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Critical Access Hospitals (CAHs) – Resources

Selected recent or important resources focusing on Critical Access Hospitals (CAHs).

Hospital Compare Quality Measure Results for CAHs, 2017
Examines Hospital Compare inpatient and outpatient process of care and structural measures among Critical Access Hospitals (CAHs) in 2017. Includes data on reporting rates and performance for specific quality measures, and state-by-state comparison of CAH reporting rates for inpatient and outpatient measures.
Additional links: State-Specific Reports
Author(s): Megan Lahr, Tongtan Chantarat, Mariah Quick, Ashleigh Norris, Ira Moscovice
Date: 04/2019
Type: Document
Sponsoring organization: Flex Monitoring Team
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Electronic Capabilities for Patient Engagement among U.S. Non-Federal Acute Care Hospitals: 2013-2017
Describes hospital trends regarding patients' ability to view, download, and transmit (VDT) electronic health information and other capabilities related to online patient engagement. Provides data and analysis by hospital type, including Critical Access Hospitals (CAHs) and rural hospitals, on the percent of: hospitals where patients can VDT their health data electronically; active patient portals; and hospitals offering electronic capabilities to their patients, such as refill requests, bill pay, and other services.
Author(s): JaWanna Henry, Wes Barker, Lolita Kachay
Date: 04/2019
Type: Document
Sponsoring organization: Office of the National Coordinator for Health Information Technology
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Recorded Webinar: The ABCs of Antibiotic Stewardship
Provides a webinar recording addressing antibiotic stewardship for Critical Access Hospitals. Focuses on the core elements of antibiotic stewardship, the related Medicare Beneficiary Quality Improvement Project (MBQIP) measure for CAHs, and the current performance of Oklahoma's CAHs on antibiotic stewardship implementation.
Date: 03/2019
Type: Video/Multimedia
Sponsoring organizations: Oklahoma State University Center for Rural Health, Stratis Health
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2017 National and State Healthcare-Associated Infections Progress Report
Examines progress on reducing health-care associated infection rates for 6 types of infections in 4 types of hospitals using data from the National Healthcare Safety Network. Compares observed versus expected infection rates using 2015 baseline data with standardized infection ratios (SIR) and use of ventilators, urinary catheters, and central lines using standardized utilization ratios (SURs). Includes national and state data tables on SIR and SUR for Critical Access Hospitals.
Date: 03/2019
Type: Website
Sponsoring organization: Centers for Disease Control and Prevention
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Facility-Based Ambulatory Care Provided to Rural Medicare Beneficiaries in 2014
Chartbook describing claims, costs, and common diagnoses in facility-based ambulatory care provided to rural Medicare patients. Features statistics in various categories with breakdowns by Federally Qualified Health Centers in rural and urban areas, Rural Health Clinics, Critical Access Hospitals, and Prospective Payment Systems in rural and urban areas.
Author(s): Alex R. Schulte, Denise A. Kirk, Kristie W. Thompson, George H. Pink
Date: 03/2019
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Report to Congress on Medicaid and CHIP, March 2019
Reports on three aspects of Medicaid: improving the structure of Disproportionate Share Hospital (DSH) payment reductions, oversight of upper payment limits for supplemental payments to hospitals, and Disproportionate Share Hospital (DSH) payments to states. Chapter 3 includes the third annual report on DSH payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Table 3-1 identifies DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2019
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Critical Access Hospital Requirements: CMS Emergency Preparedness Final Rule
Provides a reference source for Critical Access Hospital (CAH) requirements related to the final rule from Centers for Medicare & Medicaid Services (CMS), "Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers." Includes excerpts from the final rule as well as related CMS interpretive guidelines for CAHs. Addresses development of an emergency plan, related policies and procedures, communications, training, and more.
Date: 03/2019
Type: Document
Sponsoring organization: Office of the Assistant Secretary for Preparedness and Response
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Implementation and Early Results of the Flex Program's Innovative Models Program Area: Final Evaluation Report
Reports on the implementation of the Flex Program and the integration of the Innovative Health Care Models (Innovative Projects) program area in 7 states focused on telehealth, care coordination, and quality improvement. Highlights lessons learned, program discussion, and the evaluation methods for each of the projects. Builds on a 2018 briefing paper, An Interim Evaluation Report of the Innovative Projects Portfolio of the Medicare Flex Grant Program.
Author(s): John A. Gale, Sara Kahn-Troster, Andrew Coburn
Date: 03/2019
Type: Document
Sponsoring organization: Flex Monitoring Team
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Illinois Critical Access Hospitals: Exploring the Financial Impacts of the Swing Bed Program
Examines the swing bed program in 30 Illinois Critical Access Hospitals (CAHs) by analyzing financial indicators, patient outcomes, and community benefits. Includes background information on the swing bed program and data on rural Illinois. Covers demographic statistics for metro and nonmetro counties in 2010 and 2016.
Author(s): Melissa Henriksen, Brian Richard, Jeanna Ballard
Date: 02/2019
Type: Document
Sponsoring organizations: Illinois Critical Access Hospital Network, Northern Illinois University Center for Governmental Studies
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Improving Rural Systems of Care for Time Critical Diagnoses: A Review of State Flex Program Activities
Examines state Flex program initiatives to improve time critical diagnoses (TCD) care systems and integrate rural emergency medical services (EMS) into area care systems, particularly Critical Access Hospitals (CAHs). Briefly describes what each of the 17 participating states did to collaborate with EMS stakeholders, enhance TCD capacity, support EMS training, provide technical assistance to local EMS agencies, and collect EMS and TCD data.
Author(s): John A. Gale, Karen Pearson
Date: 01/2019
Type: Document
Sponsoring organization: Flex Monitoring Team
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MBQIP Measures Fact Sheets
Discusses the federal data collection and reporting process for Medicare Beneficiary Quality Improvement Project (MBQIP) Core Measures and MBQIP Additional Measures to help Critical Access Hospitals (CAH) and state Flex Program personnel involved in quality improvement. The measures address patient safety, patient engagement, care transitions, and outpatient care.
Date: 01/2019
Type: Document
Sponsoring organization: Stratis Health
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Patients’ Experiences in CAHs: HCAHPS Results, 2017
Shares results from the calendar year 2017 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, summarizing reporting rates and performance among all U.S. Critical Access Hospitals (CAHs). Includes detailed tables that allow state-by-state comparison of response rates and overall CAH performance.
Author(s): Mariah Quick, Tongtan Chantarat, Ashleigh Norris, Ira Moscovice
Date: 01/2019
Type: Document
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: 01/2019
Type: Map/Mapping System
Sponsoring organization: Flex Monitoring Team
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Critical Access Hospitals (CAHs)
Printable map that shows the location of Critical Access Hospitals (CAHs) nationwide by state. Data source: data.HRSA.gov, U.S. Department of Health and Human Services
Date: 01/2019
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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Critical Access Hospitals’ Community Benefit Activities: An Updated Review
Examines community benefit data from a sample of Critical Access Hospitals (CAHs) to understand how they are fulfilling their community benefit obligations, including related spending. Discusses how state Flex programs can help CAHs meet their community benefit obligations and the related Internal Revenue Service (IRS) requirements. Second of two briefs reporting project results.
Author(s): John A. Gale, Zachariah Croll, Lauren Zoll, Andrew F. Coburn
Date: 12/2018
Type: Document
Sponsoring organization: Flex Monitoring Team
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Critical Access Hospital eCQM Resource List
Resource list for electronic clinical quality measures (eCQMs), reflecting new materials and updates from the Centers for Medicare & Medicaid Services for 2018 reporting.
