Critical Access Hospitals (CAHs): Rural Health Research Products & Journal Articles

2024

Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 09/2024
This brief presents financial performance trends of hospitals who participated in Medicare's Shared Savings Program (SSP) from 2011 to 2018. Trends in six financial outcomes are compared between SSP and non-SSP hospitals over time and between rural and urban hospitals.

2023

Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
Journal Article
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 09/2023
The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.
Policy Implications of Fixed-to-Total-Cost Ratio Variation Across Rural and Urban Hospitals
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2023
This article utilizes hospital cost report data to estimate the relationship between adjusted volume and total costs of patient care. These results are used to estimate fixed-to-total-cost ratios for all nonfederal, short-term acute care hospitals in the U.S. These ratios were then stratified by rurality and Critical Access Hospital status.

2022

The Evolution of Hospital Designations and Payment in the U.S.: Implications for Rural Hospitals
Report
RUPRI Center for Rural Health Policy Analysis, RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 12/2022
Medicare hospital payment policies affecting rural hospitals play a significant role in the financial viability of rural hospitals. This report provides an overview of historic and current Medicare rural hospital payment policies and alternative payment models to understand their impact on rural hospitals and the communities they serve.

2021

Using CPT Charges as an Economic Proxy for Telehealth and Non-Telehealth Emergency Department Utilization
Policy Brief
Rural Telehealth Research Center
Date: 11/2021
This brief examines economic data on emergency department visits from unrelated rural hospitals. By using the reported Current Procedural Terminology code and associated charge, we explore the characteristics of the resulting dataset in terms of distribution and association with related variables.
Trends in Cancer Treatment Service Availability Across Critical Access Hospitals and Prospective Payment System Hospitals
Journal Article
University of South Carolina Rural Health Research Center
Date: 08/2021
This study investigated trends in cancer services availability in urban and rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs). Compared with all PPS hospitals, CAHs offered fewer cancer treatment services and experienced a decline in service capability over time.
Opioid-Related Visits to Rural Emergency Departments
Policy Brief
Maine Rural Health Research Center
Date: 02/2021
The purpose of this project was to compare rural and urban opioid-related emergency department visits. Data from the Nationwide Emergency Department Sample were used to examine rural and urban opioid-related visits over time and to compare the outcomes of these visits.
Characteristics and Challenges of Rural Ambulance Agencies – A Brief Review and Policy Considerations
Report
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 01/2021
There are 23,272 ambulance agencies in the U.S., and 73% of those agencies report serving rural areas. This paper examines current rural ambulance agency characteristics and challenges and identifies public policy considerations designed to stabilize rural ambulance agencies.
HRSA's Evidence-Based Tele-Emergency Network Grant Program: Multi-Site Prospective Cohort Analysis Across Six Rural Emergency Department Telemedicine Networks
Journal Article
Rural Telehealth Research Center
Date: 01/2021
The Health Resources and Services Administration funded six grantees to provide telehealth services in rural emergency departments (tele-ED) and gather data for the telehealth evidence base. This paper examines trends across multiple tele-ED networks and heterogeneity in processes and outcomes.

2020

Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
Journal Article
University of Minnesota Rural Health Research Center
Date: 11/2020
As increasing numbers of rural hospitals stop offering maternity care, limited information is available about local preparedness to address obstetric emergencies. This paper explores the capacity to treat obstetric emergencies encountered among rural hospitals without obstetric units.
Identifying Measures and Data Elements for the HRSA Evidence-Based Tele-Emergency Network Grant Program
Policy Brief
Rural Telehealth Research Center
Date: 03/2020
This brief details multi-project work to identify measures and develop data elements appropriate to emergency department-based telehealth, create an Excel-based tool, and systematically collect data from grantees in the Health Resources and Services Administration Evidence-Based Tele-Emergency Network Grant Program.
Emergency Department Telemedicine Consults Are Associated With Faster Time-to-ECG and Time-to-Fibrinolysis for Myocardial Infarction Patients
Journal Article
Rural Telehealth Research Center
Date: 02/2020
Acute myocardial infarction (AMI) is a common, deadly emergency requiring rapid diagnosis and treatment. In this rural cohort, emergency department-based telemedicine was associated with improved timeliness of electrocardiogram and fibrinolysis. This study adds to evidence that telemedicine can improve timeliness of AMI care in rural hospitals.
Provider-to-Provider Telemedicine Improves Adherence to Sepsis Bundle Care in Community Emergency Departments
Journal Article
Rural Telehealth Research Center
Date: 01/2020
Sepsis is a life-threatening emergency, and timely "bundled" care improves survival. In this rural cohort, telemedicine in the emergency department (tele-ED) improved sepsis bundle adherence, including timely fluid resuscitation and antibiotic administration. Tele-ED may be a scalable intervention to improve sepsis emergency care in rural EDs.

