As a small Critical Access Hospital, we have a responsibility to our community to provide the best service possible (I guess that means affordable) for the people in our service area. This includes those who are indigenous and those who are transient.
Because it is so far to the next place... well, ok, maybe 35 miles isn't so far, but it's pretty hard to hold your breath for long enough to get there from here.. Well ..we feel the need to be well prepared to take care of the challenge that we have about 25 or so times a year when having nurses, equipment, lab, diagnostic imaging, and other support services available to handle the odd "bear" of a case that occurs. This means that for the rest of the 575 or so of the emergency cases we face that we are over gunned. Those cases still need precision, but are easier to handle, like squirrels. It means that we have a heavier nursing staff than we would have based on our typical load.
It's a little bit like the choice of going out on the ocean in a very small boat because it would be safe most of the time, understanding that there are some days when a larger, more expensive, more capable craft would be a far wiser choice. If someone's life depended on it, I think that the logical choice would be to get the craft or provide the resources that can handle the worst situations we face, understanding that life and the ocean can at times overcome any preparation.
The bottom line of this comment is that small Critical Access Hospitals are faced with high fixed cost because we need to be ready coupled with low and highly variable volume because of where many of us are located (frontier areas). These challenges are why the special reimbursement is necessary. The access to care we provide is truly Critical. Unless we provide that care for the odd "bear" of a case, we don't really provide the Access we should. I guess that's why it's called a Critical Access Hospital.
The next thing we will talk about is how to break even in this setting.