Critical Access Hospital is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS). Congress created the CAH designation through the Balanced Budget Act of 1997 (Public Law 105-33) in response to over 400 rural hospital closures during the 1980s and early 1990s. Since its creation, Congress has amended the CAH designation and related program requirements several times through additional legislation.

The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, CAHs receive certain benefits, such as cost-based reimbursement for Medicare services.

Eligible hospitals must meet the following conditions to obtain CAH designation:

• Have 25 or fewer acute care inpatient beds
• Be located more than 35 miles from another hospital (exceptions may apply)
• Maintain an annual average length of stay of 96 hours or less for acute care patients
• Provide 24/7 emergency care services

Weisbrod Health offers a range of services and Hospital District leaders are committed to responsibly expanding services and facilities when financially feasible. The core services we provide today include:

• Inpatient Hospital Care including Acute & Skilled Swing Beds
• Rehabilitation Therapy
• Emergency Medicine, including Observation Room Services
• Extended Care Services
• Primary Care for people of all ages in the Rural Health Clinic
• Cardiology Specialty Services
• Chiropractor Services

In addition to the above services, Weisbrod Health has been actively recruiting healthcare professionals and staff to ensure more access to high-quality primary care and proactively applying for and receiving vitally important grant dollars to fund essential equipment purchases, programs, and other initiatives that benefit patient care, ensure workplace safety, and positively impact County residents.

Current initiatives include:

• May 2024, we welcomed Erik Ritch, MD to our Medical Staff, which allowed us to move away from using Travel/Locums providers.
• August 2024, we launched a new Medical Record System to help improve patient safety and data collection.
• Fall 2024, we start our grant-funded Quality Improvement and Quality Assurance Initiative. ($20,000)
• Fall 2024, we start our grant-funded Strategic Operational and Financial Assessment with the National Rural Health Association. ($50,000)
• In September 2024, we are launching a grant-funded Mobile Clinic offering Primary Care and Dental Services. ($168,000)
• In early Spring of 2025, we plan to break ground on a grant-funded New Clinic Building that will allow us to expand our primary, specialty, and dental care services. ($1.9 Million)

Hospital District leaders understand that to deliver high-quality healthcare and ensure Weisbrod’s competitiveness, we must have a functional facility that meets state environment of care requirements. 

A growing concern for the District is its aging facilities and doing all possible with the means we have to maintain them to standard without significant investments in upgrades to areas that have already exceeded or are near the end of their life expectancy.

We are actively seeking grant funding opportunities for each of the following initiatives. However, we recognize that we won’t be able to cover the entire expense using grant funds. Therefore, it’s crucial that we position ourselves to qualify for financing through USDA. 

In our long-term planning, and when financially feasible, the District has prioritized the following facilities and operations projects.

• Convert the existing clinic building into a more functional space for our rehab therapy department.
• Update aging systems within the hospital at or near their life expectancy (mechanical, electrical, etc.)
• Expand hospital facility, including a new wing for extended care services, pending USDA financing.

The short answer is that the hospital’s operating margins are slim, but we are actively implementing strategies to ensure its sustainability, and it is not in immediate danger of closing. 

The more complex answer is that, unfortunately, and due to many circumstances beyond our control, including continued lack of local investments and underfunded reimbursement rates from payers (both commercial insurance and the Centers for Medicare & Medicaid Services (CMS)), Weisbrod, like many other CAHs in the state and country, are increasingly vulnerable.  

Additionally, 2023 was a positive year for our financials, and through careful strategic planning, we have made several key changes this past year to help reduce expenses wherever possible. That said, the Board and organization leaders know that operating margins are not large enough, and a significant need remains for reinvestment to sustain our current facility. These funds must come from an increase in the mill levy allocated to the Kiowa County Hospital District.

Kiowa County is designated as a Health Professions Shortage Area (HPSA), meaning there is a shortage of primary care and mental health services. Once the mobile clinic is operational, we can address the dental care gap in our community. To meet the healthcare needs of our community, we must work diligently to recruit health professionals, but this cannot be done without ensuring that we have the space for new providers to practice and to accommodate patients in our waiting area and exam rooms.  Our current clinic does not have space to support the providers we have, let alone add providers or accommodate additional visiting specialists.

In addition to our commitment to meeting the health needs of our community, we must also generate revenue to improve the District’s finances. This is done through revenue generated through patient visits. 

