Category Archives: Critical Access Hospitals

Study Finds Most Successful Hospitals are Nonprofits

An article recently published in “Health Affairs” has identified that seven of the ten most profitable acute care hospitals in the United States are not-for-profit organizations. The data examined was retrieved from Medicare Cost Reports and Final Rule Data, and analysis considered the 2013 net income from patient care services per adjusted discharge.

According to the study, ” Forty-five percent of hospitals were profitable, with 2.5 percent earning more than $2,475 per adjusted discharge. The ten most profitable hospitals, seven of which were nonprofit, each earned more than $163 million in total profits from patient care services.” (Bai G. Anderson G.) Caring for patients was a net loss for 55% of hospitals in 2013. Roughly one-third of hospitals which earned a profit made between $1 and $1,000 per patient discharged. Only 12% of hospitals fared better, at $1,000+ per patient discharged.

Study co-author Ge Bai believes that it is important to understand which hospitals are profitable and to what extent they are affected by various public policies. Bai believes that it is up to the general public to monitor hospital consolidation, and to consider its impact on operating expenses and insurance negotiating power.

Mayor Laurel Prussing of Urbana, IL. discussed the phenomenon in an article published in the Associated Press. Urbana lost 11% of its assessed tax value, $6.5 million annualy, when the Carle Foundation Hospital in her city was no longer responsible for property taxes. “We need to question this whole idea of what not-for-profit means,” Prussing said. “This is a highly profitable business that manages to not pay taxes.”

Others aren’t so sure that losing money should be a prerequisite to earning nonprofit status. Danny Chun of the Illinois Hospital Association makes the case that increased spending power tends to directly benefit future patients and the community at large. He claims that income earned each year is reinvested in ” the latest technology, newer equipment, modern facilities, highly-trained staff and other programs that ensure access to quality health care services and benefit the health of their community.”

One thing is for sure: when hospital care makes up almost one-third of national health care spending, nearing $1 trillion, the debate about the relationship between nonprofit hospitals and profit margins will continue to be a hot topic.


Ge Bai, Gerard F. Anderson Health Aff May 2016 vol. 35 no. 5 889-897 doi: 10.1377/hlthaff.2015.1193

Johnson, Carla “Study: 7 of 10 most profitable US hospitals are nonprofitsAssociated Press, May 2nd, 2016./sup>

National Sexual Assault TeleNursing Center Pilot Project – Office for Victims of Crime

KS97457(200x137)Massachusetts Sexual Assault Nurse Examiners (SANEs) and the National Sexual Assault TeleNursing Center (NTC) are seeking rural communities to provide a community of support for clinicians who may conduct sexual assault examinations in rural facilities. The goal is to increase their confidence, competence, and retention and to support quality care for adult and adolescent SA patients. The NTC will use telemedicine technology to provide 24/7 remote clinician to clinician assistance from the Massachusetts SANEs.

Read more: National Sexual Assault TeleNursing Center Pilot Project – Office for Victims of Crime (Apr 21, 2014)

A rural health system can be our model

I love our rural communities. You don’t have to convince them to work together. The people are smart, work hard, and know the value of a dollar. And they can smell a skunk a mile away.

“The only constant is change” is probably the best description of our ‘new normal’ in healthcare. Decreasing inpatient volumes, hospital layoffs, declining reimbursements, mergers and affiliations. Who saw this coming? Clearly, incremental improvements to old processes is no longer “leadership.” I think our rural health system has some distinct advantages that we can learn from.

Rural communities are used to pulling together out of necessity. The local Critical Access Hospital (CAH) already supplies some of the best paying and most stable jobs in town. More importantly, it’s home. My father-in-law had to drive 25 miles to get to his CAH; trying to convince him to go 50 miles the other direction for that ‘big city’ hospital was a waste of time.

So a quality, post-discharge, patient care plan is a plausible goal. Formalizing the integration is work, but not unrealistic. Start with something simple, like HIPPA. Who needs to know what to achieve this quality patient care plan. Suddenly you’ve identified the players and defined the responsibilities. And, since it’s rural, everybody has a right to participate. Federally qualified health centers (FQHCs), rural health clinics (RHCs), community health centers (CHCs), DENTISTS (personal bias), WIC clinics, skilled nursing homes, home health agencies, faith-based organizations, and Telehealth (since most CAHs can’t provide 24×7 pharmacy services).

A review process is important for quality assurance and continuous performance improvement, which will lead to ‘discussions’ about costs and reimbursements. But there’s already one CAH/FQHC collaboration success story (Sakakawea Medical Center and Coal Country Community Health Center in N.D.), so it can be accomplished!

And once those ‘yokels’ make it work, then what’s our excuse?

U.S. News 100 Best Jobs: 38 are Healthcare (7 of top 10)

Healthcare, not surprisingly, is the top field to pursue according to the U.S. News 100 Best Jobs of 2014 report.

This is not a Highest Demand Jobs list. The rankings are based on the number of projected number of openings (through 2022), balanced by their advancement opportunities, career fulfillment and salary expectations.

Since most of these positions can be found in any size organization, from large hospital systems to critical care hospitals, community health centers and private practice settings, people have a plethora of opportunities to find the right fit for their personality.

38 of the professions are in healthcare, and they’re skewed to the top of the list!

#3     Dentist
#4     Nurse Practitioner
#5     Pharmacist
#6     Registered Nurse
#7     Physical Therapist
#8     Physician
#10   Dental Hygienist
#13   Physician Assistant
#14   Occupational Therapist
#16   Phlebotomist
#17   Physical Therapy Assistant
#21   Occupational Therapy Assistant
#22   Clinical Lab Technician
#25   Dietitian and Nutritionist
#26   Diagnostic Medical Sonographer
#27   Massage Therapist

For the full list:

Are you thankful for anything specific in the ACA?

On this Christmas Eve and I wanted to find something to be thankful for about the ACA. Community health centers (CHC), and critical access hospitals (CAH), are the backbone of our country’s incredible healthcare system. In 2011 the Bush administration expanded this safety net to 1,250 CHCs serving 20 million people. Obamacare’s ACA is further expanding the CHC program to serve 40 million in 2016. I am thankful for this very good thing.

Are you thankful for anything specific in the ACA?

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