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Critical Access Hospitals (CAHs) Resources

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

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 recruitment efforts 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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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: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Sliding Fee Scale Discount Guide for CAHs and RHCs
Contains concepts and guidance for Critical Access Hospital (CAH) and Rural Health Clinic (RHC) executives and management teams in developing a sliding fee scale discount program. Explains 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.
Author(s): Ralph J. Llewellyn
Date: 09/2017
Type: Website
Sponsoring organization: National Rural Health Resource Center
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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.
Date: 08/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Location of Critical Access Hospitals
U.S. map showing Critical Access Hospitals (CAHs). Updated quarterly.
Date: 07/2017
Type: Map/Mapping System
Sponsoring organization: Flex Monitoring Team
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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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Critical Access Hospital Finance 101
Manual providing non-technical financial information for state Medicare Rural Hospital Flexibility (Flex) Program personnel and Critical Access Hospital (CAH) board members.
Date: 06/2017
Type: Document
Sponsoring organization: National Rural Health Resource Center
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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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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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Emergency Medical Services (EMS) in the Flex Program
Recorded webinar reviewing EMS related activities that are currently funded in the fiscal year (FY) 2015 - FY 2017 Medicare Rural Hospital Flexibility (Flex) grant cycle. Also discusses Flex Program needs, recommendations from stakeholders, and opportunities for future improvement.
Additional links: Presentation Slides
Date: 03/2017
Type: Video/Multimedia
Sponsoring organizations: Federal Office of Rural Health Policy, Technical Assistance and Services Center
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CAH Financial Indicators Report: Summary of Indicator Medians by State
Presents state and national median values of 23 financial indicators included in the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS). 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: 03/2017
Type: Document
Sponsoring organization: Flex Monitoring Team
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Hospital Compare Quality Measure Results for CAHs, 2015
Examines Hospital Compare data for calendar year 2015 and summarizes reporting rates and performance among all U.S. Critical Access Hospitals (CAHs). Charts and graphs allow comparison of overall 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): Michelle Casey, Tami Swenson, Alex Evenson
Date: 02/2017
Type: Document
Sponsoring organization: Flex Monitoring Team
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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: 01/2017
Type: Document
Sponsoring organization: Stratis Health
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Accreditation Survey Activity Guide For Health Care Organizations 2017
Provides information to help your organization prepare for an onsite Joint Commission accreditation survey. Includes an ordered list of survey activities, and details the logistical needs and objectives for each activity. Also makes suggestions about which staff members should participate in each survey activity. 2017 guide contains clarifications and corrections that are specific to the Critical Access Hospital (CAH) program.
Date: 01/2017
Type: Document
Sponsoring organization: Joint Commission
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Patients’ Experiences in CAHs: HCAHPS Results, 2015
Results from the calendar year 2015 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): Michelle Casey, Tami Swenson, Alex Evenson
Date: 01/2017
Type: Document
Sponsoring organization: Flex Monitoring Team
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Cybersecurity: How a Rural Alaska Hospital is Safeguarding Its Patients’ Information
Provides an overview of cybersecurity threats and challenges faced by rural healthcare facilities. Describes how the IT staff at the South Peninsula Hospital, a Critical Access Hospital in Alaska, safeguards their hospital's data.
Author(s): Allee Mead
Location: Rural Monitor
Date: 01/2017
Type: Document
Sponsoring organization: Rural Health Information Hub
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Factsheet: Rural and Small Hospitals
Fact sheet and position statement from the American Hospital Association identifying key legislation and policy priorities for rural and small hospitals, with a particular focus on Critical Access Hospitals.
Date: 01/2017
Type: Document
Sponsoring organization: American Hospital Association
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Hurricane Response: CMS Waivers and Exceptions for Facilities
Outlines the Centers for Medicare and Medicaid Services' response to Hurricanes Nate, Maria, Irma, and Harvey. The actions are focused on maintaining access to care for affected Medicare and Medicaid beneficiaries. Includes information about administrative actions and waivers for Critical Access Hospitals, Medicare-dependent small rural hospitals, low-volume providers, and other participating facilities.
Date: 2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Critical Access Hospital Financial Pro Forma for Shared Savings
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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Critical Access Hospitals (CAHs)
Printable map that shows the location of CAHs nationwide by state. Data source: HRSA Data Warehouse, U.S. Department of Health and Human Services, December 2016.
Date: 12/2016
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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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 key 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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Federal Requirement for Physician Supervision of CRNAs
Discusses the federal requirement affecting participation in the Medicare program by Critical Access Hospital (CAH) or Ambulatory Surgical Center (ASC) regarding physician supervision of Certified Registered Nurse Anesthetists (CRNAs). Addresses the conditions for states to opt out of the physician supervision Medicare rule if they meet certain conditions, and the research comparing the outcomes between states that opt-out and those that do not.
Author(s): Steve Barnett, John H Everett, Pat Schou
Date: 11/2016
Type: Document
Sponsoring organization: National Rural Health Association
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Comparing the Community Benefit Spending of Critical Access, Other Rural, and Urban Hospitals
Examines the levels and types of community benefit spending by Critical Access, rural, and urban hospitals, and compares the spending by percentage of total expenses, as well as by category - direct patient care versus community-building activities.