Date: 11/2018
Type: Document
Sponsoring organization: Stratis Health
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Trends in Hospital System Affiliation, 2007-2016
Policy brief reporting trends in hospital system affiliation from 2007 to 2016 for hospitals in metro and nonmetro areas, and Critical Access Hospitals (CAHs). Offers characteristic statistics by hospital type and affiliation and highlights trends in hospital system affiliation by Census region.
Author(s): Onyinye Oyeka, Fred Ullrich, Keith Mueller
Date: 10/2018
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Critical Access Hospitals’ Community Health Needs Assessments and Implementation Plans: How Do They Align?
Examines how Critical Access Hospitals (CAHs) are using community health needs assessments to improve population health. Highlights common community health issues identified by the needs assessments, types of strategies CAHs used to address them, and ways to improve on their efforts to meet community needs. Discusses what state Flex programs can do to support CAHs in their work and includes a list of resources to help CAHs.
Author(s): John A. Gale, Zachariah Croll, Lauren Zoll, Andrew F. Coburn
Date: 10/2018
Type: Document
Sponsoring organization: Flex Monitoring Team
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Critical Access Hospital: 2019 National Patient Safety Goals
Identifies National Patient Safety Goals for the Joint Commission's Critical Access Hospital Accreditation Program. Covers patient identification accuracy, staff communication, infection prevention, medication safety, and more.
Additional links: Simplified Version
Date: 10/2018
Type: Document
Sponsoring organization: Joint Commission
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Medicare Payment Basics: Critical Access Hospitals Payment System
Presents an overview of Medicare payments for Critical Access Hospitals (CAHs). Compares differences in Medicare payments for CAHs, Sole Community Hospitals, and Medicare-Dependent Hospitals.
Date: 10/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress: Demonstration Project on Community Health Integration Models in Certain Rural Counties, Interim Report 2018
Provides an overview of and first year findings from the Frontier Community Health Integration Project Demonstration (FCHIP), which includes 10 Critical Access Hospitals (CAHs) in three states: North Dakota, Montana, and Nebraska. The demonstration intends to increase the quality and coordination of care, with focuses on access to and payments for telehealth, ambulance services, and skilled nursing facility/nursing facility beds, as well as related regulatory challenges.
Date: 09/2018
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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2018 Rural Hospital and Clinic Financial Summit Report: Key Financial Success Indicators and Strategies
Identifies the indicators of financial success for hospitals and clinics, provides strategies to transition into value-based payment models, and includes success stories from Summit participants and resources necessary for hospitals and clinics. Includes a table showing Critical Access Hospital financial indicators medians for 2016.
Date: 07/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Small Rural Hospital and Clinic Finance 101
Provides a manual with introductory information on healthcare facility finances and payment for state Medicare Rural Hospital Flexibility (Flex) Program personnel, and Critical Access Hospital (CAH) and Rural Health Clinic (RHC) board members.
Date: 07/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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2018 Flex Program Reverse Site Visit
Details the Flex Program's Reverse Site Visit meeting held on July 17-18, 2018 for grantees of the Medicare Rural Hospital Flexibility (Flex) Program and the Small Health Care Provider Quality Improvement Program (SHCP). Includes learning objectives and materials related to the meeting, including links to each presentation's slides. Presentations cover federal program activities, policy updates, and examples of program initiatives from several states.
Date: 07/2018
Type: Website
Sponsoring organization: National Rural Health Resource Center
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Together We Can Be Bully Free: CAH and Law Enforcement Address Peer Victimization through School-Based Program
Highlights an anti-bullying program developed by Union General Hospital, a Critical Access Hospital (CAH) in Union Parish, Louisiana. Describes how the hospital and local law enforcement collaborate to teach elementary, middle, and high school students about the negative effects bullying and how to model positive social behavior.
Author(s): Jenn Lukens
Citation: Rural Monitor
Date: 07/2018
Type: Document
Sponsoring organization: Rural Health Information Hub
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MBQIP Fundamentals Guide for State Flex Programs
Provides information about the history and status of the Medicare Beneficiary Quality Improvement Project (MBQIP). Developed for the benefit of Flex Program personnel and subcontractors and includes resources to support their work, including data report release timelines, MBQIP acronyms, and several summaries of required quality measures changes.
Date: 07/2018
Type: Document
Sponsoring organization: Stratis Health
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Quality Peer Group Indicators for Critical Access Hospitals
Describes the results of a study to identify Critical Access Hospital (CAH) peer groups for the purposes of analyzing quality performance indicators.
Author(s): Michelle Casey, Ira Moscovice, Peiyin Hung
Date: 07/2018
Type: Document
Sponsoring organization: Flex Monitoring Team
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Availability of Respiratory Care Services in Critical Access and Rural Hospitals
Policy brief describing availability of respiratory therapy and therapists in Critical Access Hospitals and in urban and rural Prospective Payment System hospitals. Includes statistics with breakdowns by hospital type and rural or urban location.
Author(s): Michelle Casey, Alex Evenson, Ira Moscovice, Zhengtian Wu
Date: 06/2018
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
Findings brief describing how uncompensated hospital care varies across regions of the country, using data from the 2014-2016 Medicare Cost Report Worksheet S-10. Features statistics including breakdowns by Critical Access Hospitals, other rural hospitals, and urban hospitals.
Author(s): Krystal G. Garcia, Kristie Thompson, Hilda A. Howard, George H. Pink
Date: 06/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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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 as NHSC approved site. Acts as a supplemental resource to the information provided in the online NHSC Site Application.
Date: 06/2018
Type: Document
Sponsoring organization: Health Resources and Services Administration
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National Quality Reporting Crosswalk for CAHs
Provides users with information about Critical Access Hospital (CAH) quality reporting initiatives occurring on a national level, including purpose, measures used, and any overlap in measures across initiatives.
Date: 05/2018
Type: Document
Sponsoring organization: Stratis Health
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Stroke Care Quality Improvement Initiatives in Critical Access Hospitals
Highlights successful evidenced-based programs implemented by Critical Access Hospitals (CAHs) and other rural hospitals to improve stroke care. Reviews key program elements, quality improvement stroke data measures, and CAH participation for state-level initiatives and covers national stroke care quality improvement initiatives.
Author(s): Megan Lahr
Date: 05/2018
Type: Document
Sponsoring organization: Flex Monitoring Team
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Ensuring Access in Vulnerable Communities: The Rural Emergency Medical Center Act of 2018
Provides an overview of the Rural Emergency Medical Center Act of 2018, which if approved, would create a new Medicare designation to allow certain hospitals to transition to a 24/7 emergency medical center with enhanced reimbursement and require them to have protocols for transport of patients to higher-level inpatient facilities if needed.
Date: 05/2018
Type: Document
Sponsoring organization: American Hospital Association
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Critical Access Hospital Swing-Bed Quality Measures: Findings from Key Informant Interviews
Results of a study to examine how Critical Access Hospitals (CAHs) are assessing the quality of care given to swing bed patients. Uses data from interviews with representatives from CAH networks, consultants, and staff members responsible for swing bed services at 10 CAHs and 2 rural PPS hospitals in 10 states.