2019

Emergency Department Telemedicine Consults Decrease Time to Interpret Computed Tomography of the Head in a Multi-Network Cohort
Journal Article
Rural Telehealth Research Center
Date: 11/2019
This was a study of emergency telemedicine (tele-ED) for stroke care in four tele-ED networks. Tele-ED was associated with decreased time to diagnostic imaging interpretation and time to thrombolytic medication. The effect of tele-ED varied by network, suggesting network characteristics may influence the realized tele-ED benefit for stroke care.
2019 Wage Index Differences and Selected Characteristics of Rural and Urban Hospitals
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 05/2019
This brief characterizes rural/urban disparities in the 2019 Centers for Medicare & Medicaid Services hospital wage index by describing and comparing the wage indices of rural and urban hospitals by the number of beds, the amount of net patient revenue, and Medicare payment classification.
Rural/Urban and Regional Variation in the 2019 CMS Hospital Wage Index
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 05/2019
This brief describes the geographic variation of the 2019 Centers for Medicare & Medicaid Services hospital wage index by rural/urban definition, census region, Frontier and Remote Area codes and state.
Geographic Variation in the 2019 Risk of Financial Distress Among Rural Hospitals
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 04/2019
This brief investigates 2019 geographic variation in risk of financial distress among rural hospitals.
Trends in Risk of Financial Distress Among Rural Hospitals, 2015 to 2019
Policy Brief
Rapid Response to Requests for Rural Data Analysis
Date: 04/2019
This brief investigates 2015 to 2019 trends in risk of financial distress among rural hospitals by census region and Medicare payment classification.

2018

Trends in Hospital System Affiliation, 2007-2016
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2018
This policy brief updates a RUPRI Center brief published in 2014 and documents the continued growth in system affiliation by both metropolitan and non-metropolitan hospitals.
Telestroke Adoption Among Community Hospitals in North Carolina: A Cross-Sectional Study
Journal Article
Rural Telehealth Research Center
Date: 05/2018
This study identifies community and hospital characteristics associated with the adoption of telestroke among acute care hospitals in North Carolina.

2017

Improving Access to High Quality Sepsis Care in a South Dakota Emergency Telemedicine Network
Policy Brief
Rural Telehealth Research Center
Date: 08/2017
This brief describes an implementation initiative designed to increase use of emergency department-based telemedicine consultation for patients with severe sepsis or septic shock. This initiative is the first step of an analysis to estimate the effect of telemedicine on sepsis care and outcomes.

2016

Telemedicine Penetration and Consultation Among Rural Trauma Patients in Critical Access Hospital Emergency Departments in North Dakota
Policy Brief
Rural Telehealth Research Center
Date: 09/2016
This study describes the penetration of ED-based telemedicine in North Dakota critical access hospitals and its use for rural trauma patients. Investigators showed that telemedicine subscription increased to 81 percent of rural North Dakota hospitals, and 11 percent of patients in a telemedicine-capable ED used telemedicine as part of their care.
2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2016
The profitability of urban hospitals to that of rural hospitals are compared for fiscal years 2012-2014 based on size and rural Medicare payment classifications.
Geographic Variation in the Profitability of Urban and Rural Hospitals
Policy Brief
North Carolina Rural Health Research and Policy Analysis Center
Date: 03/2016
Historic and recent evidence suggest that unprofitability can reduce hospital services and quality, or worse, lead to closure. This study describes the current geographic variability of hospital profitability by comparing the 2014 profitability of CAHs, other rural hospitals, and urban hospitals by census region, census division, and state.

2015

Rural Bypass for Elective Surgeries
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 11/2015
Describes the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distribution of volume among Critical Access Hospitals (CAHs) that offer elective surgical services, and factors predictive of bypass.
The Rising Rate of Rural Hospital Closures
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 07/2015
Discusses the increase in rural hospital closure rates, including the causes of closures and its impact on rural communities.
Minimum Distance Requirements Could Harm High-Performing CAHs and Rural Communities
Journal Article
North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
Date: 04/2015
Compares the effect of location on critical access hospitals' size, quality of care, and financial strength. Discusses implications of minimum distance requirements on critical access hospitals.
Surgical Services in Critical Access Hospitals, 2011
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2015
This brief describes the types and volume of major surgical services provided in critical access hospitals across four regionally representative states in 2011.
Financially Fragile Hospitals: Mergers and Closures
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 01/2015
Evaluates the causes of financial stress in rural hospitals, and describes the impact rural hospitals have on their communities. Also discusses the ways in which rural hospitals and communities have responded to this financial stress.
The Effect of Surgery on the Profitability of Rural Hospitals
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 2015
Presents research on the effect of providing surgery in rural hospitals. Examines the availability of surgery's effect on trauma outcomes and economies in rural communities.

2013

Change in Profitability and Financial Distress of Critical Access Hospitals From Loss of Cost-Based Reimbursement
Rapid Response to Requests for Rural Data Analysis
Date: 12/2013
Changes to Critical Access Hospitals' reimbursement, such as a reversion to prospective payment, would have marked negative effects on CAHs. About three quarters of CAHs would operate at a loss. The number of CAHs at high risk for financial distress would nearly triple, and nearly half would be at medium-high to high risk of financial distress.
Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close
Rapid Response to Requests for Rural Data Analysis
Date: 12/2013
Changes to Critical Access Hospitals' reimbursement may spur some to close. This analysis considers the communities served by the 93 CAHs with the lowest profitability and therefore most likely to close due to a change in Medicare reimbursement.