Author(s): John Gale, Zach Croll, Andrew Coburn, Jamar Croom
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 leaders understand potential threats to their health information technology systems and how to assess and protect them. Includes a discussion of what to do if a cyberattack or data breach happens.
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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Electronic Capabilities for Patient Engagement among U.S. Non-Federal Acute Care Hospitals: 2012-2015
Data brief regarding how hospitals can and do provide health information in electronic format to their patients. Includes data and statistics for Critical Access Hospitals as well as trends in the availability and sharing of information electronically between facilities.
Author(s): JaWanna Henry, Yuriy Pylypchuk, Vaishali Patel
Date: 09/2016
Type: Document
Sponsoring organization: Office of the National Coordinator for Health Information Technology
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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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The Future of Critical Access Hospitals and Rural Health Care
Presents an overview of the market forces and public policy affecting the closure of Critical Access Hospitals, and identifies strategies to positively impact the future of rural healthcare. Includes recommendations addressing Medicaid payment options provided by the Rural Policy Research Institute (RUPRI) Health Panel.
Author(s): Keith J. Mueller
Date: 07/2016
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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2016 Financial Leadership Summit Report: Strategies for Rural Hospitals Transitioning to Value-based Purchasing and Population Health
Provides rural hospital administrators key strategies to meet the challenges of the changing healthcare environment. Includes discussion on alternative payment models, the impact of market forces, successful examples and lessons learned, and offers information for the development of tools supporting hospitals and networks as they transition to value-based purchasing and population health.
Author(s): Mark Chustz, et al.
Date: 07/2016
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Hospital Compare Quality Measure Results for CAHs, Q2 2014 - Q1 2015
Discusses the reporting rates and performance of U.S. Critical Access Hospitals on CMS Hospital Compare quality measures. Includes data and statistics comparing inpatient and outpatient CAH participation, state rankings, process of care, median time to receiving care, and structural quality measures. Also includes links to state specific reports for 45 states.
Author(s): Michelle Casey, Tami Swenson, Alex Evenson
Date: 06/2016
Type: Document
Sponsoring organization: Flex Monitoring Team
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Illinois Critical Access Hospital Network (ICAHN)
Brief video describing the Illinois Critical Access Hospital Network (ICAHN) and the services it provides to meet the needs of rural hospitals across its state. Describes how ICAHN has helped 54 hospitals transition from competition to collaboration.
Date: 05/2016
Type: Video/Multimedia
Sponsoring organization: Rural Health Information Hub
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Proactively Pursuing Value-Based Payment
Profile of a program developed at a Critical Access Hospital (CAH) located in rural Washington that is transitioning from volume- to value-based care. The CEO of the hospital is working with payers to design a value-based payment contract that will help the facility fund the continued transition to value-based care and hopes to create a payment model that other CAHs in the state can adopt.
Date: 05/2016
Type: Document
Sponsoring organization: Rural Health Value
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State Variations in the Rural Obstetric Workforce
Illustrates the challenges affecting the obstetric workforce in Critical Access Hospitals and other rural hospitals having at least 10 births in 2010 using data derived from a telephone survey conducted in 9 states.
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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Medicare Beneficiary Quality Improvement Project (MBQIP) Quality Reporting Guide
A guide to assist Flex Coordinators and Critical Access Hospital staff who are working with the Medicare Beneficiary Quality Improvement Project (MBQIP) better understand the measure reporting process. Detailed information is provided on how to register for the reporting site, which measures are to be reported, and how to submit measures.
Date: 04/2016
Type: Document
Sponsoring organization: Stratis Health
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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 12, 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
A 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. Rural hospitals are divided by the size of the Prospective Payment System (the number of beds), and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), and Rural Referral Centers (RRCs).
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. Information on rural hospitals is broken down by Critical Access Hospitals (CAHs) and "other rural hospitals" (ORH), which includes Medicare Dependent Hospitals, Sole Community Hospitals, and rural PPS 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 providing an overview of the current value of swing beds as a critical healthcare service providing quality of care, helping to reduce readmission rates, and creating 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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Patients’ Experiences in CAHs: HCAHPS Results, Q2 2014 - Q1 2015
Results of the April 2014 - March 2015 Hospital Consumer Assessment of Healthcare Providers and Systems survey of reporting rates and performance in Critical Access Hospitals in the United States. Includes data broken down by state, national ranking, and links to state specific reports.
Author(s): Michelle Casey, Peiyin Hung, Alex Evenson
Date: 02/2016
Type: Document
Sponsoring organization: Flex Monitoring Team
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Report to Congress on Medicaid Disproportionate Share Hospital Payments
First annual report on Medicaid Disproportionate Share Hospital (DSH) payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Discusses Medicaid policy, current and future DSH allotments, and data needs. Table B-3 projects FY2018 DSH payments under different scenarios, with data for urban and rural hospitals and for Critical Access Hospitals.
