October 18, 2017

Jackie Medland: Highlands-Cashiers Hospital’s Role as a Critical Access Hospital

By Jackie Medland
President/CNO, Highlands-Cashiers Hospital

This month, I’d like to focus on what it means to be a Critical Access Hospital (CAH) so readers can better understand some of the unique features of Highlands-Cashiers Hospital and our dedicated caregivers who so compassionately serve this community.

Our CAH designation means several things. It means we operate within a set of rules established by the federal government, unlike those that exist for larger, typically urban hospitals. It also means that we’re located in a remote, rural area surrounded by challenging terrain even in the best of times – let alone the times when we’re hampered by severe weather, such as our visit from Hurricane Irma last month.

In 1997, Congress included the Critical Access Hospital (CAH) designation in its Balanced Budget Act to financially strengthen these small but important hospitals and to increase rural patients’ access to important and necessary care. A facility can only be classified as a CAH if it’s over 35 miles from the nearest hospital, or 15 miles away if located in mountainous terrain like HCH.  A CAH must provide “24/7” emergency care and maintain no more than 25 beds with an average hospital stay of less than four days. Despite their small size and remote locations, CAHs are still required to meet rigorous clinical and environmental standards set by the federal government. In fact, we recently passed an exacting survey of our facility and the care we provide by the Joint Commission, a federally approved inspection and accreditation entity.

As you may have heard, since 2010, there has been a wave of hospital closures across the nation with 80 CAHs closing across the country, including three in North Carolina.  In America today, more than one rural hospital closes every month.  Foreshadowing future risk, one of three CAHs nation-wide currently operates at a financial loss.

Thankfully, Highlands-Cashiers – with Mission Health’s crucial support – is neither part of this statistic nor your average CAH. Our generous community sustained our operation last year by providing nearly $1.5 million in philanthropic support. We’re further strengthened by our nearby sister CAHs, Angel Medical Center and Transylvania Regional Hospital, and by Mission Hospital, through which patients can access the next level of tertiary care. Our patients can also take advantage of the expertise of specialty physicians through the telehealth program, whereby Asheville clinicians are consulted via digital technology. Our community benefits immensely from the telehealth program because distance is no longer an obstacle to care.

Over the last year, caregivers at Highlands-Cashiers Hospital have touched 4,200 lives. Our new ED treats an average of 15 patients per day, and we’ve seen as many as 30 per day over the past couple months.  At the same time, we serve approximately nine inpatients per day and treat an average of 30 outpatients daily for tests and treatments. Our patient population is unique in that it surges during the summer months, when volumes can as much as triple.

I appreciate the continuing opportunity to work together to create a stronger, healthier community.

Coming soon: Next month I’ll share information about our provider teams and the many important clinical services they offer.

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