Critical Access Hospitals (CAHs) – Resources

How Critical Access Hospitals Are Addressing the Social Needs of Rural Populations
Describes Critical Access Hospital (CAH) initiatives that address the social needs of their communities. Summarizes interviews with 14 CAHs and identifies key facilitators and barriers to program success, as well as advice for other CAHs interested in implementing similar programs.
Author(s): Megan Lahr, Tongtan Chantarat, Mariah Quick, Madeleine Pick, Ira Moscovice
Date: 11/2021
Sponsoring organization: Flex Monitoring Team
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The Association Between System Affiliation and Financial Performance in Critical Access Hospitals
Examines the association between Critical Access Hospital (CAH) health system affiliation and financial performance as measured by the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS). Discusses trends in health system affiliation as an alternative to closures as well as potential downsides of affiliation.
Author(s): Laura Bozovich, Kathleen Knocke, George Pink, Ann Howard, Kristin L. Reiter
Date: 10/2021
Sponsoring organization: Flex Monitoring Team
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The Swing Bed Program: Impacting Patients, Providers, and Community
Brief video overview of the swing bed program, which helps rural hospitals provide patient- and community-centric post-acute healthcare. Describes the history, related policy issues, early implementation, and evolution of the program.
Date: 08/2021
Sponsoring organization: Rural Health Information Hub
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History of the Swing Bed: A Look Through the Rural Rearview Mirror
Reviews the history of the swing bed program, which helps rural hospitals serve patients and the community through provision of post-acute care. Shares insights from experts who describe early implementation and key program elements that have contributed to the program's success.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 08/2021
Sponsoring organization: Rural Health Information Hub
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Understanding the Rural Swing Bed: More than Just a Reimbursement Policy
Provides an overview of the swing bed program and its role as a patient-centric post-acute care solution that helps rural hospitals serve their communities. Discusses the impact of the program, reimbursement, quality measures, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 08/2021
Sponsoring organization: Rural Health Information Hub
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Mid-Level Leaders and the Transition to Value Video Series
A 6-part video series on healthcare leadership for mid-level Critical Access Hospital (CAH) leaders. Provides information and strategies on leading a team through the shift to value-based payment with training modules on strategic and systems thinking, collaborative and change leadership, healthcare finance, and talent development.
Additional links: Action Plan, Discussion Questions and Recommended Activities, Resource Guide
Date: 05/2021
Sponsoring organizations: National Rural Health Resource Center, Technical Assistance and Services Center
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Evaluation of the Use of CAH Cohorts for Quality Improvement Activities
Describes how State Flex Programs (SFPs) use cohorts of Critical Access Hospitals (CAHs) in quality improvement initiatives. Discusses the benefits and challenges of CAH cohorts, how SFPs are evaluating the impact of these initiatives, and opportunities to enhance the use of cohorts in Flex Program activities. Includes findings from interviews with six SFPs.
Author(s): John Gale, Celia Jewell, Sara Kahn-Troster, Nathan First
Date: 03/2021
Sponsoring organization: Flex Monitoring Team
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The Effect of Medicare Payment Standardization Methods on the Perceived Cost of Post-Acute Swing Bed Care in Critical Access Hospitals
Discusses the different payment systems the Centers for Medicare and Medicaid Services (CMS) uses to reimburse for post-acute care in Critical Access Hospitals (CAHs), prospective payment system (IPPS) hospitals, and skilled nursing facilities (SNFs). Describes how the payment standardization methods may influence post-acute care discharge patterns and access to care for rural residents. Examines the effects of these payment methods on the perceived cost of CAH swing bed care as it relates to the Medicare Spending per Beneficiary performance measure.
Author(s): Tyler Malone, Denise Kirk, Kristin Reiter
Date: 03/2021
Sponsoring organization: North Carolina Rural Health Research Program
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CAH Partnerships During the COVID-19 Pandemic
Presents findings from a survey of Critical Access Hospitals (CAHs) in eight states on how they partnered with communities and public health agencies in response to the COVID-19 pandemic. Discusses the type of support CAHs received from their State Flex Program (SFP).
Author(s): Madeleine Pick, Megan Lahr, Keelia Silvis, Ira Moscovice
Date: 03/2021
Sponsoring organization: Flex Monitoring Team
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Monitoring State Flex Program Financial and Operational Improvement Activities
Presents the results of a qualitative evaluation of State Flex Program interventions implemented under Program Area 2: Financial and Operational Improvement (FOI). Describes the type of projects proposed by a subset of 14 State Flex Programs, key themes, and challenges faced to monitoring and documenting these interventions on financial and operational performance. Includes an inventory of all 45 State Flex Program FOI initiatives.
Author(s): John Gale, Sara Kahn-Troster, Zachariah Croll, Nathan First
Date: 03/2021
Sponsoring organization: Flex Monitoring Team
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