Date: 02/2016
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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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 related to the replacement of Critical Access Hospital (CAH) facilities using data from Medicare cost reports, and historical financial and utilization data. Includes discussion on 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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Guidance on the Physician Quality Reporting System (PQRS) 2014 Reporting Year and 2016 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)
Lists frequently asked questions concerning Rural Health Clinics, Federally Qualified Health Centers, and Critical Access Hospitals who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
Date: 2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Critical Access Hospital-Relevant Measures for Health System Development and Population Health (Policy Brief)
Describes measures of health system development and population health performance which are aimed to help benchmark and improve performance in Critical Access Hospitals.
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 (Policy Brief)
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.
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
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 current 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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Results from 2012 Tax-Exempt Hospitals’ Schedule H Community Benefit Reporting
Reports community benefit of hospitals by measuring financial costs incurred through charity care, financial assistance and spending to fill gaps in Medicaid and Medicare payments. Findings are divided into urban/suburban and rural locations by zip code.
Date: 05/2015
Type: Document
Sponsoring organizations: American Hospital Association, Ernst & Young LLP
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Statement by George Stover, Rice County Hospital District 1, before the Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies
Testimony presented at a May 7, 2015 Labor-HHS Subcommittee hearing on rural health. Discusses regulatory and reimbursement challenges facing Critical Access Hospitals.
Author(s): George Stover
Date: 05/2015
Type: Document
Sponsoring organization: Senate Committee on Appropriations
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Statement by Julie Petersen, PMH Medical Center, before the Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies
Testimony presented at a May 7, 2015 Labor-HHS Subcommittee hearing on rural health. Provides an overview of rural healthcare innovations in Washington State. Discusses challenges facing the state's Critical Access Hospitals and other small rural hospitals.
Author(s): Julie Petersen
Date: 05/2015
Type: Document
Sponsoring organization: Senate Committee on Appropriations
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Revisions to State Operations Manual (SOM) Appendices A, G, L and T Related to Hospitals, Rural Health Clinics, Ambulatory Surgical Centers and Swing Beds
Revises the Centers for Medicare & Medicaid Services' State Operations Manual (SOM) to reflect regulation changes affecting Hospitals, Rural Health Clinics, Ambulatory Surgical Centers and Swing Beds in hospitals.
Date: 04/2015
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Revisions to State Operations Manual (SOM), Appendix W for Critical Access Hospitals
Detailed information about the state survey process for Critical Access Hospitals (CAHs).
Date: 04/2015
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals
Policy brief evaluating 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). Evaluates the methods and data of the OIG report.
Author(s): Kristin Reiter, 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). Concludes that swing bed usage has significantly increased in recent years and that there would be significant savings to the Medicare program if swing bed services were reimbursed 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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The 21st Century Rural Hospital: A Chart Book
Presents an extensive overview of the rural hospital of the 21st century. Discusses how rural hospitals have transformed from a traditional inpatient and emergency department facility to an integrated health system providing a wide variety of services. Contains sections with data about U.S. rural hospitals, the patient population, inpatient and outpatient services and finance.
Author(s): Victoria A. Freeman, Kristie Thompson, H. Ann Howard, Randy Randolph, G. Mark Holmes
Date: 03/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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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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International Classification of Disease: CMS's Efforts to Prepare for the New Version of the Disease and Procedure Codes
Review of the efforts undertaken by the Centers for Medicare and Medicaid Services (CMS) to prepare for the transition to the 10th revision of the International Classification of Diseases (ICD-10) codes. Evaluates the materials developed and activities undertaken by CMS to help providers’ transition and describes concerns of stakeholder organizations, including rural-specific considerations.
Additional links: Highlights
Date: 01/2015
Type: Document
Sponsoring organization: Government Accountability Office
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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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Meaningful Use Attestations Among US Hospitals: The Growing Rural-Urban Divide
An analysis of the Electronic Health Record Incentive Program adoption in metropolitan, micropolitan, and rural hospitals in the U.S. Compares rural and urban hospitals that were attesting to meaningful use and receiving federal incentive payments.
Author(s): Ryan H. Sandefer, David T. Marc, Paul Kleeberg
Location: Perspectives in Health Information Management, 2015 (Spring), 1-10
Date: 2015
Type: Document
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Guidance on the Physician Quality Reporting System (PQRS) 2013 Reporting Year and 2015 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)
Lists frequently asked questions concerning Rural Health Clinics, Federally Qualified Health Centers, and Critical Access Hospitals who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
Date: 2015
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
Examines current obstetric practice models in Critical Access Hospitals (CAHs) and other rural hospitals to understand obstetric care services and obstetric workforce issues. Also reports on the types of clinicians providing obstetric care in rural hospitals, including obstetricians, family physicians, certified nurse midwives, and general surgeons.
Author(s): Katy Kozhimannil, Michelle Casey, Peiyin Hung, Shailendra Prasad, Ira Moscovice
Date: 11/2014
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Does Rurality Affect Observation Care Services Use in CAHs for Medicare Beneficiaries?
Describes the use of observation services across levels of rurality by Medicare beneficiaries in CAHs, the demographics and health status of patients receiving these services, and the characteristics of their observation stays.