Author(s): Michelle Casey, Ira Moscovice, Henry Stabler
Date: 04/2018
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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CAH Financial Indicators Report: Summary of Indicator Medians by State
Presents state and national median values of 22 financial indicators included in the CAH Financial Indicators Report. Indicators represent six domains: profitability, liquidity, capital structure, revenue, cost, and utilization. A description of each indicator is provided, and appendix shows median indicator values by state. Indicators are specifically designed to help CAHs compare their financial performance with other CAHs.
Date: 03/2018
Type: Document
Sponsoring organization: Flex Monitoring Team
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Geographic Variation in the 2016 Profitability of Urban and Rural Hospitals
Findings brief describing differences in profitability of Critical Access Hospitals, other rural hospitals, and urban Prospective Payment Systems hospitals, with breakdowns by census region, census division, and state.
Author(s): George H. Pink, Kristie Thompson, H. Ann Howard, Mark Holmes
Date: 03/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Interpreting MBQIP Hospital Data Reports for Quality Improvement
Designed to help Critical Access Hospital (CAH) staff use Medicare Beneficiary Quality Improvement Project (MBQIP) Hospital Data Reports to support quality improvement efforts and improve patient care in their facility. Includes examples of how to interpret MBQIP reports, links to additional resources, and a glossary of key words and definitions.
Date: 03/2018
Type: Document
Sponsoring organization: Stratis Health
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National Healthcare Safety Network Annual Facility Survey for CAHs
Webinar recording discusses the annual facility survey and location mapping for Critical Access Hospitals (CAHs). Compares the results for 2015 to 2016 on a number if factors, such as non-profit ownership, average number of beds, and medical school affiliation, among others.
Additional links: Webinar Recording, Webinar Slides
Date: 02/2018
Type: Video/Multimedia
Sponsoring organizations: Centers for Disease Control and Prevention, Federal Office of Rural Health Policy
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Critical Access Hospital R&D: Investing in Value Based Care Capacity
Provides slides discussing Critical Access Hospital research and development investments focusing on delivering healthcare under Medicare value-based payment models. Includes maps showing Medicare Accountable Care Organizations (ACOs) by county for 2013 and 2015.
Date: 02/2018
Type: Presentation Slides
Sponsoring organization: Rural Health Value
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Young Rural Healthcare Leaders Share Experiences and Insights
Interviews with four Critical Access Hospital leaders under the age of forty, who share their experiences helping their facilities and communities. They also offer advice to others interested in rural hospital leadership. Interviewees include Benjamin Anderson, CEO of Kearny County Hospital in Lakin, Kansas; Melissa Kelly, CEO and CFO of Pender Community Hospital in Pender, Nebraska; Stephanie Orr, CNO at Steele Memorial Medical Center in Salmon, Idaho; and Adam Willmann, CEO and President of Goodall-Witcher Hospital Authority in Clifton, Texas.
Citation: Rural Monitor
Date: 01/2018
Type: Document
Sponsoring organization: Rural Health Information Hub
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Fact Sheet: 2019 Merit-based Incentive Payment System (MIPS) Payment Adjustments Based on 2017 MIPS Final Scores
Reviews program definitions and 2017 MIPS eligibility & exclusion criteria, discusses how final scores are assigned by MIPS eligible clinicians, explains issues related to MIPS performance periods, and addresses other topics related to MIPS payment adjustments. Includes a section explaining how payment adjustments are applied to MIPS eligible clinicians who are practicing in Critical Access Hospitals.
Date: 2018
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Stratis Health 2018 MIPS Estimator
Web-based tool allows providers to calculate a composite Merit-based Incentive Payment System (MIPS) score. Presents data submission methods to produce the highest base-line score and enables workflow adjustments to improve patient outcomes.
Date: 2018
Type: Tool
Sponsoring organization: Stratis Health
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Rural Health Research Recap: Effects of Rural Hospital Closures
Summarizes key findings from the Rural Health Research Centers' most recent research on the effects of rural hospital closures. Examines rural hospital closures and conversions, payment models, the loss of obstetric services, and more. Provides links to each of the referenced source documents.
Date: 12/2017
Type: Document
Sponsoring organization: Rural Health Research Gateway
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Rural Health Research Recap: Rural Hospital Closures
Summarizes key findings from the Rural Health Research Centers' most recent research on rural hospital closures. Discusses hospitals by U.S. census region, rural hospital closures between 2005 and 2017, urban and rural hospital profitability, and the financial distress index. Provides links to each of the referenced source documents.
Date: 12/2017
Type: Document
Sponsoring organization: Rural Health Research Gateway
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MedPAC Report to the Congress: Physician Supervision Requirements in Critical Access Hospitals and Small Rural Hospitals
Provides background information on Medicare physician supervision requirements, and examines how enforcement of these requirements impacts access to care, quality of care, and staffing needs in Critical Access Hospitals (CAHs) and small rural hospitals. Findings are based on interviews with CMS officials, hospital association representatives, and CAH administrators in several states.
Date: 12/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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State Flex Program Rural Emergency Medical Services Assessment Strategies
Policy brief describing the emergency medical service (EMS) assessment projects and tools implemented by five State Flex Programs in Arizona, California, Minnesota, Nebraska, and Wisconsin to improve the integration of EMS into rural systems of care. Identifies differences in EMS focused State Flex activities and collaborations to improve local and regional EMS capacity and performance.
Author(s): Karen Pearson, John Gale, Sara Kahn-Troster, Andrew Coburn
Date: 11/2017
Type: Document
Sponsoring organization: Flex Monitoring Team
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Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
Provides information concerning the potential effects of Medicaid Disproportionate Share Hospital (DSH) payment on rural hospitals in 47 states. Features statistics on hospital Medicaid DSH payments by state and census region, with breakdowns for urban, rural, and Critical Access Hospitals.
Author(s): Erin M. Mobley, Fred Ullrich, Keith J. Mueller
Date: 11/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Sliding Fee Scale Discount Guide for CAHs and RHCs
Provides concepts and guidance to help Critical Access Hospital (CAH) and Rural Health Clinic (RHC) executives and management teams develop a sliding fee scale discount program. Addresses how these programs relate to Internal Revenue Code Section 501(r) compliance and participation in the National Health Service Corps (NHSC). Includes an example of a sliding fee schedule.
Date: 09/2017
Type: Website
Sponsoring organization: National Rural Health Resource Center
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The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
Findings brief describing variation in the number of hospitals in rural areas providing Medicare post-acute care (PAC) and hospice care, average amount of revenue generated for these services, and financial importance to rural hospitals. Includes statistics on 2015 Medicare PAC and hospice care revenue as percentage of patient revenue in 1,205 Critical Access Hospitals and 964 Prospective Payment System hospitals.
Author(s): Alex Schulte, H. Ann Howard, George H. Pink
Date: 07/2017
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars Is the Problem
Examines the characteristics of rural hospitals with and without quality star ratings, and explains how the current methodology disproportionately affects rural hospitals. Makes recommendations for improving the utility of the Hospital Quality Star Rating system, especially for the purpose of comparing quality among rural hospitals or between rural and urban hospitals.
Author(s): Kristie W. Thompson, Randy K. Randolph, Kristin L. Reiter, George H. Pink, G. Mark Holmes
Date: 06/2017
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Results from 2013 Tax-Exempt Hospitals’ Schedule H Community Benefit Reporting
Reports the community benefit of hospitals by measuring financial costs incurred through charity care, community building activities, financial assistance, and underpayments or unreimbursed care from Medicare and Medicaid. Provides findings specific to rural areas and Critical Access Hospitals (CAHs). Analysis was performed using data from 1,300 hospitals' Form 990 Schedule Hs for tax year 2013.
