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Avera Queen of Peace receives Critical Access Hospital designation, but what does that mean?

Change will not results in loss of services, hospital officials stress

Hilary Rockwell, incoming regional president and CEO of Avera Queen of Peace Hospital in Mitchell, and Doug Ekeren, outgoing regional president and CEO, speak at a press conference on Tuesday, March 28, 2023 on the hospital receiving designation as a Critical Access Hospital. The change in designation is not expected to impact patient services.
Erik Kaufman / Mitchell Republic

MITCHELL — A change coming to how Medicare bills Avera Queen of Peace Hospital will not impact hospital services for most patients, according to officials.

The hospital was recently granted a change in designation from a Prospective Payment System hospital to a Critical Access Hospital by the Centers for Medicare and Medicaid Services. Officials at the hospital requested the change so that Avera Queen of Peace is in a better position to meet future challenges in the health care industry, according to hospital leadership.

“I appreciate the great deal of work our team did to request this change, because it will better cover the cost for the care we provide,” Doug Ekeren, outgoing regional president and CEO of Avera Queen of Peace Hospital said. “Approximately half of United States hospitals finished 2022 with a negative margin as growth in expenses outpaced revenue increases. In light of trends like that, we need to be creative and focus on our financial health so that Avera Queen of Peace can continue to serve Mitchell and the surrounding area. Being a Critical Access Hospital provides a better fiscal foundation upon which we can continue to build our services.”

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Manthey takes over the chief medical officer role on March 1 at the Mitchell hospital and will continue to practice emergency medicine.

Patients will not notice changes to their care experience or the services provided, according to Ekeren, who hosted a press conference at the hospital with other Avera officials on Tuesday afternoon.

The biggest change that comes with the designation is that Critical Access Hospitals can have a maximum of 25 acute care inpatient beds due to the health care industry shifts away from inpatient care into more outpatient care. The Avera Queen of Peace Hospital census has only reached that number a handful of times in the past three years, according to materials provided by Avera.


In a public health emergency such as the COVID-19 pandemic, the Department of Health and Human Services could allow Avera Queen of Peace to surpass the 25-bed limit, if needed.

Avera officials stressed that the change in designation will not result in a loss of services, something that is sometimes perceived as a result of becoming a Critical Access Hospital.

“It is important to note that there have not been any services identified that we will need to discontinue because of our (new) status,” said Hilary Rockwell, the incoming regional president and CEO of Avera Queen of Peace.

That includes emergency services, which will still provide the same care on a 24/7 basis that it has in the past.

“As always, we’ve been willing to take everybody who comes through the door. We want people who need us to come through the door. That won’t change at all. We’ll still have 24/7 and offer the same high-quality (emergency room) service that we always have,” said Darren Manthey, incoming chief medical officer for the hospital. “We want to keep all the people who come to Mitchell if we can, if that’s where they get the best care.”

The change is also not expected to impact staffing at the hospital.

“It is simply a change in the way we get paid by Medicare. We will have staff that we need to take care of patients, whatever those needs are, and the (needs) literally change day to day,” Ekeren said.

For non-Medicare patients, changes to hospital operations will be virtually indiscernible.


“Medicare patients will notice a little (change) on their statements because Medicare requires us to bill a little differently based on copay amounts,” Ekeren said. “There is literally no change for non-Medicare patients.”

Transition to take place over next nine months

Some of the conditions needed to become a Critical Access Hospital include having 25 or fewer acute care inpatient beds, being located more than 35 miles from another hospital, or being more than a 15-mile drive from another hospital in an area with mountainous terrain or only secondary roads, maintaining an annual average length of stay of 96 hours or less for acute care patients and providing 24/7 emergency care services.

There are benefits that come with being a Critical Access Hospital, including allowing flexible staffing and services to the extent permitted under state licensure, capital improvement costs included in allowable costs for determining Medicare reimbursements and access to flex program education resources, technical assistance and grants.

While there may not be a reduction in services, Rockwell suggested patients could actually see an expansion of services in some ways.

“We will continue to explore ways that we can expand our offerings to the community, such as with our addition this spring of acute dialysis services that will enable patients who once needed to go to a different community for that care to receive it in Mitchell,” Rockwell said. “Right now, if you are a chronic dialysis patient and you get pneumonia and need to be hospitalized, we often have to transfer them to Yankton or Sioux Falls. Our hope is as we get this set up we could keep those patients here.”

Expansion and improvement of services is always a goal of the Avera Queen of Peace and the Avera system in general, Rockwell said.

“We are always looking at ways to grow our services and availability,” Rockwell said.

Quality care will remain a focus with the new designation, and that commitment was reflected in the fact that Avera Queen of Peace was recently recognized as a Top 20 hospital by the National Rural Health Association. The Top 20 hospitals each year are gleaned from the Top 100 Rural and Community Hospitals as determined by the Chartis Rural Hospital Performance Index.


“Avera Queen of Peace is one of only 17 hospitals in the nation to be recognized in the Top 100 list each year since it was started in 2016. Furthermore, we have been on the Top 20 list three times,” Ekeren said. “That is an exceptional track record of high-quality care, and this new CAH designation won’t have any impact on our commitment to that.”

Erik Kaufman joined the Mitchell Republic in July of 2019 as an education and features reporter. He grew up in Freeman, S.D., graduating from Freeman High School. He graduated from the University of South Dakota in 1999 with a major in English and a minor in computer science. He can be reached at ekaufman@mitchellrepublic.com.
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