2012

Quality Reporting for CAHs and Rural PPS Hospitals: The Potential Impact of Composite Measures
Policy Brief
Upper Midwest Rural Health Research Center
Date: 07/2012
As a part of a larger project that examined alternative ways of identifying high quality rural hospitals, this report assesses the use of composite scores for public reporting of quality measures as one way of addressing the low volume issue for small rural hospitals.

2011

Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 (Final Report)
Rapid Response to Requests for Rural Data Analysis
Date: 04/2011
This report provides descriptive evidence on current trends in the availability and use of swing beds and skilled nursing facility services in rural areas.

2010

Community Benefit Activities of Critical Access Hospitals, Non-Metropolitan Hospitals and Metropolitan Hospitals: National and State Data (State reports)
Maine Rural Health Research Center
Date: 03/2010
Quality, financial, and community benefit indicators of critical access hospital (CAH) performance are being analyzed by the Flex Monitoring Team. Here, state-level data on performance of CAHs in each state are summarized.
Monitoring the Community Benefits of CAHs: A Review of the Data (Briefing Paper)
Maine Rural Health Research Center
Date: 03/2010
There is a growing national interest in the benefits provided by nonprofit and public hospitals to their communities in exchange for the tax benefits or public funding that they receive.
Monitoring the Community Benefits of Critical Access Hospitals: A Review of the Data
Policy Brief
Maine Rural Health Research Center
Date: 03/2010
This brief examines the community benefit activities of critical access hospitals (CAHs) using data from the Flex Monitoring Team's (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service's (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.

2008

Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
NORC Walsh Center for Rural Health Analysis
Date: 10/2008
This brief presents research conducted to better understand critical access hospitals' (CAHs') experiences in operating emergency medical service (EMS) units. The benefits and challenges that CAH providers face in operating EMS services are discussed.
Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services (Final Report)
NORC Walsh Center for Rural Health Analysis
Date: 08/2008
This study examined Medicare Cost Report and claims data for hospitals before and after critical access hospital (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.
Critical Access Hospitals' Experience With Medicare Advantage Plans
NORC Walsh Center for Rural Health Analysis, RUPRI Center for Rural Health Policy Analysis
Date: 03/2008
This report details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage plans.

2007

Intensive Care in Critical Access Hospitals
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 2007
Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.
Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
Journal Article
FORHP-funded Individual Grantees
Date: 2007
Describes the results of a study to assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.
Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
Journal Article
Maine Rural Health Research Center
Date: 2007
Describes the results of a study investigating the use of critical access hospital (CAH) emergency rooms by patients with mental health problems to understand the role these facilities play in rural mental health needs and the challenges they face.
Variations in Financial Performance Among Peer Groups of Critical Access Hospitals
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 2007
Reports findings from a study that investigated whether indicators of financial performance and condition systematically vary among peer groups of Critical Access Hospitals (CAHs).

2006

Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
Upper Midwest Rural Health Research Center
Date: 10/2006
This report analyzes critical access hospital inpatient hospitalizations and transfers and assesses the implications for national quality measurement and reporting.
Quality and Performance Improvement Grant Activities Under the Flex Program
Maine Rural Health Research Center
Date: 08/2006
This paper describes quality and performance improvement activities proposed by states during the 2005 grant year under the Medicare Rural Health Flexibility Program.
Creating Program Logic Models: A Toolkit for State Flex Programs
Maine Rural Health Research Center
Date: 04/2006
This is a tool for planning, managing, reporting on, and assessing Flex Program goals, activities, and accomplishments; assistance in identifying/defining measurable outcomes; information linking state-level Flex Program strategies to measurable outcomes; and a consistent program-reporting framework to share results internally and externally.

2005

Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
Maine Rural Health Research Center
Date: 09/2005
This survey investigates the extent and types of cases that present with mental health problems in critical access hospital emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to these patients.
Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
Maine Rural Health Research Center
Date: 03/2005
Three years of data were used to examine services offered by critical access hospitals (CAHs). The authors investigated how the services offered by CAHs have changed, the role of network affiliations in the changes, and the reasons administrators gave for reported service expansions. They also looked at how services in CAHs have changed over time.

2004

Comparative Performance Data for Critical Access Hospitals
Journal Article
Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
Date: 2004
Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.

2003

Survey of Critical Access Hospital (CAH)-Affiliated Emergency Medical Service (EMS) Providers
NORC Walsh Center for Rural Health Analysis
Date: 09/2003
This survey provides a description of emergency medical services providers in rural communities, particularly those with critical access hospitals.

2001

Rural Hospital Flexibility Program: The Tracking Project Reports First-Year Findings
Journal Article
WWAMI Rural Health Research Center
Date: 2001
In 1999, the Rural Hospital Flexibility Program National Tracking Team made site visits to 24 critical access hospitals (CAHs) in order to determine the extent of program implementation in the states and the approaches that states, hospitals, and communities are taking in using the Flex Program to achieve improvements in rural healthcare.