Date: 05/2017
Type: Document
Sponsoring organizations: American Hospital Association, Ernst & Young LLP
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A Study of HCAHPS Best Practices in High Performing Critical Access Hospitals
Provides an overview of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and presents HCAHPS best practices of high performing Critical Access Hospitals (CAHs). Findings are based on focus group discussions with 38 hospitals across 17 states.
Date: 05/2017
Type: Document
Sponsoring organization: Stratis Health
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Identifying Adverse Drug Events in Rural Hospitals: An Eight-State Study
Analyzes adverse drug events (ADEs), or events involving patient injury resulting from medication use, and identifies ways to improve medication safety in rural hospitals. Uses 2013 data from eight states with significant rural populations, and examines ADE rates based on hospital characteristics and across four main categories: steroids, antibiotics, opiates/narcotics, and anticoagulants. Companion brief lists resources that can be used to reduce and prevent ADEs in rural hospitals, including rural prospective payment system (PPS) hospitals and Critical Access Hospitals (CAHs).
Additional links: Resources to Reduce Adverse Drug Events in Rural Hospitals
Author(s): Michelle Casey, Peiyin Hung, Emma Distel, Shailendra Prasad
Date: 05/2017
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Critical Access Hospital Financial Model
Excel-based modeling tool designed to help Critical Access Hospitals (CAHs) anticipate and analyze the financial impacts of joining a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO).
Date: 2017
Type: Tool
Sponsoring organization: Rural Health Value
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Demonstrating Critical Access Hospital Value: A Guide to Potential Partnerships
Provides a three-step framework to help Critical Access Hospitals (CAHs) quantify and demonstrate their value to potential partners. Includes an editable worksheet that can be used to document and track progress as your CAH moves through each of the three steps - understanding the potential partner, identifying the CAH value proposition, and presenting the CAH value message.
Date: 2017
Type: Document
Sponsoring organization: Rural Health Value
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MBQIP Talking Points
List of summary statements that Flex Program staff can use to help address concerns and encourage Critical Access Hospital (CAH) participation in quality reporting and improvement programs. Included statements can be adapted to help frame responses and discussions related to CAH quality improvement participation.
Date: 12/2016
Type: Document
Sponsoring organization: Stratis Health
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MBQIP Quality Measure Trends, 2011-2016
Examines trends in 37 Medicare Beneficiary Quality Improvement Project (MBQIP) quality measures from 2011 to 2016. Groups Critical Access Hospitals (CAHs) within 45 State Flex Programs into five regions, and organizes data into tables and figures which allow in-depth comparisons of the national, regional, and state trends for each MBQIP measure. Presents findings across five quality measure domains: patient engagement, care transitions, outpatient, inpatient, and patient safety.
Author(s): Tami Swenson, Michelle Casey
Date: 11/2016
Type: Document
Sponsoring organization: Flex Monitoring Team
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Reassessing Financial Peer Groups for Critical Access Hospitals
Policy brief analyzing the influence of hospital, geographic, and community characteristics on the financial performance and conditions of Critical Access Hospitals (CAHs). Discusses the current factors of net patient revenue, government ownership, provision of long-term care, and operation of a Rural Health Clinic (RHC), which are used to determine peer groups for the Critical Access Hospital Financial Indicators Report (CAHFIR).
Author(s): Walter L. Hawkins, Kristin L. Reiter, George H. Pink
Date: 11/2016
Type: Document
Sponsoring organization: Flex Monitoring Team
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Economic Impact of a Critical Access Hospital on a Rural Community
Estimates the economic impact of a Critical Access Hospital (CAH) on a rural community. Uses data collected from 2012 to 2016, representing 91 CAHs across 18 states. Discusses direct impacts, such as employee wages and benefits, as well as secondary benefits such as construction activity and retail spending.
Author(s): Gerald A. Doeksen, Cheryl F. St. Clair, Fred C. Eilrich
Date: 10/2016
Type: Document
Sponsoring organization: National Center for Rural Health Works
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Rural Hospital Participation and Performance in Value-based Purchasing and Other Delivery System Reform Initiatives
Reports on the participation of delivery system reform initiatives by rural hospitals, and discusses the supporting factors and challenges for successful participation. Includes data comparing rural and urban Hospital Value-Based Payment (HVBP) performance.
Author(s): Karen E. Joynt, Nguyen Nguyen, Lok Wong Samson, et al.
Date: 10/2016
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Trends in Risk of Financial Distress among Rural Hospitals
Illustrates the proportion of rural hospitals, including Critical Access Hospitals (CAHs), at high risk of financial distress by Census region and Centers for Medicare & Medicaid Services (CMS) payment type for the 2013-2016 period.
Author(s): Brystana G. Kaufman, Randy Randolph, George H. Pink, Mark Holmes
Date: 10/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Cybersecurity Threats in Rural America: How to Protect Your Critical Access Hospitals
Webinar recording designed to help Critical Access Hospital (CAH) leaders understand potential threats to their Health Information Technology (HIT) systems, and how to assess and protect them. Includes discussions on how to respond to a cyberattack or data breach.
Additional links: Presentation Slides, Webinar Recording
Author(s): Joe Wivoda
Date: 09/2016
Type: Video/Multimedia
Sponsoring organization: Technical Assistance and Services Center
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Population Health Strategies of Critical Access Hospitals
Provides examples of population health strategies developed by Critical Access Hospitals (CAHs) from 8 different rural communities that have significantly contributed to the improvement of population health and the health of their community.
Author(s): John Gale, Andrew Coburn, Karen Pearson, Zachariah Croll, George Shaler
Date: 08/2016
Type: Document
Sponsoring organization: Flex Monitoring Team
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Overall Hospital Quality Star Ratings on Hospital Compare: Overview for Flex Programs and Rural Stakeholders
Provides background information and the methodology used for the development of the CMS Overall Hospital Star Ratings posted on the Hospital Compare website. Discusses the implications these ratings have on Critical Access Hospitals and other small rural hospitals.
Date: 07/2016
Type: Document
Sponsoring organization: Stratis Health
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Deliberation Makes a Difference: Preparation Strategies for TeamSTEPPS Implementation in Small and Rural Hospitals
Reports on a study of TeamSTEPPS implementation at 14 Critical Access Hospitals (CAHs) in Iowa. Offers recommendations for preparing for and implementing the TeamSTEPPS quality improvement initiative based on the results.
Author(s): Xi Zhu, Jure Baloh, Marcia M. Ward, Greg L. Stewart
Citation: Medical Care Research and Review, 73(3), 283-307
Date: 06/2016
Type: Document
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Medicare Copayments for Critical Access Hospital Outpatient Services - Update
Estimates the impact of Medicare Part B coinsurance on beneficiaries receiving outpatient services at Critical Access Hospitals (CAHs), and identifies the Medicare fee-for-service (FFS) proportion of key services provided in CAHs.
Author(s): Allison Briggs, Matthew Toth, Sara Freeman
Date: 06/2016
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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State Variations in the Rural Obstetric Workforce
Illustrates the challenges affecting the obstetric workforce in Critical Access Hospitals (CAHs) and other rural hospitals having at least ten births in 2010 by analyzing data derived from a telephone survey conducted in 9 states. Includes data for each state on hospital and provider characteristics, and services provided for labor and delivery.
