Hospital Association of Pennsylvania > Advocacy > Federal Advocacy > Letter to PA Delegation on Rural Health Care Priorities


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Letter to Pennsylvania Congressional Delegation on Rural Health Care Priorities

March 24, 2014

Dear Members of the Pennsylvania Delegation:

On behalf of The Hospital & Healthsystem Association of Pennsylvania and the below listed organizations, I am writing to impress the importance of Medicare policies targeted to support access to care in rural communities. Many of you met with rural hospital leaders on March 6 and had an opportunity to hear about the challenges facing our rural health care providers but also the work they are engaged in to promote better health and better care at lower cost. We appreciate the opportunity to reiterate rural hospital priorities as Congress addresses the sustainable growth rate (SGR).

The Medicare-Dependent Small Rural Hospital (MDH) program and Low-Volume Hospital Adjustment (LV) are set to expire on March 31, 2014. The MDH program is designed to support small rural hospitals that serve a large Medicare population and consequently rely heavily on Medicare payments to sustain hospital operations. The LV hospital adjustment provides a payment adjustment to small rural hospitals that are unable to achieve economies of scale due to a limited number of discharges. The combined impact of these programs for Pennsylvania is more than 21 million dollars annually. Both programs are key factors in the viability of the hospitals they support. We urge you to advocate for the MDH program and LV adjustment be extended for the full duration of whatever SGR legislation moves forward.

In addition to the threat of payment cuts, Critical Access Hospitals (CAHs) are facing regulatory policies that will significantly impact the provision of care. Medicare requires physicians to certify that patients admitted to a CAH will be discharged or transferred to another hospital within 96 hours for the CAH to receive payment for the patient’s services under Medicare Part A. Recent guidance from the Centers for Medicare & Medicaid Services related to the two-midnight admissions policy provides for enforcement of the “condition of payment” which will threaten patients’ access to longer care when needed. We urge you to support H.R. 3991 and S. 2037, the Critical Access Hospital Relief Act, which would remove the 96-hour physician certification requirement as a condition of payment.

Finally, particularly in the context of the SGR package, we remain concerned about the impact of proposed payment cuts targeting rural providers including Sole Community Hospitals and Critical Access Hospitals. We urge you to support federal programs that account for the particular economic challenges facing rural communities and reject arbitrary payment cuts.

Rural hospitals are critical to the patients they serve and the communities they support, but they are also key to the wellbeing of the broader health care delivery system across the commonwealth. We ask for the unified support of the delegation on these key priorities for Pennsylvania.  


Andy Carter
President and Chief Executive Officer
The Hospital & Healthsystem Association of Pennsylvania


Barnes-Kasson County Hospital
Bucktail Medical Center
Clarion Hospital
Cole Memorial Corry Memorial Hospital
Elwood City Hospital
Endless Mountains Health Systems
Fulton County Medical Center
JC Blair Health System
Jersey Shore Hospital
Meyersdale Medical Center
Muncy Valley Hospital
Penn Highlands Healthcare
Pocono Medical Center
Punxsutawney Area Hospital
Schuylkill Medical Center East Norwegian Street
Schuylkill Medical Center South Jackson Street
Somerset Hospital
St. Luke’s Miners Campus
Sunbury Community Hospital
Titusville Area Hospital
Troy Community Hospital
Tyler Memorial Hospital
Tyrone Hospital
Wayne Memorial Hospital   

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