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Rural Health
Research Gateway

Critical Access Hospitals (CAHs)

Completed Projects

Listed by project completion date. You can also view these projects alphabetically.

2025

  • Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19
    This study described and compared the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. Researchers identified factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.
    Research center: ETSU/NORC Rural Health Research Center
    Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Healthcare access, Hospitals and clinics, Medicare, Social determinants of health

2023

  • Changes in Hospital Services Offered After Mergers, Acquisition and Affiliations
    Hospitals have affiliated with systems in increasing numbers since 2007, as of 2016 reaching 56.1 percent of nonmetropolitan prospective payment system hospitals and 42.8 percent of critical access hospitals. This project examined resulting changes in services offered by rural hospitals, hypothesizing shifts of some services to regional hospitals and growth in some service lines.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Networking and collaboration

2021

  • How Medicare Payment Standardization Affects the Perceived "Cost" of Post-Acute Care Provided in Critical Access Hospital Swing Beds
    Medicare-allowed charges are adjusted for geographic cost differences and payments that support larger Medicare program goals. This study aimed to identify the effects of the payment standardization method on the perceived "cost" of post-acute care provided in Critical Access Hospital swing beds.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics, Medicare, Post-acute care
  • The Current Distribution of the General Surgery Workforce in Rural America
    This project described the current national supply and distribution of general surgeons in rural vs. urban areas of the United States as well as geographic variability in the supply of general surgeons across the rural/urban and intra-rural dimensions at the regional level.
    Research center: WWAMI Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Health services, Healthcare access, Hospitals and clinics, Physicians, Rural statistics and demographics, Workforce

2019

  • Analyzing Data from the Evidence-Based Telehealth Network Grant Program Grantees and Preparing Manuscripts to Further the Evidence Base for Tele-ED
    This project's main purpose was to analyze data using the revised Tele-Emergency Performance Assessment Reporting Tool gathered from Evidence-Based Tele-Emergency Network Grant Program grantees on all of their cases using telehealth in the emergency department (tele-ED) and a matched sample of non-tele-ED records to conduct comparative effectiveness analysis to help establish the evidence base for tele-ED.
    Research center: Rural Telehealth Research Center
    Topics: Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Telehealth
  • Exploring Global Budgets as a New Reimbursement Model for Low-Volume Critical Access Hospitals
    Given the complexity of the Global Budget reimbursement model, we were interested to learn if there are aspects of the model that could be applied to consolidate reimbursement across rural and frontier health care settings, particularly for CAHs with low-volume (e.g., < 5 acute patients as a daily census).
    Research center: North Dakota and NORC Rural Health Reform Policy Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Hospitals and clinics
  • Financial Impact of Reimbursing CAH Swing Bed Days at the SNF PPS Rate
    This study assessed the financial impact of changing Critical Access Hospital (CAH) swing bed reimbursement from the cost-based system to the skilled nursing facility (SNF) prospective payment system (PPS).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Long-term care, Medicare, Post-acute care

2018

2017

2016

  • Can a Model Predict Financial Distress Among Rural Hospitals?
    This project will extend an existing model of CAH financial distress to other types of rural hospitals. A valid model would be helpful to ORHP and state Offices of rural Health interested in predicting financial distress or closure of rural hospitals.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics

2015

  • Quality of Surgical Care services in Critical Access Hospitals (CAHs)
    This project builds on prior work examining rural residents' bypass behavior of their local CAH to hospitals outside their community. Using recently identified inpatient surgical procedures that are commonly performed in CAHs, we will examine and compare outcomes (e.g. post-surgical complication rates, adverse events) of these procedures between CAHs and non-CAHs.
    Research center: RUPRI Center for Rural Health Policy Analysis
    Topics: Critical Access Hospitals (CAHs), Hospitals and clinics
  • What Does it Cost to Operate a Rural Free-Standing Emergency Department (RFED)?
    In recent months, there have been numerous media reports of rural hospital closures and the adverse effect on communities. In the face of hospital closure, one alternative for maintaining access to healthcare is a rural free-standing emergency department (RFED).
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Medicare