Author(s): Peiyin Hung, Katy B. Kozhimannil, Michelle M. Casey, Carrie Henning-Smith, Shailendra Prasad
Date: 05/2016
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Improving Efficiency and Preserving Access to Emergency Care in Rural Areas
Provides an overview of the current policies and strategies in place to ensure access to emergency department services in rural areas and the challenges they face today. Guides a discussion to alternative strategies that support outpatient-only services, such as a stand alone emergency department and a clinic that offers ambulatory services. Slides from MedPAC public meeting held on April 8, 2016.
Author(s): Jeff Stensland, Zach Gaumer
Date: 04/2016
Type: Presentation Slides
Sponsoring organization: Medicare Payment Advisory Commission
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Reducing Potentially-Preventable Readmissions in Critical Access Hospitals
Policy brief describing evidence-based readmission prevention programs and strategies shown to be effective at reducing readmission rates for small rural hospitals, including Critical Access Hospitals (CAHs).
Author(s): Emma Distel, Michelle Casey, Shailendra Prasad
Date: 03/2016
Type: Document
Sponsoring organization: Flex Monitoring Team
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2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
Compares the total margin and operating margin of rural and urban hospitals using 2012-2014 profitability data. Analysis divides rural hospitals by the size of the prospective payment system and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare dependent hospitals, sole community hospitals, and rural referral centers.
Author(s): Sharita R. Thomas, G. Mark Holmes, George H. Pink
Date: 03/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Geographic Variation in the Profitability of Urban and Rural Hospitals
Analyzes and compares the 2014 profitability margins of rural and urban hospitals by census region, census division, and by state. Provides information on rural hospitals broken down by Critical Access Hospitals (CAHs) and other rural hospitals; the other rural hospitals group includes Medicare dependent hospitals, sole community hospitals, and rural prospective payment system hospitals.
Author(s): Sharita R. Thomas, George H. Pink, G. Mark Holmes
Date: 03/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Impact of Swing Beds
Policy brief describes the current value of swing beds as a critical healthcare service that provides quality care and can help reduce readmission rates. Discusses how swing beds can create additional revenue for small rural hospitals at risk of experiencing financial challenges.
Author(s): Jim Parrish, Ann Turner, Margaret Woeppel
Date: 02/2016
Type: Document
Sponsoring organization: National Rural Health Association
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CMS Manual System: Revisions to Medicare State Operations Manual, Chapter 9 - Critical Access Hospital (CAH) Recertification Checklist: Rural and Distance or Necessary Provider Verification
Provides a list of the necessary components to be confirmed when Critical Access Hospitals (CAHs) are surveyed for recertification to determine if they meet the rural location and distance or necessary provider requirements to maintain their CAH status. Identifies the procedures used by the CMS Regional Office and state survey agencies to determine if CAHs meet the necessary requirements.
Date: 02/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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2016 Rural Hospital Replacement Facility Study
A slide presentation examining the impact of replacing Critical Access Hospital (CAH) facilities using data from Medicare cost reports and historical financial and utilization data. Discusses profit margins, growth in services, operating efficiencies, and quality improvement.
Date: 2016
Type: Presentation Slides
Sponsoring organizations: National Rural Health Association, Stroudwater Associates
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Rural Relevance 2016: Vulnerability to Value, A Hospital Strength INDEX Study
Examines rural and Critical Access Hospitals using the Hospital Strength INDEX to assess their performance and financial vulnerability and compares their location to communities with greater health disparities, as identified by the Health Disparities Index. Estimates the impact of a shift to value-based payments. In order to access the research study a free registration is required.
Date: 2016
Type: Document
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Critical Access Hospital-Relevant Measures for Health System Development and Population Health
Describes performance measures for assessing health system development and population health in Critical Access Hospitals (CAHs). Discusses how the measures can help CAHs and other stakeholders benchmark and improve performance.
Author(s): John Gale, Andrew Coburn, Zach Croll
Date: 12/2015
Type: Document
Sponsoring organization: Flex Monitoring Team
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Impact of Financial and Operational Interventions Funded by the Flex Program
Analyzes the impact of Flex Program sponsorship and associated financial and operational activities on the financial performance of Critical Access Hospitals.
Author(s): Rebecca G. Whitaker, George H. Pink, G. Mark Holmes
Date: 11/2015
Type: Document
Sponsoring organization: Flex Monitoring Team
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Estimated Costs of Rural Freestanding Emergency Departments
Provides an overview of the rural freestanding emergency department (RFED) model as a feasible alternative for hospitals at risk of closure, or preparing for closure, to keep emergency services within the rural community.
Author(s): J. Dunc Williams, Paula H. Song, George H. Pink
Date: 11/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Are You Ready to Begin a Capital Project? A Guide, Toolkit and Resources for Critical Access Hospitals and Rural Health Centers
Determines organizational readiness of Critical Access Hospitals and Rural Health Clinics as they proceed through the process of developing capital projects, and helps them prevent any drawbacks due to an inadequate plan. The manual is divided into two major sections: Self-assessment provides tools to identify current capabilities and weaknesses that can be used as a starting point to build a capital project; and External Influences provides tools to examine patient population and the community’s demand for services and healthcare trends to ensure the capital project is responsive to current and future needs.
Author(s): Capital Link
Date: 11/2015
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Small Rural Hospital Transition (SRHT) Project Guide: A Rural Hospital Guide to Improving Care Management
Helps hospital management teams recognize best practices associated with care management and other opportunities for performance improvement to support quality of care. Includes information regarding care management roles and staffing needs with a focus on the discharge planning process. Serves as a resource for State Offices of Rural Health directors and Flex Program coordinators to help rural hospitals with transition efforts in developing training programs that will support performance improvement.
Author(s): Stroudwater
Date: 10/2015
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Small Rural Hospital Transition (SRHT) Project Guide: A Guide for Rural Hospitals to Identify Populations and Shift to Population Health
Helps hospital management teams recognize specific patient populations associated with a higher percentage of total healthcare expenditures and helps hospitals focus their programs on these population groups to improve quality of care, healthcare outcomes, and reduce healthcare costs. Serves as a resource for State Offices of Rural Health directors and Flex Program coordinators to help rural hospitals with transition efforts to value-based payment models.
Author(s): Stroudwater Associates
Date: 09/2015
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Performance Measurement for Rural Low-Volume Providers: Final Report
Identifies challenges to measuring healthcare performance among low-volume rural providers, and presents recommendations to meet these challenges. Primary focus is on finding appropriate quality measures for use within Centers for Medicare and Medicaid Services' (CMS) pay-for-performance programs and encouraging rural participation in CMS quality improvement initiatives.
Date: 09/2015
Type: Document
Sponsoring organization: National Quality Forum
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Evidence-Based Programs and Strategies for Reducing Healthcare-Associated Infections in Critical Access Hospitals
Highlights successful, evidence-based programs and approaches that Critical Access Hospitals (CAHs) may use to curb healthcare-associated infections (HAIs).
Author(s): Michelle Casey, Shailendra Prasad, Emma Distel, Alex Evenson
Date: 09/2015
Type: Document
Sponsoring organization: Flex Monitoring Team
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Reporting of Healthcare-Associated Infections by Critical Access Hospitals
Describes state requirements for reporting healthcare-associated infections (HAIs) and the implications for Critical Access Hospitals (CAHs). Also analyzes HAI data reported by CAHs via Hospital Compare.
Author(s): Michelle Casey, Emma Distel, Alex Evenson, Shailendra Prasad, Peiyin Hung
Date: 09/2015
Type: Document
Sponsoring organization: Flex Monitoring Team
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Critical Access Hospital Financial Pro Forma
Financial modeling resource used to assist rural hospitals in projecting long-term finances under the Fee-For-Service (FFS)/cost-based reimbursement systems.
