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Obama's more limited proposal to eliminate critical access status only for hospitals less than 10 miles from another hospital and to cut the reimbursement to 100 percent of reasonable costs.
• Hollingsworth said she interprets the inspector general's report to threaten the 26 South Dakota hospitals the state designated as critical access hospitals even though they are less than 35 miles from other hospitals. Another 12 rural South Dakota critical access hospitals are not threatened because they are more than 35 miles from their closest neighbor.
• The rural hospitals need the higher Medicare payments because they cannot make ends meet at the lower rate paid to larger hospitals, Hollingsworth said. Those smaller hospitals don't have enough other patients to subsidize losses on Medicare, she said.
• Hollingsworth said she doubts Congress will accept the proposed change, but state officials will work with South Dakota's congressional delegation and others to fight the proposal.
• "Believe me, we'd be weighing in loud and clear," she said.
• Mark Thompson, chief financial officer of Regional Health, said he doesn't know

if the proposed change would lead to the closure of the system's hospital in Deadwood. But the loss of critical access status would cost the Lead-Deadwood Regional Hospital about $500,000 to $750,000 a year because Medicare reimbursements outside the program are about 70 percent of what critical access hospitals get, he said.
• Reimbursements to critical access hospitals already have reduced from 101 percent of costs to 99 percent because of the automatic federal budget cuts, Thompson said.
• "If you're going to further reduce the hospital reimbursement, it would make it difficult to provide the same level of service in these communities, if not impossible," Thompson said.
• Mike Burket, CEO of the Platte Health Center, located about 29 miles from the nearest other hospital, said his facility's existence would be threatened if it lost the higher Medicare reimbursement. Not only Medicare patients, but also others would have to travel farther for care if the hospital closed, he said.
• "It would have catastrophic effects for health care," Burket said.
• In nearby Parkston, Avera St. Benedict Health Center CEO Gale Walker said his hospital might survive the proposed change because it also operates a nursing home, assisted living center, a medical clinic and other facilities. But he said the

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