Rural Health Clinic

1. Rural Health Clinic • Provider Based • Licensure • Ownership and Control • Administration and Supervision • Clinical Services • Financial Integration • Public Awareness • Location

2. Rural Health Clinic • Provider Based Reimbursement • Costs are reported on hospital’s cost report. • Subject to same caps, unless the hospital is less than 50 beds. • Fiscal Intermediary • Provider based has same FI as parent. • Freestanding RHC will have a different fiscal intermediary.

3. Swing Beds

4. Swing Bed Program • A bed that can be used to provide either acute or skilled nursing facility (SNF) care, as needed.

5. Swing Bed Program • The Swing Bed Program allows the physician to "swing" a patient’s level of care from "acute" to "skilled" rehab while the patient remains in the hospital. If the patient requires acute care again, he/she can be "swung" back to acute care.

6. Who needs a swing bed? • When a patient reaches the point in recovery where acute care hospitalization is no longer necessary, but they are not physically able to go home, a Swing Bed is a positive interim step.

7. Swing Bed Program • The program was developed in the 1970s to use excess hospital beds in rural areas to deliver long-term care for the frail and disabled. • Informally, it was known as “the swing-bed program.” • The swing-bed idea arose from a two sets of problems facing rural health care systems: • (1) hospitals were built on a scale that often resulted in their having more beds than patients to fill them, and • (2) frail elderly people who were disabled often needed to go to nursing homes far from where they lived.

8. Swing Bed Program • A solution was to use empty hospital beds for patients needing long-term skilled nursing care. • In 1973 Medicare funded a three-year swing-bed experiment involving twenty-five hospitals in rural Utah. • The idea took hold and today, more than 60 percent of rural hospitals have swing-bed arrangements.

9. Swing Bed Program • Skilled nursing services include injections, IV feedings, catheter placement, rehab services (PT, OT, ST) • Intermediate Nursing (Nursing Facility Level) • “Caring for the Walking Wounded” (Changing dressings) • Custodial • Administering single medications and assisting with activities of daily living (dressing, bathing etc.)