Date: 08/2015
Type: Tool
Sponsoring organization: Rural Health Value
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Charity Care and Uncompensated Care Activities of Tax-Exempt Critical Access Hospitals
Analyzes charity care, uncompensated care, and bad debt activities of Critical Access Hospitals (CAHs) compared with other rural non-CAH and urban hospitals. Discusses the implications of ACA-mandated hospital financial assistance, emergency care, and billing and collection policies for CAHs.
Additional links: Policy Brief
Author(s): John Gale, Jamar Croom, Zachariah Croll, Andrew Coburn
Date: 06/2015
Type: Document
Sponsoring organization: Flex Monitoring Team
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Swing Bed Reimbursement in Critical Access Hospitals
March 2015 webinar discussion in response to the release of a report from the Office of the Inspector General (OIG) on the value of swing bed programs vs. skilled nursing facilities (SNF) in Critical Access Hospitals. Covers the major components of the swing bed program, reviews the report, and provides an example of a successful program in Kentucky. Presented by Brock Slabach, National Rural Health Association; Kristin L. Reiter, Associate Professor in the Department of Health Policy and Management at the University of North Carolina at Chapel Hill and Research Fellow at the Cecil G. Sheps Center for Health Services Research; and Susan Starling, CEO/President at Marcum and Wallace Memorial Hospital. 60 minutes.
Additional links: Audio Recording, PowerPoint Handout, Transcript
Date: 03/2015
Type: Video/Multimedia
Sponsoring organization: Rural Health Information Hub
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A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals
Evaluates the methods and data of a March 2015 report from the Office of the Inspector General (OIG), U.S. Department of Health and Human Services, commenting on Medicare reimbursement policy for swing bed services in Critical Access Hospitals (CAHs).
Author(s): Kristin L. Reiter, G. Mark Holmes
Date: 03/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Medicare Could Have Saved Billions at Critical Access Hospitals If Swing-Bed Services Were Reimbursed Using the Skilled Nursing Facility Prospective Payment System Rates
Reports the Inspector General’s findings from a study of swing bed services and reimbursement at Critical Access Hospitals (CAHs). Addresses changes in swing bed usage over time and examines the potential impact to Medicare of reimbursing swing bed services at skilled nursing facility (SNF) prospective payment system (PPS) rates.
Date: 03/2015
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants?
Report discusses the various payment models that may affect the financial performance of rural hospitals and the variables (geographic, community, market, and hospital) that affect rural hospital costs.
Author(s): Kristin Moss, G. Mark Holmes, George H. Pink,
Date: 02/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Surgical Services in Critical Access Hospitals, 2011
Illustrates the major surgical services provided in Critical Access Hospitals (CAHs) by type and capacity in both inpatient and outpatient settings.
Author(s): Paula Weigel, Fred Ullrich, Marcia M. Ward, Keith J. Mueller
Date: 02/2015
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Critical Access Hospitals’ Receipt of Medicare and Medicaid Electronic Health Record Incentive Payments
Describes Critical Access Hospital (CAH) participation in Medicare and Medicaid electronic health record (EHR) incentive programs and compares participation rates between states and by facility characteristics.
Author(s): Peiyin Hung, Michelle Casey, Ira Moscovice
Date: 01/2015
Type: Document
Sponsoring organization: Flex Monitoring Team
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Medicare Beneficiaries Paid Nearly Half of the Costs for Outpatient Services at Critical Access Hospitals Report
Compares the system Medicare used to calculate outpatient coinsurance amounts for patients who receive services at Critical Access Hospitals (CAHs) with the system used for acute-care hospital patients. Recommends that the Centers for Medicare and Medicaid Services seek legislative authority to modify the coinsurance calculation.
Date: 10/2014
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Rural Hospital Performance Improvement (RHPI) Project: Best Practice Concepts in Revenue Cycle Management
Explains revenue cycle management from patient admission to evaluating measures of success for rural hospitals and offers guidance on best practices. The document is aimed to help hospital business administration improve their revenue cycle performance as well as provide State Offices of Rural Health directors, and Flex program coordinators, a better understanding on the subject so they may develop educational trainings.
Date: 08/2014
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Program Evaluation Workshop Materials for State Flex Programs
Includes presentations and workshop materials regarding program evaluation, demonstrating value and outcomes, project management, logic models, return on investment, evaluation best practices, and Rural Hospital Performance Improvement projects for state Flex programs.
Date: 07/2014
Type: Website
Sponsoring organization: Technical Assistance and Services Center
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Which Medicare Patients Are Transferred from Rural Emergency Departments?
Analyzes transfers of Medicare beneficiaries who received emergency care in a Critical Access Hospital or rural hospital and were transferred to another hospital for care.
Author(s): Michelle Casey, Jeffrey McCullough, Robert Kreiger
Date: 06/2014
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement
Examines how proposed changes to Critical Access Hospital (CAH) cost-based reimbursement would affect the financial vulnerability of CAHs. Uses models to forecast the financial impact of 20 and 30 percent reductions in Medicare revenue, and the resulting implications for rural healthcare access.
Author(s): Mark Holmes, George H. Pink
Date: 12/2013
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Implications for Beneficiary Travel Time if Financially-Vulnerable Critical Access Hospitals Close
Examines potential increases in beneficiary travel times and distances if financially-vulnerable Critical Access Hospitals (CAHs) close. Analysis is based on a review of 93 CAHs identified as financially-vulnerable and likely to close if reimbursement methods or eligibility requirements change.
Author(s): Victoria A. Freeman, Randy K. Randolph, George Pink, Mark Holmes
Date: 12/2013
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Most Critical Access Hospitals Would Not Meet the Location Requirements if Required to Re-Enroll in Medicare
Recommends that CMS seek legislative authority to remove the permanent distance exemption for Critical Access Hospitals (CAHs) that currently have Necessary Provider designations.
Date: 08/2013
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Critical Access Hospital (CAH) Emergency Services and Telemedicine: Implications for Emergency Services Condition of Participation (CoPs) and Emergency Medical Treatment and Labor Act (EMTALA) On-Call Compliance
Memorandum clarifying the CMS Conditions of Participation (CoP) for Critical Access Hospital emergency services and Emergency Medical Treatment and Labor Act (EMTALA) On-Call Compliance.
Date: 06/2013
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evidence-Based Medication Safety Quality Improvement Programs and Strategies for Critical Access Hospitals
Discusses evidence-based medication safety Quality Improvement (QI) programs and strategies that could be implemented in Critical Access Hospitals (CAHs). Strategies address in person or telehealth staffing, staffing workflow, technology, quality, and effective reconciliation strategies.
Author(s): Jill Klingner, Shailendra Prasad
Date: 05/2013
Type: Document
Sponsoring organization: Flex Monitoring Team
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Compliance Review Initiative: Advancing Effective Communication in Critical Access Hospitals
Describes a communication initiative so that limited English proficient individuals can effectively participate in healthcare services at Critical Access Hospitals.
Date: 04/2013
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2 (Final Rule)
Specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and Critical Access Hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments.
Citation: Federal Register, 77(171), 53968-54162
Date: 09/2012
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evidence-Based Surgical Care Quality Improvement Programs and Strategies for Critical Access Hospitals
Focuses on evidence-based surgical care QI programs and strategies applicable to inpatient and outpatient surgeries in CAHs. One in a series of policy briefs identifying and assessing evidence-based patient safety and quality improvement interventions for use by state Flex Programs and Critical Access Hospitals (CAHs).
