VDA case studies: two VDA payments, built around each hospital’s facts

Case study 1: Several of the system’s hospitals qualified, and every one that did was paid

The health system

A small regional health system in the South, with several rural hospitals. Some are SCHs; others are MDHs.

What happened

Leadership first contacted RRP about one hospital after inpatient discharges fell sharply in a single year. They weren’t sure Medicare would see the decline as beyond the hospital’s control.

• At that hospital, two long-tenured admitting physicians left in the same year: one relocated, and the other was out because of illness. Patients and referring doctors had relied on both.
• At another hospital in the system, a family physician and a general surgeon retired within months of each other. Temporary physicians kept services open, but they did not bring in the referrals the retiring physicians had.

How RRP built the requests

RRP knew what to look for. The team reviewed every hospital in the system, told leadership plainly which had qualifying years, and confirmed that each qualifying hospital’s records tied its decline to the physician departures and documented its response:

• Temporary physicians to keep services open
• Prompt, sustained recruiting for permanent replacements
• Efforts to control costs
• Rural locations that made some specialties difficult, and at times impossible, to recruit

The team built a separate request for each hospital and year, organized like a case for the Medicare Administrative Contractor (MAC): each finding, the evidence behind it, and the rule it rests on. Each was filed with the hospital’s MAC, and RRP handled the MAC’s questions through each decision. Hospital staff provided records and a few focused interviews; RRP prepared the analysis and the requests.

The result

Every hospital with a qualifying year was paid. A question about one hospital turned into paid requests for every hospital in the system that qualified, with one senior RRP contact from the first call through payment.

What this case shows: A VDA question about one hospital can be a reason to check every hospital in the system. Eligibility and evidence depend on each hospital and each year.

What this means for your hospital: Your staff’s part can be records and a few focused interviews. Each hospital and year gets its own request, and RRP handles the MAC’s questions through each decision.

Case study 2: One rural hospital was paid for two years with different causes

The hospital

A rural SCH in the West that serves as a referral center for a wide area.

What happened

Discharges fell in two years, with a different staffing disruption behind each decline:

• Year one: anesthesia providers resigned, disrupting the surgery schedule until replacement coverage was in place, and nurse staffing shortages led the hospital to divert some patients to other facilities.
• Year two: physicians in several specialties, including hospitalists, resigned over a period of months. Some on-call shifts went uncovered and some services were interrupted.

How RRP built the requests

RRP saw that both years qualified, each with its own cause, timeline, and records. Board minutes recorded the problems as they unfolded and showed the hospital working to stay staffed:

• Traveling nurses brought in through staffing agencies
• Temporary anesthesia providers under contract
• Interim physicians covering call
• Aggressive recruiting, including changes to compensation
• A rural location that made some specialties difficult, and at times impossible, to recruit
• Steps to control costs, such as cutting back on outside contract services where it could

The hospital kept its core staff and services in place while volume fell, so most costs remained. That is the kind of fixed-cost pressure a VDA is meant to address.

The team built a separate request for each year, tied each decline to its causes using the hospital’s own records, and handled the MAC’s follow-up questions on both. A few focused interviews with the staff who knew firsthand how the departures affected surgery, nursing, and patient care provided what the work needed; RRP prepared both requests and answered the MAC.

The result

Both years were paid, with one senior RRP contact from the first interview through both payments.

What this case shows: A prior VDA request is not a template for a later year. Build each request around the events, timeline, and records for that year.

What this means for your hospital: If discharges fell in more than one year, each year can stand on its own cause. Board minutes that recorded staffing problems as they happened are the kind of record that supports it.

Details have been changed to protect client confidentiality.

Why hospitals bring VDA work to RRP

• Decades of hospital reimbursement experience. RRP’s leadership has spent its career in Medicare reimbursement.
• Requests organized like a case for the MAC. Each finding, the evidence behind it, and the rule it rests on.
• RRP handles the MAC. The team answers the auditors’ questions and stays with each request until it is decided.
• Fees tied to recovery. RRP is paid based on what your hospital is paid.
• Build the case while the people who know it are still there. A strong request depends on staff who saw what happened and how the hospital responded. Filing soon after you confirm eligibility helps preserve that firsthand knowledge. The 2026 NSI National Health Care Retention & RN Staffing Report found average hospital-wide staff turnover of 18.5% in 2025. Rebuilding a case after key staff leave is far harder.

Source: 2026 NSI National Health Care Retention & RN Staffing Report (PDF), NSI Nursing Solutions.