A Clinically Based Service Limitation Option for Alternative Model Rural Hospitals

Alternative model rural hospitals are designed to address problems faced by small, isolated rural hospitals. Typically, hospital regulations are reduced in ex-change for a limit on the services that al-ternative models may offer. The most common service limitation is a limit on length of stay (LOS), a method with little empirical or conceptual support. The pur-pose of this article is to present a clini-cally based service limitation for alterna-tive model rural hospitals, such as the rural primary care hospital. The proposal is based on an analysis of Medicare dis-charges from rural hospitals most likely to convert and the judgments of a techni-cal advisory panel of rural clinicians