Author(s): Yvonne Jonk, Heidi O’Connor, Walter Gregg
Date: 10/2014
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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Medicare Beneficiaries Paid Nearly Half of the Costs for Outpatient Services at Critical Access Hospitals Report
Analyzes the system that Medicare used to calculate outpatient coinsurance amounts for patients who receive services at CAHs versus the system used for patients who receive services at acute-care hospitals. Recommends 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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Care Coordination Comparative Matrix
Identifies rural health networks that are developing or implementing value-based models and recaps brief interviews with the network leaders that are implementing or developing care coordination initiatives. The matrix allows rural health networks to share features and lessons learned through the process of implementing the care coordination programs with one another.
Date: 08/2014
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Rural Hospital Performance Improvement (RHPI) Project: Best Practice Concepts in Revenue Cycle Management
Provides rural hospitals a full explanation of revenue cycle management from patient admission to evaluating measures of success and offers guidance that is generally accepted as best practice concepts. 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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Framing Rural Health Value Webinar Series: Summary Report
Provides a summary of the Framing Rural Health Value Webinar Series, held during May through August, 2014. Series provided aid to the state Medical Rural Hospital Flex Programs in understanding the changing landscape of rural healthcare and program design for Fiscal Year 2015. Includes case studies, recommended interventions, and outcomes.
Date: 08/2014
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Medicare Billing Information for Rural Providers and Suppliers
Provides Medicare billing charts and information on where to submit claims for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Skilled Nursing Facilities, Home Health Agencies, Critical Access Hospitals, and Swing Bed services.
Date: 08/2014
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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RHITND Sourcebook
Provides a reference and resource demonstrating the projects of the Rural Health Information Technology Network Development (RHITND) Program funded during Federal fiscal years 2011-2013.
Date: 07/2014
Type: Document
Sponsoring organization: National Rural Health Resource 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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Medicare Rural Hospital Flexibility Critical Access Hospital Designation Resource Guide 2014
Provides information and resources for rural hospitals participating in Medicare to convert into a Critical Access Hospital (CAH) status.
Date: 06/2014
Type: Document
Sponsoring organization: California State Office of Rural Health
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New Models for Rural Post-Acute Care: Critical Access Hospitals Optimize Patient Outcomes, Value, and Financial Stability
Authors report on the Transitional Care Model, as developed and experienced at the Mayo Clinic. By adopting a care coordinating approach and leveraging their strengths, Critical Access Hospitals can thrive and provide significant benefits to acute hospitals, patients and families, and the communities they serve.
Author(s): Mark Lindsay, Karl Palmer, Terry Hill, et al.
Date: 05/2014
Type: Document
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Collaborative Community Health Needs Assessments: Approaches and Benefits for Critical Access Hospitals
Informs the efforts of state Flex Programs to support Critical Access Hospitals in conducting collaborative Community Health Needs Assessments. The results of these assessments can be used by hospitals as well as state Flex Programs to inform their ongoing strategic initiatives.
Author(s): John A. Gale, Andrew F. Coburn, Helen E. Newton
Date: 05/2014
Type: Document
Sponsoring organization: Flex Monitoring Team
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National Health Service Corps Site Reference Guide
Serves as clarification for NHSC sites regarding eligibility requirements and qualification factors, the application and recertification process, site roles and responsibilities, clinician recruitment, and technical assistance. This document is a supplement to the online NHSC Site Application.
Date: 04/2014
Type: Document
Sponsoring organization: Health Resources and Services Administration
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Critical Access Hospital Population Health Summit: Improving Population Health: A Guide for Critical Access Hospitals
Presents highlights from a summit held in Bloomington, MN, March 25-26, 2014. Included national rural hospital and population health experts who discussed recommendations for Critical Access Hospitals and small rural hospitals regarding population health needs in their communities.
Author(s): Karla Weng
Date: 03/2014
Type: Document
Sponsoring organization: Technical Assistance and Services Center
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Collaboration, Not Competition to Improve Community Health
Darrold Bertsch, CEO of Sakakawea Medical Center and Coal Country Community Health Center, Hazen, N.D., discusses how a rural Critical Access Hospital (CAH) and Federally Qualified Health Center (FQHC) can work in an integrated and collaborative setting to provide better service to their communities.
Author(s): Matthew Weinstock
Date: 03/2014
Type: Document
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Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
Examines health conditions of patients discharged from rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs).
Author(s): Victoria A. Freeman, Randy K. Randolph, Mark Holmes
Date: 02/2014
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Primer for Rural Health Network Memorandum of Agreement/Understanding
Defines and explains how to develop a Memorandum of Agreement (MOA)/Memorandum of Understanding (MOU) as a formal business document to be used when creating a network of two or more separate groups or organizations.
Date: 2014
Type: Document
Sponsoring organization: National Rural Health Resource 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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Illinois Critical Access Hospitals: Managing Healthy Communities in Rural Illinois
Highlights strategies used by 25 Illinois Critical Access Hospitals (CAHs) to accomplish meaningful population health management. Includes statistics on costs per Medicaid enrollee with breakdowns by 12 Midwestern states, and health outcome ranks by Illinois county. Third in a series of four white papers on Illinois CAHs.
Author(s): Melissa Henriksen, Norman Walzer
Date: 10/2013
Type: Document
Sponsoring organization: Illinois Critical Access Hospital Network
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Emergency Department Super Utilizer Programs: Rural Health Systems Analysis and Technical Assistance Project
White paper describing a super utilizer program design, implementation, operation, and assessment for rural hospitals to improving participant health, reducing ED visits, and decrease hospital charges. “Super utilizer” patients often present to the emergency department (ED) with chronic and low acuity health concerns that are inappropriately addressed in a ED setting designed to care for acute, episodic, and emergent health conditions.
