Rural Health
Resources by Topic: Critical Access Hospitals
Average Salary Expense in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Examines and compares wage patterns of Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals as related to the Low Wage Index Policy (LWIP) in effect from 2020-2022. Utilizes hospital data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) between 2018 and 2022 and analyzes median salaries. Discusses the impact of Medicare payments and LWIP on hospitals.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Examines and compares wage patterns of Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals as related to the Low Wage Index Policy (LWIP) in effect from 2020-2022. Utilizes hospital data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) between 2018 and 2022 and analyzes median salaries. Discusses the impact of Medicare payments and LWIP on hospitals.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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2025 National CAH Quality Inventory & Assessment National Report
Presents a high-level summary of key data points from the September-November 2025 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; median swing bed admissions and swing bed length of stay; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; CAH quality payment model participation; and CAH quality improvement topic priorities.
Author(s): Madeleine Pick, Robert Barclay
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Presents a high-level summary of key data points from the September-November 2025 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; median swing bed admissions and swing bed length of stay; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; CAH quality payment model participation; and CAH quality improvement topic priorities.
Author(s): Madeleine Pick, Robert Barclay
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Strategies for Critical Access Hospital Financial and Operational Performance Improvement: A Systematic Review
Summarizes findings from a systematic review of peer-reviewed and grey literature published since 2000 regarding financial and operational performance improvement interventions implemented by Critical Access Hospitals (CAHs) and rural hospitals in the United States and in other developed countries. Identifies key intervention areas, including service line optimization, revenue and cost management, and technology adoption, among others. Describes how State Flex Programs and hospital administrators can use these findings to inform decision-making and resource allocation.
Author(s): Angelina Budko, Laura Bozovich McFadyen, Carrie Baldwin-SoRelle, et al.
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Summarizes findings from a systematic review of peer-reviewed and grey literature published since 2000 regarding financial and operational performance improvement interventions implemented by Critical Access Hospitals (CAHs) and rural hospitals in the United States and in other developed countries. Identifies key intervention areas, including service line optimization, revenue and cost management, and technology adoption, among others. Describes how State Flex Programs and hospital administrators can use these findings to inform decision-making and resource allocation.
Author(s): Angelina Budko, Laura Bozovich McFadyen, Carrie Baldwin-SoRelle, et al.
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Trends in Inpatient Revenue and Volume Among Critical Access Hospitals
Examines trends in Critical Access Hospital (CAH) revenue and volume between 2017 and 2024. Presents data on average outpatient-to-total revenue and mean average daily census among CAHs each year by CAH urban or rural location, region, profit status, and system affiliation.
Author(s): Tyler Malone, Angelina Budko
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Examines trends in Critical Access Hospital (CAH) revenue and volume between 2017 and 2024. Presents data on average outpatient-to-total revenue and mean average daily census among CAHs each year by CAH urban or rural location, region, profit status, and system affiliation.
Author(s): Tyler Malone, Angelina Budko
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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A Chartbook on the Characteristics and Needs of Frontier Critical Access Hospitals
Summarizes findings from a 2025 national survey of executives from 117 Critical Access Hospitals (CAHs) in frontier counties. Includes data on the distribution and characteristics of frontier CAHs. Identifies themes related to financial and operational challenges, service availability, and access to care in frontier settings.
Author(s): John A. Gale, Rebecca Stearns, Zachariah Croll, Jayne Foley
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Summarizes findings from a 2025 national survey of executives from 117 Critical Access Hospitals (CAHs) in frontier counties. Includes data on the distribution and characteristics of frontier CAHs. Identifies themes related to financial and operational challenges, service availability, and access to care in frontier settings.
Author(s): John A. Gale, Rebecca Stearns, Zachariah Croll, Jayne Foley
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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Location of Critical Access Hospitals
U.S. map showing Critical Access Hospitals (CAHs). Updated quarterly.
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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U.S. map showing Critical Access Hospitals (CAHs). Updated quarterly.
Date: 04/2026
Sponsoring organization: Flex Monitoring Team
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National Health Service Corps Site Reference Guide
Provides clarification for National Health Service Corps (NHSC) sites regarding eligibility requirements, qualification factors, compliance, roles and responsibilities, and other factors for becoming an NHSC approved site. Acts as a supplemental resource to the information provided in the online NHSC Site Application.
Date: 04/2026
Sponsoring organization: Health Resources and Services Administration
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Provides clarification for National Health Service Corps (NHSC) sites regarding eligibility requirements, qualification factors, compliance, roles and responsibilities, and other factors for becoming an NHSC approved site. Acts as a supplemental resource to the information provided in the online NHSC Site Application.
Date: 04/2026
Sponsoring organization: Health Resources and Services Administration
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Michigan Rural Maternal Health Environmental Scan: Final Report
Provides an overview of maternal health in rural Michigan. Includes information on challenges, innovations, and policy opportunities in Critical Access Hospitals (CAHs); hospital and emergency obstetric readiness; Alliance for Innovation on Maternal Health (AIM) initiatives; and supporting access to maternal healthcare.
Date: 03/2026
Sponsoring organization: Michigan Center for Rural Health
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Provides an overview of maternal health in rural Michigan. Includes information on challenges, innovations, and policy opportunities in Critical Access Hospitals (CAHs); hospital and emergency obstetric readiness; Alliance for Innovation on Maternal Health (AIM) initiatives; and supporting access to maternal healthcare.
Date: 03/2026
Sponsoring organization: Michigan Center for Rural Health
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Characterizing Early Adopters of the Rural Emergency Hospital Designation
Compares 42 hospitals that have received Rural Emergency Hospital (REH) designations to the 447 REH-eligible hospitals that have not converted to identify characteristics of early converters. Characteristics evaluated include Critical Access Hospital status, ownership and affiliations, healthcare utilization, staffing, available services, and finances.
Author(s): Jonah M. Graves, R.J. Waken, Fengxian Wang, Paula Chatterjee, Karen E. Joynt Maddox
Citation: Health Affairs Scholar, 4(3)
Date: 03/2026
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Compares 42 hospitals that have received Rural Emergency Hospital (REH) designations to the 447 REH-eligible hospitals that have not converted to identify characteristics of early converters. Characteristics evaluated include Critical Access Hospital status, ownership and affiliations, healthcare utilization, staffing, available services, and finances.
Author(s): Jonah M. Graves, R.J. Waken, Fengxian Wang, Paula Chatterjee, Karen E. Joynt Maddox
Citation: Health Affairs Scholar, 4(3)
Date: 03/2026
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An Examination of All-Payer Inpatient Rural Hospital Bypass
Examines the extent to which rural patients bypassed their nearest rural hospital for inpatient care in eight states. Analyzes data on inpatient hospital admissions for rural residents of these states using the 2018 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Identifies factors associated with hospital-level bypass rates by patient and hospital characteristics.
Author(s): Craig D. Holden, Shena Popat, Alana Knudson, Marilyn G. Klug
Date: 03/2026
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Examines the extent to which rural patients bypassed their nearest rural hospital for inpatient care in eight states. Analyzes data on inpatient hospital admissions for rural residents of these states using the 2018 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Identifies factors associated with hospital-level bypass rates by patient and hospital characteristics.
Author(s): Craig D. Holden, Shena Popat, Alana Knudson, Marilyn G. Klug
Date: 03/2026
Sponsoring organization: ETSU/NORC Rural Health Research Center
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