 2005
• Activities include
• Development of Clinical protocols to guide
  patients transfers and the delivery of trauma
  services
• EMS specific performance and quality improvements
  programs
• EMS Needs Assessments

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Tami Lichtenberg Program Manager, Rural Health
Resource Center 600 E. Superior St., Suite
404 Duluth, MN 55802 218-727-9390, ext.
230 tlichten_at_ruralcenter.org