Rural Health
Research Gateway

Critical Access Hospitals (CAHs)

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2024

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.
  • Factors Associated With Lengths-of-Stay for Inpatients With Substance Use Disorders
    Policy Brief
    Rural Health Equity Research Center
    Date: 04/2023
    This policy brief identifies factors associated with inpatient length-of-stay (LOS) for the treatment of substance use disorders (SUDs), and whether there are systematic differences in LOS for rural and urban residents.

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

2020

2019

2018

2017

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.
  • State Variations in the Rural Obstetric Workforce
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    Many types of staff are necessary to successfully run an obstetrics unit. Rural hospitals face unique staffing challenges. This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
  • 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

  • Estimated Costs of Rural Freestanding Emergency Departments
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2015
    A rural freestanding emergency department (RFED) is one potential model for providing emergency services in areas where hospitals have closed. The North Carolina Rural Health Research Program's Findings Brief, Estimated Costs of Rural Freestanding Emergency Departments explains the RFED concept and estimates RFED costs in three scenarios.
  • 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.
  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2015
    This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals and analyzes current patterns of non-local delivery by rural women's health insurance status and residential rurality.
  • A Comparison of Closed Rural Hospitals and Perceived Impact
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 04/2015
    This policy brief compares selected characteristics of abandoned rural hospitals and their markets to those of converted rural hospitals.
  • 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.
  • The 21st Century Rural Hospital: A Chart Book
    Chartbook
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2015
    This chartbook presents a broad profile of rural hospitals and includes information on location, who they serve, services they provide, how they ensure outpatient services for their communities, other community benefits they provide, and financial performance. Each page includes charts comparing rural hospitals to each other and to urban hospitals.
  • Do Current Medicare Rural Hospital Payment Systems Align With Cost Determinants?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2015
    To inform policy discussions on how complex current payment models may affect rural hospitals, the North Carolina Rural Health Research Program studied differences in financial condition among rural hospitals and important determinants of differences in rural hospital costs.
  • 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.

2014

  • The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014
    This brief details rural hospital obstetric staffing patterns in nine states by critical access hospital status. The purpose was to examine obstetric practice models in rural hospitals, providing information to rural hospitals with obstetric care units regarding workforce and informing policymakers about the context in which the hospitals operate.
  • Does Rurality Affect Observation Care Services Use in CAHs for Medicare Beneficiaries?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2014
    This brief describes the use of observation services across levels of rurality by Medicare beneficiaries in critical access hospitals, the demographics and health status of patients receiving these services, and the characteristics of their observation stays.
  • Which Medicare Patients Are Transferred From Rural Emergency Departments?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2014
    A brief from the University of Minnesota Rural Health Research Center analyzes transfers of Medicare beneficiaries who received emergency care in a critical access hospitals or rural hospitals and were transferred to other hospitals for care.
  • Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 02/2014
    This brief examines health conditions of patients discharged from rural prospective payment system (PPS) hospitals and critical access hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs).

2013

2012

2011

2010

2008

2007

  • State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 10/2007
    This report explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural healthcare infrastructure and discusses which activities were considered most successful by state Flex coordinators.
  • Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2007
    This policy brief examines the second-year participation and quality measure results for critical access hospitals in the Centers for Medicare and Medicaid Services Hospital Compare public reporting database.
  • Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results: Briefing Paper
    University of Minnesota Rural Health Research Center
    Date: 04/2007
    This brief examines the second-year participation and quality measure results for critical access hospitals in the Centers for Medicare and Medicaid Services Hospital Compare public reporting database for hospital quality measures.
  • State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program (Policy Brief)
    Policy Brief
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2007
    To understand the priorities/accomplishments of state Flex Grant Programs, the Flex Monitoring Team asked Flex coordinators to identify and discuss their states' three most successful initiatives in the last two years. Interviews were conducted with Flex coordinators and State Office of Rural Health staff in 45 states.
  • Rural Hospital Emergency Department Quality Measures: Aggregate Data Report
    University of Minnesota Rural Health Research Center
    Date: 03/2007
    This report shares findings from a project testing emergency department (ED) quality measures in critical access hospitals in Washington state. The quality measures focused on patients presenting to the ED with chest pain/acute myocardial infarction or trauma and patients seen in the ED who were transferred to another hospital for care.
  • The Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 02/2007
    This policy brief discusses the findings of a project to understand the community involvement and impact of critical access hospitals and the Medicare Rural Hospital Flexibility Program (Flex Program).
  • Exploring the Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 01/2007
    This paper reports on a series of site visits to six diverse rural communities and critical access hospitals to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs.
  • 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

2005

  • Contracting With Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
    Policy Brief
    NORC Walsh Center for Rural Health Analysis, North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 12/2005
    This policy brief summarizes the experience of critical access hospital (CAH) administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans.
  • 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.
  • Financial Indicators for Critical Access Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2005
    The purpose of this study was to develop and disseminate comparative financial indicators specifically for critical access hospitals using Medicare Cost Report data.
  • The Availability and Use of Capital by Critical Access Hospitals
    University of Minnesota Rural Health Research Center
    Date: 03/2005
    This paper examines the experiences of critical access hospitals (CAHs) in meeting their capital needs. It focuses on their efforts to obtain capital, the capital sources tapped through these efforts and how CAHs have used the capital they have been able to obtain over the last few years and assesses their current capital needs.
  • Community Involvement of Critical Access Hospitals: Results of the 2004 National CAH Survey
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    This report provides a start for understanding critical access hospital (CAH) community involvement. Data were collected and analyzed from a survey of CAH administrators conducted in 2004. Respondents were asked about community involvement activities, such as community needs assessments and hospital activities supporting special populations.
  • 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

  • Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    This paper describes the patient safety results from a 2004 survey of critical access hospital administrators.
  • Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
    University of Minnesota Rural Health Research Center
    Date: 09/2004
    This paper describes quality improvement efforts in critical access hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. It includes data on the use of clinical guidelines and quality measures in CAHs and the role of Medicare Quality Improvement Organizations.
  • 2004 CAH Survey National Data
    University of Minnesota Rural Health Research Center
    Date: 08/2004
    The Flex Monitoring Team conducted a national survey of critical access hospital (CAH) administrators between January and April 2004. The survey's purpose was to document program-related experiences of CAHs during the last two years to help shape public policy to improve the effectiveness of the Flex Program and CAHs.
  • A Synthesis of State Flex Program Plans 2003-2004
    University of Minnesota Rural Health Research Center
    Date: 05/2004
    This paper highlights recent trends in the development and implementation of state Flex Programs, whose goal is to strengthen the rural healthcare infrastructure using critical access hospitals as the hub of organized, local systems of care.
  • The Financial Benefits of Critical Access Hospital Conversion for FY 1999 and FY 2000 Converters
    University of Minnesota Rural Health Research Center
    Date: 01/2004
    This paper discusses the impact of conversion to critical access hospital (CAH) status on the financial condition of rural hospitals one and two years after conversion. CAHs pre- and post-conversion revenues are compared, and CAH revenues are compared to small rural hospitals that did not convert to cost-based Medicare reimbursement.
  • Quality Improvement Strategies and Best Practices in Critical Access Hospitals
    University of Minnesota Rural Health Research Center
    Date: 01/2004
    This paper describes critical access hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. It includes lists of changes made to staffing, training, equipment, and other issues related to QI.
  • 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

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.

2000