VDA case studies: two recoveries, 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 Sole Community Hospitals; others are Medicare-Dependent Hospitals.

What happened

Leadership first contacted us 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 we built the requests

We knew what to look for. We reviewed every hospital in the system, told leadership plainly which had qualifying years, and found 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

We built a separate request for each hospital and year, organized like a legal brief, filed each with the hospital’s Medicare Administrative Contractor (MAC), and handled the MAC’s questions through each decision. Hospital staff gave us records and a few focused interviews; RRP did the rest.

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.

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

The hospital

A rural Sole Community Hospital 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 we built the requests

We 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.

We 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 gave us what we needed; RRP did the rest.

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.

Details have been changed to protect client confidentiality.

Why hospitals bring VDA work to RRP

• Decades of hospital reimbursement experience. Our leadership has spent its career in Medicare reimbursement.
• Requests organized like legal briefs. We document each case against the rules the MAC applies.
• We handle the MAC. We answer the auditors’ questions and stay with each request until it is decided.
• Fees tied to recovery. Our contingent fee is invoiced after your hospital receives payment. No Recovery, No Fee. It’s That Simple.
• 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.