Author(s): Christopher D. Stamy, A. Clinton MacKinney
Date: 10/2013
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Progress and Challenges with the Implementation and Use of Electronic Health Records among Critical Access Hospitals
Provides an analysis of the adoption of health information technology and electronic health records by Critical Access Hospitals.
Author(s): Meghan Hufstader Gabriel, Michael F. Furukawa, Emily B. Jones, Jennifer King, Leila K. Samy
Date: 09/2013
Type: Document
Sponsoring organization: Office of the National Coordinator for Health Information Technology
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Critical Access Hospital Year 8 Hospital Compare Participation and Quality Measure Results
Examines 2011 participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures.
Additional links: Policy Brief
Author(s): Michelle Casey, Peiyin Hung, Ira Moscovice
Date: 09/2013
Type: Document
Sponsoring organization: Flex Monitoring Team
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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 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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Critical Access Hospital Blueprint for Performance Excellence
Highlights a Critical Access Hospital (CAH) Performance Excellence Summit held in Minneapolis, Minnesota on June 6 and 7, 2013. The goal of the Summit was to assemble national rural hospital experts to create a recommended blueprint for sustainable CAH excellence. Components discussed were leadership, strategic planning, partners, measurement, workforce, operations, and impact. Hosted by the Technical Assistance and Services Center (TASC).
Date: 06/2013
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Obstetric Services and Quality Among Critical Access, Rural, and Urban Hospitals in Nine States
Compares the characteristics and quality of obstetric care in Critical Access Hospitals, other rural hospitals, and their urban counterparts.
Author(s): Katy Kozhimannil, Peiyin Hung, Maeve McClellan, et al.
Date: 06/2013
Type: Document
Sponsoring organization: University of Minnesota Rural Health Research Center
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The Role of Small and Rural Hospitals and Care Systems in Effective Population Health Partnerships
Explains how small and rural hospitals and their systems can develop community and other partnerships to effectively implement population health management and improve their community's health status. Includes five case studies.
Date: 06/2013
Type: Document
Sponsoring organization: Health Research & Educational Trust
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Evidence-Based Medication Safety Quality Improvement Programs and Strategies for Critical Access Hospitals
Examines evidence-based medication safety Quality Improvement (QI) programs and strategies that could be implemented in Critical Access Hospitals (CAHs).
Author(s): Jill Klingner, Shailendra Prasad
Date: 05/2013
Type: Document
Sponsoring organization: Flex Monitoring Team
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Inpatient Urological Surgery at Critical Access Hospitals in the United States
Examines the difference in access to urological care and inpatient surgery performed in rural hospitals versus rural Critical Access Hospitals (CAHs) nationwide. Includes data and statistics broken down by region, CAH status, age, race, income, and hospital admission type.
Author(s): Adam J. Gadzinski, Justin B. Dimick, Zaojun Ye, David C. Miller
Location: The Journal of Urology, 189(4), 1475-1480
Date: 04/2013
Type: Document
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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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RWHC Hospital Trustee Manual
A series of brief articles covering hospital governance that includes: meeting ground rules, responsibilities and liabilities of non-profit directors, board self assessment, ensuring quality, health information technology, leadership and advocacy for rural health. Edited by Tim Size.
Date: 03/2013
Type: Document
Sponsoring organization: Rural Wisconsin Health Cooperative
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Critical Access Hospitals: Adding Value to the American Healthcare System
Describes the role that Critical Access Hospitals (CAHs) play in the United States healthcare delivery system.
Author(s): Michael Falatko, Edward Gamache
Date: 02/2013
Type: Document
Sponsoring organization: Rural Wisconsin Health Cooperative
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Rural Hospital Participation in the Medicare Shared Savings Program
Proposes modifications of the Medicare Shared Savings Programs (MSSP) and the Advanced Payment Program to include Critical Access Hospitals and affiliated providers.
Author(s): Lynn Barr
Date: 02/2013
Type: Document
Sponsoring organization: National Rural Health Association
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Illinois Critical Access Hospitals: Collaborating for Effective Rural Health Care
Results of a survey of 86 Critical Access Hospitals (CAHs) in six Midwestern states, describing efforts to achieve successful rural collaborative partnerships. Includes demographic data for the study area with breakdowns by population, number of people 65 and older, and health insurance status. Second in a series of four white papers on Illinois CAHs.
Author(s): Melissa Henriksen, Norman Walzer, Andy Blanke
Date: 01/2013
Type: Document
Sponsoring organization: Illinois Critical Access Hospital Network
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North Carolina Rural Health Research and Policy Analysis Cartographic Archive
A list of maps in PDF that define rural and characterize rural America. Thematic maps cover demographics, frontier counties, health status, critical access hospitals, rural hospitals, skilled nursing facilities, and health workforce supply.
Date: 2013
Type: Map/Mapping System
Sponsoring organization: North Carolina Rural Health Research Program
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Why Do Some Critical Access Hospitals Close Their Skilled Nursing Facility Services While Others Retain Them?