Author(s): Jill Klingner, Michelle Casey, Shailendra Prasad, Walter Gregg, Ira Moscovice
Date: 08/2012
Type: Document
Sponsoring organization: Flex Monitoring Team
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Evidence-Based Acute Myocardial Infarction (AMI) Quality Improvement Programs/Strategies for Critical Access Hospitals
Discusses evidence-based AMI Quality Improvement (QI) programs and strategies that are applicable to Critical Access Hospitals (CAHs). Covers Centers for Medicare and Medicaid (CMS) AMI quality measures.
Author(s): Shailendra Prasad, Jill Klingner, Michelle Casey, Walter Gregg, Ira Moscovice
Date: 08/2012
Type: Document
Sponsoring organization: Flex Monitoring Team
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Community Health Needs Assessment Toolkit
Designed to help rural hospitals conduct a community health needs assessment, which is a requirement for all 501(c)(3) hospitals.
Author(s): Gerald A. Doeksen, Cheryl F. St. Clair
Date: 05/2012
Type: Document
Sponsoring organizations: National Center for Rural Health Works, Oklahoma Office of Rural Health
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Critical Access Hospital Governing Board Manual: Volume II
Written with governing board members in mind, addresses several pressing issues facing Critical Access Hospital (CAH) governing boards. Builds on the material found in the Governing Board Manual: Volume I, and focuses on the following topic areas: the board member's role, regulatory, compliance, and fiduciary responsibilities, hospital finance, trends in quality and health information, and strategic and long-term planning. Includes several articles authored by past or current CAH board members.
Date: 02/2012
Type: Document
Sponsoring organization: Illinois Critical Access Hospital Network
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Critical Access Hospital Ethics Committee Resource Guide
Offers practical suggestions for the development of an effective Critical Access Hospital ethics committee and includes examples highlighting challenging ethics conflicts common to rural settings.
Author(s): William A. Nelson, Barbara A. Elliott
Date: 2012
Type: Document
Sponsoring organization: National Rural Health Association
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Evidence-Based Falls Prevention in Critical Access Hospitals
Identifies and assesses evidence-based patient safety and quality improvement interventions for state Flex Programs and Critical Access Hospitals to help them implement falls prevention programs.
Author(s): Karen B. Pearson, Andrew F. Coburn
Date: 12/2011
Type: Document
Sponsoring organization: Flex Monitoring Team
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Pneumonia Quality Improvement Programs and Strategies in Critical Access Hospitals
Discusses several QI strategies which have been shown to improve pneumonia care and may be replicable in Critical Access Hospital (CAHs). Includes a reference table to help in determining which strategies may be useful for implementation in hospitals.
Author(s): Michelle Casey, Jill Klingner, Shailendra Prasad, Walter Gregg
Date: 06/2011
Type: Document
Sponsoring organization: Flex Monitoring Team
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Improving Hospital Patient Safety Through Teamwork: The Use of TeamSTEPPS in Critical Access Hospitals
Provides information on how state Flex programs and Critical Access Hospital (CAHs) have successfully adapted and used TeamSTEPPS to improve patient safety through team training.
Author(s): Andrew Coburn, Zach Gage-Croll
Date: 06/2011
Type: Document
Sponsoring organization: Flex Monitoring Team
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A Guide to Financing Strategies for Hospitals: With Special Consideration for Smaller Hospitals
Explores seven strategies that help hospitals achieve capital access. Discusses smaller organizations, such as rural hospitals, Critical Access Hospitals, and stand-alone community hospitals.
Date: 12/2010
Type: Document
Sponsoring organization: Health Research & Educational Trust
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Critical Access Hospital Replacement Process: The Manual
Describes the facility replacement process, including the phases, actions, and involved parties that are needed. Offers guidance on the facility replacement process, including assessing the Critical Access Hospital’s physical and financial situation, gaining community support, identifying and obtaining financing, working with lenders and Federal enhancement programs, and completing the design and construction process.
Date: 10/2010
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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Critical Access Hospital Replacement Process: The Roadmap
Provides a visual overview of the entire facility replacement process. Divided into four phases including Planning, Design and Financing, Endorsement, and Construction. Each phase is further described by events, actions, duration, costs/fees, and involved parties.
Date: 10/2010
Type: Document
Sponsoring organization: Federal Office of Rural Health Policy
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A Comparison of Rural Hospitals with Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment
Compares the financial performance and condition of rural hospitals with special Medicare payment provisions - Critical Access Hospitals (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), and Rural Referral Centers (RRCs) - to urban and rural hospitals paid under prospective payment.
Additional links: Findings Brief: A Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment, 4/2010, Findings Brief: Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals with Special Medicare Payment Provisions, 9/2010
Author(s): G. Mark Holmes, George H. Pink, Sarah A. Friedman, Hilda A. Howard
Date: 08/2010
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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A Manual on Effective Collaboration Between Critical Access Hospitals and Federally Qualified Health Centers
Highlights how through cooperation and collaboration, Critical Access Hospitals (CAHs) and Federally Qualified Health Centers (FQHCs), especially those near each other and serving similar communities, can meet community needs, enhance roles, and stabilize and expand needed services and rural delivery systems.
Date: 04/2010
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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CAH Legislative History
Describes pieces of legislation that have resulted in the creation and modification of the Critical Access Hospital (CAH) program.
Date: 2010
Type: Document
Sponsoring organization: American Hospital Association
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Critical Access Hospitals (CAHs): Distance from Other Providers and Relocation of CAHs with a Necessary Provider Designation
September 7, 2007 letter from CMS to State Survey Agency Directors. Explains the criteria to determine whether a Critical Access Hospital (CAH) applicant satisfies the regulatory requirement. Explains the criteria to determine whether a CAH with a necessary provider designation remains essentially the same provider, serving the same service area after relocation. Supersedes the November 14, 2005 guidance on this topic.
Date: 09/2007
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Critical Access Hospital Recognition
Lists hospitals that have received the Critical Access Hospital (CAH) Recognition certificate, established by the National Rural Health Resource Center and the Federal Office of Rural Health Policy. Hospitals are nominated by state Flex programs in recognition of their accomplishments using funded provided through the Rural Hospital Flexibility Program. Provides a brief summary of each awardee's project and outcomes.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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CAHMPAS Data Query Tool
Tool allows Critical Access Hospitals (CAHs) to compare their performance with other hospitals by location, revenue, and other operational measures.
Type: Tool
Sponsoring organization: Flex Monitoring Team
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Eligible Hospital / Critical Access Hospital eCQMs
Features updated electronic clinical quality measures (eCQMs) for Hospital Inpatient Quality Reporting (IQR) Program and the Medicare and Medicaid Promoting Interoperability programs for 2019 reporting in Eligible Hospitals and Critical Access Hospitals (CAHs).
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Code of Federal Regulations: Title 42 Public Health, Chapter 4, Subchapter G, Part 425: Medicare Shared Savings Program
Details and describes the regulations for Accountable Care Organizations (ACOs) to participate in the Medicare Shared Savings Program. Provides information on eligibility, application procedures, reporting requirements, and special assignment conditions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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MBQIP Monthly
A monthly electronic newsletter providing Critical Access Hospitals (CAHs) information and support for quality reporting and improvement. Includes news items about the Medicare Beneficiary Quality Improvement Project (MBQIP).