2010

  • Measuring the Community Benefits and Impact of Critical Access Hospitals
    This project will develop, test, and implement a set of community benefits and impact indicators for Critical Access Hospitals (CAHs). These indicators will assist CAHs, policymakers, and rural stakeholders to understand the impact of CAHs on their communities and local health care delivery systems.
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals (CAHs)

2009

  • Critical Access Hospital Readiness for CMS Value-Based Purchasing
    The purpose of this project will be to assess Critical Access Hospital readiness for participation in a Value-based Purchasing program similar to that proposed by CMS for Prospective Payment System hospitals.
    Research center: Upper Midwest Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Quality

2008

  • Critical Access Hospital Conversion Tracking
    Information regarding new CAH conversions will be gathered from Flex coordinators and CMS, and added to the CAH management information dataset that is housed at UNC. Flex coordinators will also be queried regarding topics of interest to the coordinators, the monitoring team, and the federal Office of Rural Health Policy.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topic: Critical Access Hospitals (CAHs)
  • Developing a Financial Performance Measurement System for Critical Access Hospitals
    This project uses research and expert opinion to select dimensions and indicators of financial performance, develop appropriate bases or methods of peer comparison, investigate the relationship between quality of care and financial performance, and identify characteristics of high performing CAHs.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing
  • Impact of CAH Conversion on Hospital Costs and Mix of Services
    This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals (CAHs), Health services, Healthcare financing
  • Quality Improvement Organizations' Contributions to Rural Hospital Performance
    This qualitative study is designed to gather information on best-practices in Quality Improvement Organization (QIO)-rural hospital partnerships. Specifically, this study will identify successful and replicable examples in which QIOs have worked with rural and critical access hospitals to improve processes of care, implement health information technology and promote organizational safety culture.
    Research center: NORC Walsh Center for Rural Health Analysis
    Topics: Critical Access Hospitals (CAHs), Health information technology, Hospitals and clinics, Quality

2006

  • Community Impact Assessment
    This project will evaluate the impact of the Flex program on local communities. Activities will focus on identifying the ways in which the program could have a measurable effect, as well as the ways in which Flex program coordinators intended to affect community health. A briefing paper that integrates information on scope of services, networking, and quality will be produced. Additionally, case studies will be conducted in six CAH communities.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Networking and collaboration, Rural Hospital Flexibility Program
  • Financial Performance of Critical Access Hospitals, Pre- and Post-Conversion
    Making use of the financial indicators developed by project staff, the focus of this project is a longitudinal analysis of the dimensions and indicators of financial performance. Descriptive analyses are used to capture changes in all dimensions of financial performance pre- and post-conversion.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Healthcare financing, Medicare Prospective Payment System (PPS), Rural Hospital Flexibility Program
  • Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
    This project drew on a survey of patients sampled from the service areas of 25 Critical Access Hospitals (CAHs) from different regions of the country. The purpose of this project is to identify policy and programmatic issues related to bypass, specifically targeting CAHs in order to offer evidence and guidance to policymakers, CAH administrators, and planners on the location of healthcare resources, factors that affect patient actions for planning programs, and the adjustment of policies in order to retain patients locally.
    Research center: FORHP-funded Individual Grantees
    Topics: Critical Access Hospitals (CAHs), Health services

2005

  • Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
    This project will survey Emergency Room (ER) managers in a nationally representative sample of Critical Access Hospitals (CAHs) to determine the proportion of ER encounters involving mental health pathology, types of mental health problems most commonly seen in these encounters, and resources available to CAHs to address the problems encountered.
    Research center: Maine Rural Health Research Center
    Topics: Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Mental and behavioral health
  • Role of Intensive Care Units in Critical Access Hospitals
    This project will examine the role that intensive care units (ICUs) play in Critical Access Hospitals (CAHs). The number and geographic distribution of CAH with ICUs will be described, and types of services provided in these units discussed.
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Health services
  • Special Study of EMS Issues
    This study will focus on state, community, and hospital level initiatives designed to build the infrastructure to support EMS service capacity and encourage the integration of these services into the rural healthcare infrastructure in the areas of quality improvement, financing, staffing, medical control, and networking and integration.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Networking and collaboration

2003

2002

2001