Examines the factors related to the operation of skilled nursing services by Critical Access Hospitals (CAHs) and specifically the factors related to closure of skilled nursing units by some CAHs and the continued provision of these services by others.
Author(s): John A. Gale, Zachariah T. Croll, Andrew F. Coburn, Walter R. Gregg
Date: 11/2012
Type: Document
Sponsoring organization: Flex Monitoring Team
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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.
Location: 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
This policy brief focuses on evidence-based AMI Quality Improvement (QI) programs and strategies that are applicable to CAHs.
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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Quality Reporting for CAHs and Rural PPS Hospitals: The Potential Impact of Composite Measures (Policy Brief)
Assesses the use of composite scores for public reporting of quality measures as one way of addressing the low volume issue for small rural hospitals, including Critical Access Hospitals (CAHs) and Rural Prospective Payment System (PPS) hospitals.
Author(s): Michelle Casey, Peiyin Hung, Ira Moscovice
Date: 07/2012
Type: Document
Sponsoring organization: Upper Midwest Rural Health Research Center
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Community Health Needs Assessment Toolkit
Provides a toolkit to complete the requirement of the Patient Protection and Affordable Care Act of 2010 which requires that all 501(c)(3) rural hospitals conduct a community health needs assessment.
Author(s): Gerald A. Doeksen, Cheryl F. St. Clair, Val C. Schott
Date: 05/2012
Type: Document
Sponsoring organization: National Center for Rural Health Works
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Rural Relevance Under Healthcare Reform
Highlights the level of comparative performance achieved by rural hospitals in regards to quality, patient satisfaction and operational efficiency for the types of healthcare most applicable to rural communities. Published by iVantage Health Analytics.
Date: 04/2012
Type: Document
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Anticipating the Rural Impact of Medicare Value-Based Purchasing
Discusses the design and implementation of Medicare value-based purchasing (VBP) programs and describes the five provider types: prospective payment hospitals, Critical Access Hospitals, skilled nursing facilities, home health agencies, and physician office practices.
Author(s): A. Clinton MacKinney, Keith J. Mueller, Nicholas P. Lillios, et al.
Date: 04/2012
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in Critical Access Hospitals (Policy Brief)
Discusses the use of patient safety culture surveys as a means to promote organizational learning and build a culture of safety.
Author(s): Zachariah T. Croll, Andrew F. Coburn, Karen B. Pearson
Date: 04/2012
Type: Document
Sponsoring organization: Flex Monitoring Team
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Evidence-Based Heart Failure Quality Improvement Programs & Strategies for Critical Access Hospitals
Describes evidence-based heart failure Quality Improvement (QI) programs and strategies that can be used in Critical Access Hospitals.
Author(s): Walter Gregg, Jill Klingner, Michelle Casey, Shailendra Prasad, Ira Moscovice
Date: 03/2012
Type: Document
Sponsoring organization: Flex Monitoring Team
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Public Reporting of Quality by Critical Access Hospitals: The Key Issues
Policy paper reviews the progress made in rural hospital public reporting of quality from 2005-2012 with an increased emphasis and use of data for measuring performance and maintaining payment. Describes the current challenges Critical Access Hospitals (CAH) face when participating in quality reporting.
Date: 01/2012
Type: Document
Sponsoring organization: National Rural Health Association
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Relevant Quality Measures for Critical Access Hospitals
Policy brief describes quality measures relevant to Critical Access Hospitals (CAHs) and identifies policy implications.
Author(s): Michelle Casey, Ira Moscovice, Jill Klingner, Shailendra Prasad
Date: 01/2012
Type: Document
Sponsoring organization: Flex Monitoring Team
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Rural Hospital Replacement Facility Study, 2011
Studies Critical Access Hospitals (CAHs) operating in replacement facilities. Addresses the impact associated with a new facility, including patient volumes, operating efficiency, and financial impacts.
Date: 2012
Type: Document
Sponsoring organization: Stroudwater Associates
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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 that highlight the challenging and all too familiar ethics conflicts common to rural settings.
Author(s): William A. Nelson, Barbara A. Elliott
Date: 2012
Type: Document
Sponsoring organization: The Dartmouth Institute for Health Policy and Clinical Practice
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Evidence-based Falls Prevention in Critical Access Hospitals
Policy brief identifying and assessing evidence-based patient safety and quality improvement interventions appropriate for use by state Flex Programs and CAHs.
Author(s): Karen B. Pearson, Andrew F. Coburn,
Date: 12/2011
Type: Document
Sponsoring organization: Flex Monitoring Team
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Medicare Shared Savings Program: Accountable Care Organizations, Final Rule
Summarizes segments of the rule on Medicare Accountable Care Organizations (ACOs) as they affect family practitioners in small and medium-sized practices, including Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs).
Date: 11/2011
Type: Document
Sponsoring organization: American Academy of Family Physicians
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New Project Targets CAH Quality Measures and Reporting
Discusses MBQIP, the Flex Medicare Beneficiary Quality Improvement Project, which is helping Critical Access Hospitals improve patient care quality and operations, and more accurately report rural health care quality.