Type: Journal/Newsletter
Sponsoring organization: Stratis Health
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Core Competencies for State Flex Program Excellence Guide
A framework of tools, resources, and training developed for state Medicare Rural Hospital Flexibility Programs (Flex) to help them develop and maintain core competencies. Includes a program self-assessment, process improvement tools, and guides to understanding policies and regulations, quality improvement, and systems of care, among others.
Type: Website
Sponsoring organization: Technical Assistance and Services Center
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Population Health Portal
Provides tools and resources to help Critical Access Hospitals (CAHs), Flex Coordinators, and rural health networks use a systems-based approach to move forward with value-based compensation for care. Includes a readiness assessment tool to identify strengths and needs, and a data tool for accessing public health and hospital data by county and state.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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The Freestanding Emergency Department Financial Assessment Strategic Tool (FED FAST)
Provides a means to evaluate the financial feasibility of transforming a rural hospital into a rural freestanding emergency department (RFED) in high, medium, and low volume settings.
Type: Tool
Sponsoring organization: North Carolina Rural Health Research Program
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CAH Financial Indicators Primer and Calculator Resources
Introduces the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) financial indicators and provides editable templates and calculators CAHs can use to assess their facility’s financial performance and compare it to peer facilities.
Type: Tool
Sponsoring organization: Flex Monitoring Team
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CMS State Operations Manual (SOM)
Provides guidance to state agencies that survey healthcare facilities and providers to determine if they are in compliance with the Medicare Conditions of Participation (CoP). Includes appendices with regulatory information specific to Critical Access Hospitals (Appendix W), and Federally Qualified Health Centers/Rural Health Clinics (Appendix G). Can be used by healthcare facilities as a tool to self-evaluate their compliance with Medicare CoP.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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CAH Financial Indicators Data Summary Reports: Medians & Quartiles by State & Peer Group
Presents state and national median and quartile values of financial indicators in a series of annually published Critical Access Hospital financial indicator reports. Aimed to capture the financial performance of Critical Access Hospitals.
Type: Website
Sponsoring organization: Flex Monitoring Team
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Network Aim for Sustainability Portal
A compilation of tools, resources, and educational materials based on the Baldrige Performance Excellence framework developed for rural health network grantees to use for sustainability efforts.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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Medicare Learning Network: Swing Bed Services
Provides information about the requirements Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds, as needed, to provide either acute or Skilled Nursing Facility care.
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Care Coordination Toolkit
Provides supporting resources and best practices designed to help identify and implement a rural care coordination program. Consists of several modules each concentrating on different aspects of care coordination programs.
Type: Website
Sponsoring organization: Rural Health Information Hub
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Medicare Learning Network: Critical Access Hospital
Booklet providing information about Critical Access Hospital (CAH) designation and payments. Includes a list of CAH resources and helpful websites.
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Flex Program Fundamentals
Provides overview information on the Medicare Rural Hospital Flexibility (Flex) Program, which supports Critical Access Hospitals (CAHs). Designed to be a resource for current Flex Program staff, as well as an orientation manual for new staff.
Type: Document
Sponsoring organization: Technical Assistance and Services Center
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Facts about Critical Access Hospital Accreditation
Discusses accreditation of Critical Access Hospitals, including benefits, standards, the survey process, performance measurements, and cost.
Type: Document
Sponsoring organization: Joint Commission
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Economic Impact: Tools and Templates
Access tools and templates for studying the economic impact, in rural areas, of Federally Qualified Health Centers (FQHCs), Critical Access Hospitals, different health care providers, the social service sector, Medicaid, medical schools, and telemedicine.
Type: Website
Sponsoring organization: National Center for Rural Health Works
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On Center
This blog serves as a tool for conversation between the National Rural Health Resource Center and its customers and partners. Contributions from staff focus on performance improvement, health information technology, recruitment and retention, community health assessments, and networking.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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Health.mil Rates and Reimbursement: Hospital Classifications
Identifies TRICARE reimbursement methodologies for Sole Community Hospitals (SCH) and Critical Access Hospitals (CAHs). Also lists CAH inpatient and outpatient cost to charge ratios (CCRs).
Type: Website
Sponsoring organization: Military Health System
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Toolkit for Using the AHRQ Quality Indicators
Resource for hospitals planning to use the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs), including the Patient Safety Indicators (PSIs), to track and improve inpatient quality and patient safety. Also serves as a general guide to applying improvement methods in a hospital setting.
Type: Tool
Sponsoring organization: Agency for Healthcare Research and Quality
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QualityNet
Serves as a Centers for Medicare & Medicaid Services (CMS) approved website for secure communications and healthcare quality data exchange between: quality improvement organizations (QIOs), hospitals, physician offices, nursing homes, end stage renal disease (ESRD) networks and facilities, and data vendors.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Beneficiary Quality Improvement Project (MBQIP)
Resources designed to help Critical Access Hospitals understand and execute the MBQIP measures. Includes tools and strategies rural hospitals can use to report, analyze, and translate their data into actual quality improvement.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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State Flex Profiles
Profiles of each state's Rural Hospital Medicare Flexibility (Flex) Program activities related to supporting Critical Access Hospitals (CAHs). Includes state Flex program contacts.
Type: Website
Sponsoring organization: Technical Assistance and Services Center
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PubMed Search: Critical Access Hospitals
Searches PubMed's collection of journal article citations on the topic of Critical Access Hospitals.
Type: Literature Search
Sponsoring organization: U.S. National Library of Medicine
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Health Information Technology Toolkit for Critical Access and Small Hospitals
Provides Critical Access Hospitals and small hospitals numerous resources in health information technology (HIT), including information addressing health information exchange and personal health records.
Type: Website
Sponsoring organization: Stratis Health
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Survey & Certification - Certification & Compliance: Critical Access Hospitals
Provides basic information about being certified as a Medicare Critical Access Hospital (CAH) provider. Includes links to applicable laws, regulations, and compliance information.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Critical Access Hospital (CAH) State-level Quality, Financial, and Community Engagement Data
State-level reports on the financial, quality, and community benefit indicators of Critical Access Hospitals (CAHs).
Type: Website
Sponsoring organization: Flex Monitoring Team
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State Survey Agency Directory
A directory of state agencies that handle survey and certification of certain healthcare facilities including Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) for compliance with the Medicare health and safety standards. Updated quarterly.
Type: Directory
Sponsoring organization: Centers for Medicare and Medicaid Services
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Small or Rural Update Newsletters
Newsletters of the AHA Section on Small or Rural Hospitals targeted to small and rural hospitals. Each newsletter provides information on federal legislative and regulatory activity affecting payment, quality, and access to care.
Type: Journal/Newsletter
Sponsoring organization: American Hospital Association
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AHA Critical Access Hospitals
Information on American Hospital Association (AHA) advocacy activities related to Critical Access Hospitals (CAHs). Includes news, resources, and more.
Type: Website
Sponsoring organization: American Hospital Association
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CMS Critical Access Hospitals Center
Presents regulations and notices, press releases, program memorandums, and other information from CMS related to the Critical Access Hospitals (CAHs) program.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Critical Access Hospital Accreditation
Information on the Joint Commission survey process for Critical Access Hospital (CAH) accreditation.
Type: Website
Sponsoring organization: Joint Commission
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Code of Federal Regulations: 42 CFR 485: Subpart F, Conditions of Participation: Critical Access Hospitals (CAHs)
Sets forth the conditions that a hospital must meet to be designated as a Critical Access Hospital (CAH).
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Last Updated: 4/16/2019