As mentioned earlier, the new clinic space is ALREADY funded through a grant that the District applied for and received, at no additional expense to the taxpayers of Kiowa County for the build. This new space not only addresses our healthcare needs but also serves as a sound investment, generating revenue through patient visits.  The same is true for the mobile clinic, which was made possible through a grant, ensuring no extra financial burden on our taxpayers for the acquisition.

The Mill Levy is the “tax rate” that is applied to the assessed value of the property. One mill is one dollar per $1,000 dollars of assessed value. KCHD is a special district and has their own Mill Levy, and all the funds generated from that specific Mill Levy come directly to the hospital.

A Mill Levy Lift is another way of describing an ask of taxpayers to increase the amount of tax the the Hospital District receives. The Kiowa County Hospital District and its Board of Directors is pursuing a Mill Levy Lift this year, asking voters to make an informed decision on the matter that will appear on the 2024 General Election Ballot.

It is important to note that if approved, the Mill Levy Lift will not have a direct impact on voters in Kiowa County who do not own property or pay property taxes.

In 1991 the Kiowa County Hospital District Mill Levy was lifted from 3.26 to 14.56 Mills.

In 1994 De-Brucing passed. “Debrucing” refers to the act of removing the revenue limits imposed by Colorado’s Taxpayer Bill of Rights (TABOR). When a municipality or other government entity “debruces,” it means that voters have approved a measure to allow that entity to retain and use revenue that would otherwise have to be refunded under TABOR limits. The Mill Levy was set at 13.23 in 1994 and has remained there since.

Impact to the Taxpayer:

• Current Amount $13.23 per year for every $1,000 of assessed property value.
• Increase of $6.22 per year for every $1,000 of assessed property value.
  • Less than 2 cents per day for every $1,000 of assessed property value.
• Total of $19.45 per year for every $1,000 of assessed property value.
•  

How to calculate the impact this will have on YOU:
> Get Instant Results, Use the Mill Levy Calculator Below 

The Tax Slip shows two-line items that have Hospital in the description:

1. Public Hospital Fund – Kiowa County Commissioners manage the allocation of these funds through their annual budget process.
   • Funds generated support the Kiowa County Ambulance Service.
   • History of these funds: prior to 2021 the Ambulance received 5 Mills, in 2021 the County Commissioners decreased the amount the Ambulance Service receives to 3 Mills.
   • The Ambulance Service has been operating at a loss since that change in 2021, putting additional financial pressure on the Hospital District to fill the gap financially to keep this vital service available to the residents of Kiowa County.  
2. Kiowa County Hospital – 13.230 Mills, which the Hospital District receives directly.

As a special hospital district and a designated critical access hospital serving Kiowa County, operating and maintaining our facilities takes several revenue streams, including money generated from local taxpayers. The sources of funding used by KCHD to maintain its services and facilities are as follows: 

1. Medicare Reimbursement through our cost reporting efforts.
   • CMS does their part to cover our cost of readiness to provide services for their portion. Every year we send them our cost report which details what it costs us to operate, minus our patient revenue (essentially, our loss). They look to see what percent of our patient population has Medicare and then they send us money to help off-set our losses for their share.
2. State & Federal Funding:
   • HCPF and other State/Federal programs offer some funding support for various things, these are not consistent and usually age out.
3. County Taxes:
   • Mill Levy Tax. These are funds that come from county landowners to support hospital operations, equipment investments and maintenance of the facilities.
4. Patient Revenue:
   • This is the money that KCHD collects from payers for the services provided. In all situations, what we receive from payers is less than what we charge for services.
   • For every $1.00 we bill to CMS we receive back $0.33

In addition to creating over $22 Million in direct and indirect economic impact to the community KCHD supports the community in several vital areas, including:

• Employing over 100 people making the Hospital District the largest employer in the county
• Direct Hospital Payroll and Benefits contributes $5 Million annually
• Indirect Hospital Payroll and Benefits contributes $4.5 Million annually
• Direct Hospital Expenditures, $5.7 Million annually
• Indirect Hospital Expenditures, $7.6 Million annually

The Hospital District believes it’s essential to explain that it’s not just a question of if we want to ensure access to healthcare in Kiowa County. In the larger picture, it’s a question as to whether we want to see Kiowa County continue to thrive in the future or not.

Multiple studies have shown that when a small rural hospital like ours closes, the community suffers from other losses, including a decline in school enrollment and businesses, a reduction in per-capita income, and an increase in unemployment. Certainly, Kiowa County would not be spared from experiencing these impacts should Weisbrod and the Hospital Districts Rural Health Clinic be forced to close their doors.