Author(s): Candi Helseth
Location: Rural Monitor, 2011(Fall)
Date: 11/2011
Type: Document
Sponsoring organization: Rural Health Information Hub
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Rural Health Networks Prove There is Strength in Numbers
Discusses how quality is increasing measurably for hospitals enrolled in rural health networks in Michigan and Montana.
Author(s): Candi Helseth
Location: Rural Monitor, 2011(Fall)
Date: 11/2011
Type: Document
Sponsoring organization: Rural Health Information Hub
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Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Final Report to the Secretary
Contains recommendations and documentation of the Negotiated Rulemaking (NRM) Committee to influence methodologies used to determine Medically Underserved Populations (MUPs) and Health Professional Shortage Areas (HPSAs).
Additional links: Appendices and Addenda, Attachments
Date: 10/2011
Type: Document
Sponsoring organization: Health Resources and Services Administration
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Value-Based Purchasing Demonstrations for Critical Access and Small PPS Hospitals
White paper discussing the expanded quality reporting programs for Critical Access Hospitals (CAHs) and hospitals excluded from the inpatient Value-Based Purchasing (VBP) program due to a low number of cases. Includes recommendations to the Secretary of Health and Human Services on the rural implications from the Affordable Care Act (ACA) provision on inpatient hospital VBP program.
Date: 09/2011
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Quality of Care and Patient Outcomes in Critical Access Hospitals
Compares quality of care and patient outcomes for Critical Access Hospitals (CAHs) and non-CAHs using national data from 2008 and 2009.
Author(s): Karen E. Joynt, Yael Harris, E. John Orav, Ashish K. Jha
Location: JAMA, 306(1), 45-52
Date: 07/2011
Type: Document
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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 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 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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Risk of Financial Distress Among Critical Access Hospitals: A Proposed Model
Presents a model to predict the financial distress of CAHs that can be used by administrators and state program officers as an early warning system to identify hospitals at increased risk of facing financial distress.
Author(s): Mark Holmes, George H. Pink,
Date: 04/2011
Type: Document
Sponsoring organization: Flex Monitoring Team
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Provision of Long Term Care Services by Critical Access Hospitals: Are Things Changing?
Discusses trends in access to post-acute and long term care (LTC) services in rural areas and the roles Critical Access Hospitals play.
Author(s): Melanie Race, John Gale, Andrew Coburn,
Date: 03/2011
Type: Document
Sponsoring organization: Flex Monitoring Team
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Changes in Obstetrical Services Among Critical Access Hospitals
Reports trends in the provision of obstetrical services in CAHs from 2000 to 2009.
Author(s): Mark Holmes, Saleema Karim, George Pink
Date: 03/2011
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 CAH’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: Profitability of Rural Hospitals Paid Under Prospective Payment Compared to Rural Hospitals with Special Medicare Payment Provisions
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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Electronic Medical Record Systems in Critical Access Hospitals: Leadership Perspectives on Anticipated and Realized Benefits
Reports findings of a survey of hospital leadership administered in Iowa concerning the effectiveness of electronic medical records (EMRs) in increasing performance quality and reducing healthcare costs.
Author(s): Troy R. Mills, Jared Vavroch, James A. Bahensky, Marcia M. Ward
Location: Perspectives in Health Information Management, 7(Spring)
Date: 04/2010
Type: Document
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States’ Use of Cost-Based Reimbursement for Medicaid Services at Critical Access Hospitals
Explains cost-based reimbursement for Critical Access Hospitals. Documents which of the 45 states with CAHs utilize a cost-based reimbursement methodology for Medicaid.
Author(s): Andrea Radford, Mike Hamon, Caitlin Nelligan
Date: 04/2010
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, CAHs and 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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The Role of State Flex Programs in Supporting Quality Improvement in Critical Access Hospitals
Reports that the Flex Program has been instrumental in funding and providing leadership for the development of Critical Access Hospital (CAH) quality improvement initiatives.
Author(s): Andrew Coburn, John Gale, Melanie Race, Mark Richards, Anush Hansen
Date: 04/2010
Type: Document
Sponsoring organization: Flex Monitoring Team
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Monitoring the Community Benefits of Critical Access Hospitals: A Review of the Data
Examines the community benefit activities of Critical Access Hospitals (CAHs) using data from the Flex Monitoring Team’s (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service’s (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.
Additional links: Policy Brief
Author(s): Melanie Race, John Gale, Andrew Coburn
Date: 03/2010
Type: Document
Sponsoring organization: Flex Monitoring Team
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State Flex Program EMS/Trauma Activities and Integration of Critical Access Hospitals into the Trauma System (Policy Brief)
Reports that more than one-third of all Critical Access Hospitals in the U.S. have been designated as trauma centers. The project team identified a combined total of 560 CAHs designated as trauma centers.
Author(s): Walter Gregg, Nicholas Jennings, Christopher Dickerson
Date: 03/2010
Type: Document
Sponsoring organization: Flex Monitoring Team
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Models For Quality Improvement In Critical Access Hospitals: The Role Of State Flex Programs
Examines the range of multi-Critical Access Hospital (CAH) quality improvement and performance measurement reporting (QI) initiatives supported by the Medicare Rural Hospital Flexibility Program in nine states; assessed the role of State Flex Programs in developing and supporting these initiatives; and explored their impact on the QI programs of CAHs.
