Emily Jo Cureton, The Triplicate

"Critical Access" has become something of a battle cry in the campaign against hospital "regionalization;" first waged by local doctors and now emboldened by local governments, public opinion and a temporary restraining order barring Sutter Health from changing the administrative structure of Sutter Coast Hospital until a further hearing Aug. 27.

Critical Access Hospital is a federal designation given to geographically isolated health care facilities that meet certain criteria, chiefly: providing 24-hour care while furnishing no more than 25 in-patient beds and an average patient stay of less than four days.

Opponents of regionalization have framed this program as an ominous possibility for Del Norte's 49-bed hospital, all the more likely to be realized if it becomes part of Sutter Health's West Bay Region.

On Monday, Mike Cohill, a West Bay Region president and a senior vice president for Sutter Health, addressed this topic in more measured terms, saying "it would be malfeasant for anyone associated with a rural hospital not to assess CAH."

The San Francisco-based Cohill also serves on the Board of Directors at Sutter Coast Hospital.

"We've been evaluating CAH on and off for several years. Even before Sutter Health started using a more regionalized approach to running its hospitals ... The last evaluation we got was that the hospital would not be better off as a Critical Access Hospital," he said.

Another evaluation is under way.

On paper, the hospital already fits the bill. Last year, the average number of occupied beds per day was 20.7, while the average length of stay per patient was 3.4 days.

"One of the things one is watching is, what is the average daily census," Cohill said. "One of the reasons that critical access is a more feasible alternative today than it was several years ago is that the utilization of hospitals is falling: More patients are being taken care of as out-patients and the length of stay is shortening."

Currently the hospital adjusts its daily workforce to match the average daily census.

Cohill didn't want to speculate on the likelihood Sutter Coast will apply for CAH designation in the future. If an application were to be made, whatever board of directors governs the hospital would have the authority to sign off on it.

The CAH program was established through 1997 legislation allowing small hospitals to collect cost-based payments for federally insured Medicare patients. Otherwise, Medicare reimbursements are based on a formula designed to keep the budget in check, largely determined by the Gross Domestic Product and not actual health care costs.

In 2011, 44 percent of Sutter Coast's patients were insured by Medicare.

"We have to constantly evaluate the hospital: how it's running, how efficient it is, and how financially stable it is," Cohill said.

He summed up: "All the decisions that I've made in the past and all the decisions I'm going to make in the future I believe are in the best interest of the patients that we serve."

Reach Emily Jo Cureton at ecureton@triplicate.com.