Nursing Practice Considerations for Medicare’s Reimbursement Model of Rural Emergency Hospitals

Abstract

Background: The Consolidated Appropriations Act of 2021 (Public Law 116-260) established a Rural Emergency Hospital (REH) designation under the Medicare program. Guidance includes provider staffing requirements, but the nurse staffing recommendations conflict with state boards of nursing scope of practice requirements.

Purpose: To gain a perspective regarding the nurse staffing needed to provide 24/7 emergent care and patient observation for the REH reimbursement model.

Methods: A mixed methods design of ethnography and cross-sectional descriptive data were collected through unstructured field observations, face-to-face interviews, and focus groups to evaluate descriptive data on nurse education, skill mix, and competencies.

Results: Data were collected from nursing personnel and leadership (N = 45) at four critical access hospitals (CAHs) in Kansas. The nursing workforce sample was predominantly registered nurses (87.8%) with associate degrees in nursing (51.3%). Findings reflect the need for a highly skilled, flexible staff with strong critical thinking skills and the ability to function within their full scope of practice.

Conclusions: The REH reimbursement model and associated policies do not address appropriate nurse staffing within the required scope of nursing practice and services. Initial assessment and patient transports are key factors in the REH designation, both of which require the support of registered nurses. The nurse staffing recommended for REHs does not adequately meet the needs of the service model.