Author(s): Coburn, Gale, Race, Richards, Hansen
Date: 03/2010
Type: Document
Sponsoring organization: Flex Monitoring Team
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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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The Potential Impact of Pay-for-Performance on the Financial Health of Critical Access Hospitals
Models the impact of different pay-for-performance (P4P) incentives on the financial health of Critical Assess Hospitals (CAHs).
Additional links: Policy Brief, February 2010
Author(s): Robert Town, Ira Moscovice
Date: 12/2009
Type: Document
Sponsoring organization: Flex Monitoring Team
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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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Stratis Health 2017 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.
Type: Tool
Sponsoring organization: Stratis Health
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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: Transcript
Type: Video/Multimedia
Sponsoring organization: Rural Health Information Hub
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MBQIP Monthly
A monthly electronic newsletter providing Critical Access Hospitals (CAHs) information and support for quality reporting and improvement and includes news items about the Medicare Beneficiary Quality Improvement Project (MBQIP).
Type: Journal/Newsletter
Sponsoring organization: Stratis Health
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Rural Relevance 2016: Vulnerability to Value, A Hospital Strength INDEX Study
An iVantage study about the transition of Critical Access Hospitals from volume to value using the Hospital Strength INDEX. Includes the full research study, methodology, news release, vulnerability and health disparities index infographics, and conference presentation. In order to access the research study a free registration is required.
Type: Document
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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 achieve the highest level of success. 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 Reports (CAHFIR) Primer and Calculator Resources
Introduces the Critical Access Hospital Financial Indicators Report (CAHFIR) 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 Reports (CAHFIR): Indicator Means & 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.
Type: Website
Sponsoring organization: National Rural Health Resource Center
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Swing Bed Services: Rural Health Fact Sheet Series
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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ICD-10 Toolkit
Provides guidance and assistance to rural healthcare providers in making the transition from ICD-9 to ICD-10. This toolkit is designed to be used in conjunction with any coder or physician training that a rural hospital or clinic may be doing.
Type: Tool
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.
Type: Website
Sponsoring organization: Technical Assistance and Services Center
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Care Coordination in Rural Communities
February 2014 webinar discussing the Rural Care Coordination Toolkit and provided information on how rural communities can identify and implement a care coordination program. Presented by Alexa Brown, NORC Walsh Center for Rural Health Analysis; Melissa Miles, Bi-State Primary Care Association; and Heidi Blossom, MSN, RN, Care Transitions Coordinator for MHA – An Association of Montana Health Care Providers. 60 minutes.
Type: Video/Multimedia
Sponsoring organization: Rural Health Information Hub
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Rural Care Coordination Toolkit
Designed to help identify and implement a rural care coordination program and provide supporting resources and best practices. The toolkit, developed in collaboration with the NORC Walsh Center for Rural Health Analysis, is made up of several modules each concentrating on different aspects of care coordination programs.
Type: Website
Sponsoring organization: Rural Health Information Hub
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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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Resources for Critical Access Hospitals and Small Rural Hospitals
Provides information tailored to meet the health information technology (HIT) needs of Critical Access Hospitals (CAH) and small, rural hospitals. Addresses electronic health record (EHR) benefits, meaningful use, and implementation resources.
Type: Website
Sponsoring organization: Office of the National Coordinator for Health Information Technology
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Economic Impact: Tools and Templates
Access tools and templates for studying the economic impact, in rural areas, of 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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Using Logic Models for Flex Program Planning, Management, Evaluation, and Reporting
Recording of a March 2012 webinar addressing how to develop and work with logic models as a program management and evaluation tool. Designed to assist Flex Program Coordinators with developing workplans for a noncompetitive continuation progress report.
Type: Tutorial/Training
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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AHRQ Quality Indicators Toolkit for Hospitals
Helps hospitals understand the Quality Indicators (QIs) from the Agency for Healthcare Research and Quality (AHRQ), and support the use of them to successfully improve quality and patient safety in hospitals.
Type: Website
Sponsoring organization: Agency for Healthcare Research and Quality
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QualityNet
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)
Series of 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. Includes state Flex Program contacts.
Type: Website
Sponsoring organization: Technical Assistance and Services Center
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Workflow Assessment for Health IT Toolkit
Assists people and organizations interested or involved in the planning, design, implementation, and use of health IT in ambulatory care to conduct a workflow analysis and redesign before, during, and after health information technology implementation.
Type: Website
Sponsoring organization: Agency for Healthcare Research and Quality
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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: 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 and 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
Contains a directory of state agencies that handle survey and certification of certain health care 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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AHA CAH Update Newsletter
Newsletter of the AHA Section on Small or Rural Hospitals addressing legislation and regulatory issues of interest to Critical Access Hospitals.
Type: Journal/Newsletter
Sponsoring organization: American Hospital Association
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Code of Federal Regulations: 42 CFR 485.601-645: 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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AHA Issues: 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 (CAH) 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 certification of Critical Access Hospitals (CAHs).
Type: Website
Sponsoring organization: Joint Commission
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Additional resources are available related to this guide. See the full list of resources by topic for:


Last Updated: 12/15/2017