CHANGES PROPOSED IN the Critical Access Hospital program threaten the participation by many of New England’s rural hospitals, including Redington-Fairview General Hospital in Skowhegan.

The proposals were included in a federal report released on Aug. 15 by the Office of the Inspector General of the Department of Health and Human Services.

This program, which has been in place for nearly two decades, is designed to stabilize small rural hospitals and reduce their risk of closure. It improves the financial viability and quality of key services. A designation of Critical Access Hospital provides qualifying rural hospitals with volume-appropriate Medicare reimbursement along with other regulatory provisions and technical assistance resources.

States now have the authority to determine which of their rural hospitals are “necessary providers.”

The proposed changes would replace that with a simple drive-time-distance test between hospitals, which does not take into account the types of services available at each hospital.

Most of the current Critical Access Hospitals across New England could lose this vital program, potentially affecting the lives of people who live in these communities.

Critical Access Hospitals are safety net providers for rural communities and the hubs around which local systems of care are organized.

The loss of a hospital in a rural area, therefore, will affect the economic health of the community and residents’ access to primary, emergency and acute care services.

Critical Access Hospitals serve a disproportionate share of elderly and low-income individuals, populations most affected by the burden of travel to distant hospitals.

The proposed changes coincide with rising concerns about recent growth in rural hospital closures. Many Critical Access Hospitals already face ongoing financial and operational challenges because of their rural location, workforce shortages, struggling economies and constrained resources.

Critical Access Hospital designation helps them meet these challenges while serving their communities.

The New England Rural Health Round Table works closely with Critical Access Hospitals by supporting training initiatives, quality and performance improvement programs, and networking opportunities. We know their commitment to patients and providing high-quality, cost-effective care. They care for our families and vulnerable populations, employ our neighbors and provide essential services.

Faced with the need to prepare for health reform implementation, the challenges posed by slow recovery of rural economies and a new round of rural hospital closures, we question the wisdom of overriding state determination of necessary provider status for program participation.

The Critical Access Hospital program, while modest compared to other federal programs, is crucial to rural communities as it successfully fulfills its mission of ensuring access to care and protecting the health of rural residents.

Julie Arel is executive director of the New England Rural Health Round Table.

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